Acetabular fractures are severe injuries affecting the hip socket, an important part of the hip joint. These fractures can disrupt a person’s ability to move. Understanding how these injuries occur and the available treatment options is important for managing their impact.
What is an Acetabular Fracture
The acetabulum forms the socket portion of the hip’s “ball-and-socket” joint. It is composed of three bones: the ilium, ischium, and pubis. The acetabulum and the top of the femur (thigh bone), called the femoral head, create the hip joint.
An acetabular fracture is a break in this part of the pelvic bone. These fractures are less common than other hip fractures, which often involve the upper femur. Fractures can range from simple breaks involving one wall or column to complex patterns with multiple fragments.
How These Fractures Happen
Acetabular fractures often result from high-energy trauma, such as motor vehicle collisions. In these incidents, a force can drive the femoral head against the acetabulum, often seen as a “dashboard injury” when the knee strikes the dashboard. Falls from significant heights or severe crush injuries can also cause these fractures.
In older adults, acetabular fractures can occur from less forceful incidents, such as a fall from a standing height. This is common in individuals with weakened bones due to conditions like osteoporosis. The direction and magnitude of the force determine the specific fracture pattern and can sometimes lead to a hip dislocation.
Identifying an Acetabular Fracture
Immediately following an acetabular fracture, a person experiences severe pain in the hip or groin area. Pain often worsens with movement, making it difficult or impossible to bear weight on the affected leg. Swelling and bruising around the hip joint are also common signs.
Sometimes, the injured leg may appear shorter or turned outward, indicating a possible deformity. To diagnose an acetabular fracture, a doctor conducts a physical examination and reviews the patient’s medical history. Imaging techniques such as X-rays identify broken bones and fragment alignment, while computed tomography (CT) scans provide detailed cross-sectional images for assessing the injury’s full extent.
Treatment for Acetabular Fractures
Treatment for acetabular fractures depends on the fracture pattern, severity, and the patient’s overall health. Non-surgical approaches are considered for stable, non-displaced fractures or in patients with medical conditions that make surgery too risky. Non-surgical management may involve bed rest, skeletal traction to immobilize the fracture and maintain bone alignment, and pain management with medications. Patients may also use walking aids like crutches or a walker for up to three months to avoid bearing weight on the affected leg.
For displaced fractures, open reduction and internal fixation (ORIF) is the primary surgical method. During this procedure, the surgeon repositions the bone fragments into their correct anatomical alignment. Metal plates and screws are then attached to the bone’s outer surfaces to hold the fragments securely while they heal. The goal of ORIF is to restore the hip joint’s smooth, gliding surface as precisely as possible to minimize the risk of future complications, such as post-traumatic arthritis. In some cases, particularly for older patients with severe damage or weakened bone, a total hip replacement may be performed, either immediately or as a delayed procedure, to replace the damaged joint with artificial components.
Life After an Acetabular Fracture
Recovery from an acetabular fracture, whether treated surgically or non-surgically, involves a structured rehabilitation process. Patients often have a hospital stay of about seven days after surgery. Non-weight-bearing on the affected leg is usually required for six weeks to three months, allowing bones to heal without displacement.
Physical therapy is important for restoring mobility and strength. Initially, exercises focus on maintaining range of motion and isometric strengthening, with gradual progression to stationary bike riding and gentle walking after about six weeks. Full weight-bearing is usually introduced after three to four months, once bones have healed. Potential long-term complications include post-traumatic arthritis due to cartilage damage, avascular necrosis (loss of blood supply to the bone), or nerve damage like sciatic nerve injury, which can cause foot drop. Adherence to rehabilitation protocols is important for optimizing recovery and mitigating these risks.