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Acetabular fracture is a fracture in the pelvis area due to severe orthopaedic injuries caused by significant trauma. Acetabular fixation is a surgery of the fracture in the acetabular joint which reorganizes and supports the displaced joint surfaces. These fractures are uncommon caused by direct trauma or injury and very significant as the fracture involves the major weight bearing joint. These fractures, which may affect all age groups, mostly occur in elderly as a result of fragile bones caused by osteoporosis. In young people accidental falling from heights or accidents may cause fracture to the acetabular joint. They cause pain and inability to walk which can be treated by orthopaedic surgeons that often includes surgery.
Symptoms of Acetabular Fracture
- Pain in the Hip
- Pain in groin which radiates to leg,
- Muscle spasms
- Difficulty of walking in the affected leg
Diagnosis of Acetabular Fracture
- Physical examination by orthopaedic surgeon
- An X-ray or CT scan which gives clear picture of the essential landmarks of the acetabulum which make possible the fracture visualization and degree of fracture
- Depending on the degree of hip fracture the surgeon may recommend an operation if the displacement is greater than 3 mm. The surgery may require an open reduction internal fixation to restore joint congruency and stabilization.
Before the surgery
Patients should undergo a series of tests before the surgery which includes
- Blood tests
- ECG to detect electrical heart rhythms
- A chest x-ray to rule out lung injury and
- Magnetic Resonance Venogram (MRV) to assess the veins of patient as they often develop clots with fractures of the pelvis and acetabulum
- A small pre operative doses of heparin is be given to prevent clots
- A pre operative visit to the physiotherapist who will test the strength and sensation in the legs.
During the surgery
- Surgeons perform the surgery within 1 week after the injury to reduce the risks and complications as they increase with time.
- Depending on the severity of fracture, it has been divided into three different types of surgical procedures.
- The Kocher-Langenbeck procedure for example operates through posterior side.
- The ilioinguinal procedure operates through both anterior and posterior sides of the pelvic ring.
- The last procedure, extended iliofemoral has access through lateral side. During the surgery the acetabular fractures are repaired through open reduction procedure or through internal reduction.
- The surgeon makes an incision and ligates the exposed bone fragments to maintain the fracture alignment
- In the internal reduction, bones are exposed with an excise and the surgeon uses metal screws and plates and other specific instruments to modify the bone into normal positions.
After the procedure:
- The night after surgery must be spent in the intensive care unit and the patient is monitored closely by nurses.
- The complete team of medical specialists take care of each patient after the surgery. Caring after surgery includes pain management, preventing infection, and the prevention of deep vein thrombosis, and pulmonary embolus, where a blood clot may travel through the veins to the lungs.
- Physical therapy is suggested to the patient for proper hip motion and muscle function, assistive devices like crutches or a walker may be used in this therapy.
- The patient may feel some pain which may be eased with medication provided by the nursing staff
- The oxygen mask is usually taken away after 24 hours.
- There may be some nauseating sensation and require some medication to ease
- The medical staff monitor the pulse, blood pressure and temperature extensively for 24 hours after the surgery
- Sometimes patient may require blood transfusion after the operation to replace the blood loss.
- The wound is covered with dressing attached to remove the excess fluid in the wound
- Patient has to wear elastic stockings for better circulation.
- After 48 hours of surgery the position has to be frequently changed to prevent the development of sores on the bottom and heels.
- After the surgery the patient will not allowed to carry any weight on the broken side for up to 12 weeks
- Patient has to wear support while walking which should not allow the movement on the fracture side which will prevent the early development of arthritis and long term pain
- The hip should not bear more than 30 pounds weight up to a period of 8 weeks after the surgery