Hip Socket Fracture Surgery.
Edited By: M.L. Chip Routt, Jr., M.D.
Last updated Wednesday, January 12, 2005
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Summary
Overview
Acetabular (hip socket) fractures are serious orthopedic injuries
usually resulting from significant trauma. Acetabular fracture surgery
realigns and stabilizes the displaced joint surfaces, while allowing
the patient to avoid traction and prolonged bedrest.
Characteristics of hip socket fracture
Acetabular (hip socket) fractures can result from falls, automobile
accidents, or other traumatic events. The fracture causes pain in the
hip area and the inability to walk without assistance.Types
Acetabular fractures occur in ten common fracture patterns, and other more unique patterns.Similar conditions
Injuries to the hip area such as a significant contusion (or a "deep
bruise") may be confused with acetabular fracture. However, because of
the associated pain severity, most acetabular fractures are not
confused with other conditions.Incidence and risk factors
Acetabular fractures are not common injuries. They typically occur in
adults, especially those with active lifestyles. Driving an automobile
(or motorcycle) and falling from a significant height are risk factors
for acetabular fracture.Diagnosis
The patient usually cannot walk on the affected lower limb. Attempted
hip movement produces muscle spasm and pain. The best diagnostic exams
to confirm acetabular fracture are pelvic X-rays and CAT scans.Medications
Analgesic (pain reliever) medications are somewhat helpful initially.Possible benefits of hip socket fracture surgery
Displaced and unstable acetabular fractures are improved by surgery
in many ways. The fracture fragments are realigned during the operation
and then secured using plates and screws. Accurate fracture realignment
promotes improved bone and cartilage healing, which in turn improves
long term results. Early fracture stability allows comfortable hip
movement. Acetabular motion similarly improves joint cartilage healing.
Also, the patient can be out of bed and ambulatory using crutches.
Nondisplaced but unstable fractures can be stabilized with surgery prior to fracture displacement.
Types of surgery recommended
Acetabular (hip socket) fracture operations usually require surgical
exposures in order to clean the fracture sites, realign the fracture
fragments, and apply plates and screws to secure the fracture.
Who should consider hip socket fracture surgery?
Patients with displaced and/or unstable acetabular fractures should
strongly consider having surgery. The decision to have surgery should
be discussed by the patient and physician.What happens without surgery?
After an acetabular
fracture, fragments of bone may be scattered within the body. If
surgery is not used to fix this, these displaced fragments heal in
poorly aligned locations. Consequently, the acetabular cartilage
surfaces remain incongruous, and postraumatic arthritic changes occur
in the acetabulum.Surgical options
A variety of surgical options exist for acetabular fractures. The
specific operation is selected based on the patient and their specific
fracture. Some fracture patterns are amenable to percutaneous (small
wound) surgical techniques, while others require open surgical
treatment.Urgency
Acetabular fractures are easier to repair when the surgery takes
place within the first week after the injury. Early surgery also avoids
prolonged bedrest for the patient. Delaying the operation complicates
the surgical tactic.
Risks
The risks associated with treating acetabular fractures are
numerous, and unfortunately not uncommon. These exist for both surgical
and nonsurgical treatments, and include deep vein blood clots and
pneumonia, among others. Surgical risks include, but are not limited
to, wound infection, nerve injury, and scarring.
Managing risk
Risks are best managed by being aware of their possibility and trying
to prevent them. Deep vein clots are treated with anticoagulation
(blood thinner) medications. Infections require subsequent surgeries to
cleanse the wound. An experienced surgeon should be able to handle not
only the surgery, but its complications too.Preparation
Patients are evaluated before surgery by medical, anesthesiology, and
surgical consultants as needed. The patient is educated regarding their
injury, the treatment options, and the risks of both nonoperative and
surgical treatments. An educated patient is a prepared patient.Timing
Surgery soon after the injury allows for the best treatment of the
fracture and the patient. Waiting longer than one week makes the
operation more difficult for both the patient and the surgeon.
