Fractures involving the hip socket (acetabulum) are very complex clinical problems. The difficulties include the location of the joint (deep in the hip area) and being able to line up the fracture correctly to allow full function. Patients with acetabular fractures typically have other associated injuries and fractures. Many are transferred to trauma centers who have specialists with experience in repairing these types of injuries.
As fellowship trained orthopaedic traumatologists, we have the expertise that allows us to perform the surgery accurately and efficiently. In addition, we 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 us to quickly and efficiently care for all aspects of a patients injury in a tertiary care setting.
Since acetabular fractures involve the surface of the joint (cartilage), surgical repair is usually recommended when there is significant displacement. 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. This ultimately leads to loss of cartilage and arthritis. It is therefore very important to ensure that the surface of the cartilage is repaired as accurately as possible.
Surgical repair involves re-aligning the fracture and holding the repair with plates and screws. The surgery requires specialized implants designed for repair of pelvic fractures and may require a specialized operating room table to help line the fracture up correctly. 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. In older patients who have severe damage of the joint surface primary repair with a total hip replacement at the same time may be indicated . 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. We treat all patients with a low molecular weight heparin medication for the first two weeks after surgery. Post-operative weight bearing is dictated by the fracture pattern and stability of the repair. Full recovery from these injuries is slow and often takes about 1 year. The overall risk of arthritis developing in the joint after surgery is about 20% provided the joint surface can be repaired accurately.