What is Acetabular Fracture & How is it Treated?|Causes, Symptoms, Healing Time of Acetabular Fracture

The hip joint is one of the largest joint in the body. It is a ball and socket joint in which the socket part of the joint comprises of the acetabulum and the ball part of the joint comprises of the femoral head which is the upper and of the thighbone. An individual is said to have suffered an Acetabular Fracture when there is a break in the acetabulum or the socket portion of the hip joint. ^[1] Such fractures are quite rare and in majority of cases are caused by high impact motor vehicle collision or a direct fall on the hip.

Elderly people or people with osteoporosis can suffer an Acetabular Fracture even when falling from a standing height on the hip. Acetabular Fractures almost all the time requires surgery to correct the fracture and normalize the hip to allow the individual to function normally.

An Acetabular Fracture occurs when a high impact event such as a motor vehicle collision forces the head of the femur against the acetabulum. This driving force can come from below in the knee when it hits the dashboard of the motor vehicle. Falling directly on the hip can also force the femoral head against the acetabulum such that the ball or the femur moves out of the socket. This is called as hip dislocation; however, when the impact is high then the acetabulum completely breaks. This is when Acetabular Fracture is said to have occurred. People with weak bones like the elderly or people who have a condition called osteoporosis in which the bones become weak and brittle can sustain an Acetabular Fracture with minimal impact on the hip joint.^[2]

Severe pain in and around the hip joint is the main symptom of an Acetabular Fracture. This pain gets worse with any attempts at movement. The affected individual will not be able to stand or ambulate to any significant degree. In case if a nerve gets damaged during the accident or injury then the individual will feel numbness and weakness going down the lower extremities. The area around the hip joint will be tender to touch and painful. There may also be skin discoloration seen at the injury site.^[3]

The physician will first perform a detailed physical examination of the patient focusing on the area of the injury. The hip, pelvis, and the legs will be closely checked. The physician will see if the patient is able to move his ankles and toes and whether there is any sensation loss in the feet. This is because many times the nerves also get affected as a result of the incident resulting in an Acetabular Fracture. The physician will then order x-rays and CT scan of the pelvis and hip which will confirm the diagnosis of Acetabular Fracture.^[4]

Before formulating a treatment plan for the patient the physician will study and analyze the type of fracture, the extent and severity of the injury, and the overall health condition of the patient. The treatment for Acetabular Fracture is normally surgical but conservative approach is also recommended in cases where surgery is contraindicated in a particular patient or the fracture is a very minor one.

Conservative treatments for Acetabular Fractures include utilizing walking aids to avoid putting pressure on the hip and the lower extremities until the fracture heals. Walking assistance may be needed for a minimum of three to four months after injury. The patient will also not be allowed to bend at the waist to avoid dislocating the hip. For this the patient may be provided with an abduction pillow or a knee immobilizer. The patient will also be given pain medications to deal with the pain and a blood thinner to prevent any DVTs.^[5]

Surgery is recommended for most of acetabular fractures as the fracture causes significant damage to the cartilage and surface of the bone. The main aim of surgery is to restore functionality of the hip such that the patient can do all activities normally. Through a procedure, the surgeon will try to accomplish realignment of the hip joint with the ball firmly fitting on the socket.

The surgery for acetabular fractures are not done immediately after the injury as surgeons prefer to wait for the patient to normalize from other injuries that he might have sustained and overall health condition has stabilized.^[6]

While the patient is awaiting surgery, the site of the fracture will be immobilized and the leg will be put in a traction device to prevent any pressure being applied on the hip. Traction also is helpful for providing pain relief to the patient.

During surgery, the bones of the hip are realigned and the femoral head is fit into the acetabulum. The patient is advised to not put any weight on the hip until the fracture has completely healed. In cases where the acetabulum has been damaged beyond repair then hip replacement procedure is the preferred route.

Hip Replacement is a complex and long procedure in which the natural parts of the hip joints are removed and replaced with prosthetic joints. Hip Replacement procedure is reserved only as a last resort as such a procedure carries high risk of failure of the prosthetic implants.

Postsurgery, the patient will require crutch assistance for any weightbearing activities for at least a period of six to eight weeks. The patient can then be allowed to weight bear partially. It normally takes a minimum of four to six months for an individual to completely heal from an Acetabular Fracture. In cases where Hip Replacement is done, then the recovery time can be as long as one year.

During the healing phase from Acetabular Fracture, it is extremely vital for the patient to adhere to the doctor’s advice as not following instructions may lead to unwanted complications in the form of frequent hip dislocations or recurrence of fracture which may take more time to heal.^[7]

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Also Read:

• What is Acetabular Fracture & What is its Treatment, Recovery time and Classifications?