PELVIC ACETABULAR SURGERY:

Acetabulum, a funny word you would think, but it is none other than our hip socket. Hip is the body’s largest socket. The hip joint comprises a ball on the upper end of the thigh bone, also known as the head of the femur and a socket in the pelvis. The socket is lined with smooth cartilage. The acetabulum is the “socket” of the “ball-and-socket” hip joint. When this part is fractured it is called acetabular fracture.

Like all the other joints in our body, the hip socket is a precisely fitted and mobile part. As major nerves, blood vessels, and portions of the bowel, bladder, and the reproductive organs all are in the vicinity of the pelvis, any injury to the acetabulum can occasionally damage these organs. The fracture causes pain in the hip area and the inability to walk without assistance.

The severity of the injury depends on several factors, including:

⦁ The number and size of the fracture fragments
⦁ The amount each piece is out of place
⦁ The injury to the cartilage surfaces of both the acetabulum and the head of the femur
⦁ The injury to surrounding soft tissues, such as muscle, tendons, nerves, and skin

If the bone sticks out of the skin, the fracture is called “open” or compound fractures. Open fractures are more serious as a high chance of infection occurring and immediate treatment needs to be given.

Fractures to this area are often due to high energy trauma that results from an automobile or motorcycle accidents. A fall from great heights, perhaps industrial accidents can be the other reasons. Sometimes, a minor fall of an elderly person can cause acetabulum fractures due to the weakening of bones due to osteoporosis. Older women experience this more than older men.

Treatment to this fracture depends on:

⦁ The extent of damage to the cartilage in the joint
⦁ The degree of instability in the hip
Since acetabular fractures are often caused by auto accidents, such fractures are usually accompanied by other injuries that can complicate treatment of the fracture.

X-rays and CT scans are used to confirm the fractures by medical practitioners. Acetabular fracture surgery realigns and stabilizes the displaced joint surfaces while allowing the patient to avoid traction and prolonged bed rest.

Treatment methods for the fracture include:

⦁ Non-Operative Treatment:
a. Walking Aids: To avoid bearing weight on the leg
b. Positioning Aids
i. Involves traction to the leg
ii. Best for the minority of fractures(about 11%)
iii. Can prevent further displacement of the femur into the socket but doesn’t reduce the fracture and can lead to muscle atrophy and joint stiffness, which can result in arthritis

a. Medications. Drugs to relieve pain, as well as an anticoagulant (blood thinner) to reduce the risk of blood clots forming in the veins of your legs.

1. Acetabulum Fracture Surgery: Surgery would be required if none of the noninvasive treatments work. It is done to achieve the best possible result for the patient. Acetabulum fracture surgery preserves the hip joint by accurate reconstruction of the fractured bone. The reconstruction restores the surface of the acetabulum and its accurate fit to the femoral head. In the majority of cases, arthritis is prevented and there is close to normal hip function.Depending on the fracture pattern, one of the below surgeries will be chosen for the reconstruction of the acetabulum:

⦁ Kocher-Langenbeck approach (posterior approach)
⦁ Ilioinguinal approach (simultaneous access to both anterior & posterior portions of the pelvic ring),
⦁ Extended iliofemoral approach (lateral approach)

Surgery to repair acetabulum fractures is called open reduction and internal fixation. Open because it makes an incision that exposes the broken bone fragments to sight. Reduction refers to the process by which the bone fragments are grabbed and manipulated to their normal position. Internal fixation occurs when metal screws and plates are used to hold the fractured bone fragments to the pelvis to secure it in place.

Screws and plates are used to secure the fractured bone fragments together. Typically they are made of stainless steel are safe and effective. In some cases, the acetabulum maybe beyond repaid for any long time result. In that case, it is replaced with artificial parts (prosthesis).

Even after a successful surgery, some patients might experience complications that need to looked at:

⦁ Infection
⦁ Blood Clots: Because mobility is restricted it increases the chances of blood clots in the legs
⦁ Posttraumatic Arthritis: Acetabular fractures can damage the smooth surface of the joint and with time the joint might wear away, leading to increased pain and stiffness
⦁ Sciatic Nerve Injury: The sciatic nerve is a large nerve that passes near the back of the hip socket. It supports motion and sensation in the leg and the foot. The nerve can be injured or damaged during the initial injury or during surgery.
⦁ Heterotopic Ossification: A rare problem where bone starts growing in the muscles, tendons and ligaments around the hip socket can occur after surgery. This is called heterotopic ossification. It can cause stiffness and can interfere with flexibility and functioning.

It typically takes from 9 to 12 months for an acetabular fracture to completely heal. After injury or surgery, patients must avoid putting weight on the affected leg for up to three months. If the patient starts walking too soon, it risks displacing the joint again. In the longer term, patients who have had fractured their acetabulum face an increased risk of arthritis. Physiotherapy can help to increase muscle strength and to improve the hip motion. Now, would also be the time for families and friends to be there for the patient. It is important to keep the patient’s spirits up or can lead to depression.