Acetabular Fractures

Displaced acetabular fracture before repair

3D CT scans of a displaced acetabular fracture

 Fractures involving the hip socket (acetabulum) are very difficult clinical problems. The difficulties include the location of the joint (deep in the hip area) and the difficulty in being able to line up the fracture correctly to allow full function. Patients with acetabular fractures typically have other associated injuries and fractures and many are transferred to trauma centers who have specialists with experience in repairing these types of injuries. I currently perform 40-50 pelvic and acetabular fracture repairs annually and I believe this experience helps me to perform the surgery more accurately and efficiently. In addition,   I practice at a busy regional trauma center with a dedicated trauma ICU and a team of physicians, nurses, therapists and social workers to help facilitate the care of multiply injured patients. This allows me to quickly and efficiently care for all aspects of a patients injury in a tertiary care setting.

   Acetabular  fractures involve the surface of the joint (cartilage) and in those cases in which the bone is displaced, I recommend surgical repair.  Typically the surface of the joint is smooth allowing the bones to glide past one another with very little friction.  If the surface is incongruent because the bones are not aligned, chronic damage to the joint occurs ultimately leading to arthritis and loss of cartilage.  It is therefore very important to ensure that the surface of the cartilage is repaired as accurately as possible.  Because of this, I recommend surgical repair in any fracture of the acetabulum in which the joint has more than 2 mm of displacement.  Surgical repair involves re-aligning the fracture and holding the repair with plates and screws. This is a fairly extensive surgical procedure and should be performed only by an experienced trauma surgeon with fellowship training in pelvic and acetabular reconstruction. The surgery requires specialized implants designed for repair of pelvic fractures and specialized operating room tables which help line the fracture up correctly.  The surgery typically takes 3-4 hours to perform and most patients do not need to stay in the intensive care unit after surgery.   I will occasionally recommend repair of the fracture with a primary hip replacement in older patients who have severe damage of the joint surface. Most patients stay in the hospital for 4-6 days after surgery and remain on crutches for the first 6 weeks after surgery. Pool therapy is very useful during this time as it allows for some motion without putting stress on the surgical repair.

   The biggest risk after surgery is blood clots in the veins of the legs and pelvis and I treat all patients with a medication called low molecular weight heparin for the first two weeks after surgery. After 6 weeks I allow patients to begin putting full weight on their leg and start more aggressive physical therapy.  Full recovery from these injuries is slow and often takes about 1 year to completely recover.  The overall risk of arthritis developing in the joint after surgery is about 20% provided the joint surface can be repaired accurately.