On either side of the pelvis, is one hip socket. This acetabulum is round in shape and covered inside with smooth cartilage. This cartilage forms the smooth surface of the hip joint. An acetabular fracture occurs when the socket of the hip joint is broken.
This is much less common than most hip fractures , where the to of the thigh bone is damaged, not the socket. It is very rare for both sides of the hip joint to be damaged in an injury; typically a fracture occurs to either the ball or the socket, but not both.
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Acetabular fractures either occur with high-energy trauma e. In younger patients, there is almost always significant trauma, and commonly other associated injuries, when an acetabular fracture occurs. In elderly patients, acetabular fractures can occur due to bone weakened from osteoporosis.
In these cases, an acetabular fracture may occur after a simple fall. There are a number of factors that need to be considered to determine the optimal treatment of an acetabular fracture.
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- Acetabular Fractures - Trauma - Orthobullets;
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- Acetabular Fracture Is a Broken Hip Socket.
Because the injury involves the hip joint, no matter what the treatment is, there is an increased chance for patients to subsequently develop arthritis of the hip joint. The reason hip arthritis can occur is that the socket of the hip is covered in smooth cartilage that is damaged at the time of the fracture. Carefully restoring the normal alignment of the hip joint may help slow the progression of arthritis. Therefore, treatment depends on the extent of cartilage displacement, and the stability of the hip joint.
The hip joint should be stable the ball held tightly within the socket and the cartilage should be smoothly contoured.
Acetabular fracture | Radiology Reference Article | procahlacuhist.ml
Surgery is often recommended for:. Nonsurgical treatment is generally reserved for fractures that are not out of position or patients who are not healthy enough to tolerate a major surgery. Sometimes, nonsurgical treatment is pursued with the plan to perform a typical hip replacement if arthritis develops inside the joint.
Whether or not surgery is performed, patients must avoid placing weight on the affected extremity, often for several months after the injury. Patients are usually allowed to place their foot on the ground touch-down weight-bearing , but no more force is allowed on the leg. Walking on the extremity too soon risks further displacement of the broken fragments of bone. Unfortunately, the long-term prognosis of acetabular fractures has many potential complications.
In the early period, patients who have acetabular fractures often have associated injuries including head injuries, abdominal injuries, urologic injuries, and other musculoskeletal injuries spine and knee are most common. These patients are at high risk of developing blood clots in the legs and pelvis. Acetabular fractures can also occur in a combination of patterns. Knowing the severity and specific pattern of your fracture will help your doctor determine treatment.
The anterior front and posterior back columns of the acetabulum. Left Anterior wall fracture Right Anterior column fracture. Left Posterior wall fracture Right Posterior column fracture. An acetabular fracture results when a force drives the head of the femur against the acetabulum. This force can be transmitted from the knee such as hitting the knee against the dashboard in a head-on car collision or from the side such as falling off a ladder directly onto the hip.
Depending upon the direction of the force, the head of the femur is sometimes pushed out of the hip socket, an injury called hip dislocation. When the fracture is caused by high-energy impact, patients often experience extensive bleeding and have other serious injuries that require urgent attention.
Acetabular fractures are sometimes caused by weak or insufficient bone. This is most common in older patients whose bones have become weakened by osteoporosis. Although these patients do not often have other injuries, they may have complicating medical problems, such as heart disease or diabetes. If nerve damage has occurred with the injury, the patient may feel numbness, weakness, or a tingling sensation down the leg. Patients with fractures caused by high-energy trauma will almost always go or be brought to an urgent care center or emergency room for initial treatment because of the severity of their symptoms.
If the fracture is due to high-energy trauma, there may also be injuries to the head, chest, abdomen, or legs. If there is significant blood loss, it may lead to shock—a life-threatening condition that can result in organ failure. Your doctor will perform a thorough examination of your pelvis, hips, and legs. He or she will also check to see if you can move your ankles and toes and feel sensation on the bottom of your feet.
In some cases, nerves may be injured at the same time that the acetabulum is fractured. You doctor will also carefully examine the rest of your body to determine if you have received any other injuries. These studies provide images of dense structures, such as bones. X-rays of acetabular fractures are taken from a number of different angles to show the pattern of the fracture and how out of place the bones are displacement. Computed tomography CT scans. Because of the complex anatomy of the pelvis, a CT scan is commonly ordered for acetabular fractures.
The scan will provide your doctor with a more detailed, cross-sectional image of your hip and can be helpful in preoperative planning. Left This x-ray shows a fracture of the front "wall" of bone supporting the hip socket. Right The cracks and uneven surfaces of the same fracture are shown more clearly in this 3-dimensional CT reconstruction. Nonsurgical treatment may be recommended for stable fractures in which the bones are not displaced. It may also be recommended for patients who are at higher risk for surgical complications. For example, patients with severe osteoporosis, heart disease, or other medical concerns may not be able to tolerate surgery.
Most acetabular fractures are treated with surgery. Because acetabular fractures damage the cartilage surface of the bone, an important goal of surgery is to restore a smooth, gliding hip surface. During the operation, your doctor will reconstruct the normal anatomy of the hip joint—aligning the bone fragments to restore the surface of the acetabulum, and fitting the femoral head into the hip socket.
Timing of surgery.
Fractures of the Acetabulum
Most acetabular fractures are not operated on right way. Your doctor may delay your surgery a few days to make sure your overall condition is stable and you are prepared for the procedure. During this time, your doctor may place your leg in skeletal traction to immobilize the fracture and prevent additional injury or damage to the hip socket. In skeletal traction, a metal pin is implanted in the femur or tibia bone.
Weights attached to the pin gently pull on the leg, keeping the broken bone fragments in as normal a position as possible. For many patients, skeletal traction also provides some pain relief. During surgery, the displaced bone fragments are first repositioned reduced into their normal alignment. Your doctor will then attach metal plates and screws to the outer surfaces of the bone to hold the fragments together while they heal. Depending upon the location of your fracture, your doctor will make an incision along the front, side, or back of your hip.
Occasionally, a combination of approaches or an alternative approach is used.
Left This x-ray shows a fracture of the back "wall" of bone supporting the hip. Right Here, plates and screws have been used to repair the fracture. In some cases, the acetabulum is so damaged that repair or reconstruction is unlikely to provide a good long-term result. In this situation, your doctor may recommend total hip replacement.
In this procedure, the damaged bone and articular cartilage are removed and replaced with artificial parts prosthesis. Whenever possible, the doctor will reposition the bones into their normal alignment using screw and plate fixation before performing the total hip replacement. However, if this is not feasible, the doctor may delay the procedure for a period of time to allow the fracture to first heal in its unaligned position. He or she will then perform the total hip replacement—replacing the irregular hip socket with the total hip prosthesis. Your doctor will consider many factors, including your age and activity level, in determining whether total hip replacement is the most appropriate treatment.
After surgery, you will feel some pain.
This is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover from surgery faster. Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs NSAIDs , and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids. Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive.
Opioid dependency and overdose has become a critical public health issue in the U. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.
Most patients require crutches or a walker for a period of time. For some patients, partial weight bearing may be allowed after 6 to 8 weeks. Full weight bearing will not be allowed until your bones are fully healed, which usually takes from 3 to 4 months. You may require the use of a cane or a walking aid for a longer period of time.