Surgical team
Acetabular (hip socket) surgery is best performed by an experienced
hip socket surgeon. If the surgeon is experienced, it is more likely
that the fracture realignment will heal well. Moreover, an acetabular
operation performed by an experienced surgeon will likely have fewer
complications. Many factors affect the final result; yet, it's no
secret that an experienced surgeon is a smart start toward a good
result.
Acetabular fractures are unusual and complex orthopedic injuries.
Most urban trauma centers have one or two orthopedic trauma surgeons
designated as their "Pelvic and Acetabular Team." These individuals
have a special interest in such injuries and provide care for the
patients with acetabular and pelvic ring fractures. The operations are
performed at the trauma center hospital.
Technical details
During the surgery, the acetabular (hip socket) fracture is exposed
using surgical wounds. The fracture fragments are cleansed, and the
fractures are realigned. Next, the fracture sites are stabilized with
screws and plates.Anesthetic
General anesthesia is recommended for most patients undergoing acetabular fracture surgery.Length of hip socket fracture surgery
The duration of surgery varies according to the complexity of the
fracture. Usually 3 to 6 hours are needed. Complex fractures may take
much longer.Pain and pain management
Acetabular (hip socket) fracture surgery stabilizes the previously
displaced and unstable fracture fragments. Fracture pain is diminished
by the surgery. The surgical wounds are painful and require medication.Use of medications
At first, analgesic (pain relievers) medications are administered
intravenously (directly into the blood stream). As patients begin to
feel less pain, they are weaned to oral (administered by mouth)
analgesics, followed by other less addictive medications as needed.Effectiveness of medications
The analgesic medication provides comfort which facilitates early rehabilitation.Important side effects
Narcotic analgesic medications are potentially addictive, and may produce a variety of side effects.Recovery and rehabilitation in the hospital
The recovery period encompasses three individual three-month periods.
During the first six weeks after surgery, activities are well
restricted. More aggressive range of motion and strengthening exercises
begin during the second six weeks period. Strengthening, conditioning,
and flexibility activities increase thereafter.Hospital discharge
Patients without other complicatons are discharged after they regain
normal bowel and bladder functions, they are comfortable on oral
analgesics, and the physical therapist approves the patient's
rehabilitation efforts.
Most patients are able to walk after surgery using crutches to
protect their acetabular reconstructon. Some require hip movement
restrictions according to the specific fracture patterns.
Convalescent assistance
Crutch assisted ambulatory patients with supportive families can be
discharged to home. Those patients with numerous extremity injuries may
require the services of a convalescent facility.
Physical therapy
At first, isometric and gentle range of motion exercises are supervised
by a physical therapist. After 6 weeks, hip motion and strengthening
activities are increased. Weight bearing restrictions relax as hip
strength is achieved. Aquatic programs may be beneficial for some
patients.Can rehabilitation be done at home?
After the patient is educated regarding his/her specific rehabilitation, they may begin a home exercise program.Risks
Not following the prescribed rehabilitation program can have catastrophic results such as fixation failure and others.Duration of rehabilitation
After fracture healing, a home exercise program is encouraged for life.Returning to ordinary daily activities
Patients return to their routine daily activities depending on their
injuries and activities. Sedentary workers can usually return to work
much sooner than heavy laborers.Long-term patient limitations
After acetabular surgery, high impact activities are discouraged, so
as to protect the hip joint. Most patients do whatever their hip
comfort and function allow.
Summary of hip socket fracture surgery for hip socket fracture
Acetabular (hip socket) fractures are unusual and complex orthopedic
injuries. Patients with displaced and/or unstable acetabular fractures
are treated with surgery to realign and stabilize the joint surfaces.
Early operative intervention by an experienced acetabular team improves
patient outcomes.
Surgery for Hip Socket Fracture at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington
If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4288 to make an appointment. Our clinical center is located in Seattle Washington, USA