Pelvi-acetabular trauma management

Pelvic & Acetabular Injuries

The acetabulum is the cup-shaped part of the pelvis that forms the “socket” of the ball-and-socket hip joint. An acetabular fracture occurs when this socket is broken due to extreme trauma. Pelvic and acetabular fractures require rapid and precise treatment and, in some cases, one or more surgical procedures.
Through advances in surgical treatment of pelvic injuries, an experienced orthopaedic trauma surgeon like Dr Arunva Lala has the potential to intervene and improve outcomes from these potentially devastating injuries.

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 (displaced) — In some cases, the broken ends of bones line up adequately; in more severe fractures, there may be a large gap between the broken pieces, or the fragments may overlap each other.
• 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.

Symptoms

A fractured acetabulum is almost always very painful. The pain is worsened with movement. If nerve damage has occurred with the injury, the patient may feel numbness, weakness, or a tingling sensation down the leg.

Treatment

Nonsurgical treatment may be recommended for stable fractures where the bones are not displaced or for patients who are at higher risk for surgical complications like severe osteoporosis, heart disease, or other medical concerns.
Nonsurgical treatment may include walking aids, Positioning aids and medication.
Most acetabular fractures are treated with surgery. During surgery, the displaced bone fragments are first re-positioned (reduced) into their normal alignment. The doctor will then attach metal plates and screws to the outer surfaces of the bone to hold the fragments together while they heal.
In some cases, the acetabulum is so damaged that repair or reconstruction is unlikely to provide a good long-term result. In this situation, the 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.