Pelvic & Acetabular Injruy

Overview of Pelvis Acetabular Fractures

An acetabular fracture is a break in the socket portion of the "ball-and-socket" hip joint. These hip socket fractures are not common — they occur much less frequently than fractures of the upper femur or femoral head (the "ball" portion of the joint).

The majority of acetabular fractures are caused by some type of high-energy event, such as a car collision. Many times patients will have additional injuries that require immediate treatment.

In a smaller number of cases, a low-energy incident, such as a fall from standing, may cause an acetabular fracture in an older person who has weaker bones.

Treatment for acetabular fractures often involves surgery to restore the normal anatomy of the hip and stabilize the hip joint.

The pelvis is made up of several bones (ileum, ischium and pubic bones) which create a bony ring, meeting at the pubic symphysis in the front and the sacrum (a bone situated at the lower end of the spine) in the back. Together with a number of ligaments and muscles, the bones of the pelvis support the weight of the upper body and rest on the hip joints. 

The pelvis protects abdominal organs including the intestines and the bladder, as well as major nerves and blood vessels. Pelvic fractures may occur at any location on the bones depending on the nature of the accident and the areas of impact. 

Breaks in the pelvis or acetabulum of the hip joint are among the most serious injuries treated by orthopedic surgeons. Often the result of a traumatic incident such as a motor vehicle accident or a bad fall, pelvic and acetabular fractures require rapid and precise treatment and, in some cases, one or more surgical procedures. People of all ages are vulnerable to these injuries. In addition, some elderly patients with fragile bones due to osteoporosis develop pelvic fractures and fractures of the acetabulum with a lower-impact fall. 

Treatment goals

As with any fracture, the main goal of treatment for fractures of the acetabulum and pelvis is to return the patient to their pre-injury functional level, to the greatest extent possible. This means returning comfortably to daily activities – work and play. Physicians, nurses and rehabilitation specialists design a course of treatment that seeks to get the patient back to full strength and with the range of motion that they had before the injury.

To achieve these goals, proper alignment of the bones during healing is vital. Patients with acetabular and pelvic fractures often have displacement. In other words, the bones are not in proper position and must be realigned, or put back into place. Physicians use the term reduction to describe this process.

If a joint surface malheals (that is, with irregularities), the cartilage that lines the joint will rub together and wear down, setting the stage for severe arthritis of the joint, loss of motion, decreased function and pain.

Frequently asked questions and answers

Q: Why do I need surgery for a broken pelvis?

If your surgeon recommends surgery it is because you have a displaced fracture and there is an incongruity in the acetabulum. Normally the acetabulum is a smooth cup, congruent with the femoral head, allowing for frictionless motion of the femoral head. If the fracture heals in the displaced position and there is a "step off" then the cartilage on the femoral head will wear away causing posttraumatic arthritis. This is painful and can be very debilitating and possibly may lead to a hip fusion or total hip replacement. The goal of the surgery is to:

• restore the normal shape of the acetabulum

• decrease pain and allow for early ambulatory function

• decrease the chance of post-traumatic arthritis

• delay or avoid the necessity for a total hip replacement

Q: Will I have a limp after the surgery?

Most patients that undergo aggressive rehabilitation to restore muscle strength and flexibility do not have an abnormal gait but can walk normally.

Q: Do I have to go to a rehabilitation facility after my stay at Hospital for Special Surgery?

No. Most of our patients do return home after their surgery. Physical therapy in the hospital ensures that each patient is independent on a walker or crutches and is able to manage stairs. However, there are certain situations where a patient prefers to go to a rehabilitation facility post-operatively and this can be worked out in the hospital with the trauma social worker.

Q: When can I return to work?

Typically patients with these injuries who do manual labor are on temporary disability for six to nine months following surgery. Those individuals that have jobs that are less physically demanding, ie. desk jobs, return to work much earlier (some even after a few weeks). However, each case is evaluated on an individual basis.

Q: How long do I need to go to physical therapy?

Strengthening and flexibility exercises are very important components of the rehabilitative process. Most of the exercises necessary to increase strength such as running on the treadmill and or using the stationary bicycle do not commence until full weight bearing at eight weeks. Most patients will continue with physical therapy for 6 to 12 months after surgery.

Q: How long will I be under the care of my surgeon?

Initially you will see your surgeon every couple of weeks and have conventional radiographs. At about six months you will return approximately every three months for X-rays followed by annual check-ups. Additional visits are unnecessary unless a problem arises.

Q: Is there any medication I can take or anything I can do to expedite the healing process?

No. A fractured bone typically takes eight weeks to heal. There is no medication to speed up the healing. A healthy diet and adequate sleep are always recommended. Of note, smoking has been known to delay healing and sometimes arrest healing all together.

Q: I will be undergoing repeat surgery for a pelvic fracture that happened three years ago. What are my chances for improved function and good recovery?

Unfortunately, there's no precise answer to this question. The success of the surgery depends on the potential for improving the alignment of the broken bones, your overall health, and ability to adhere to a rehabilitative program. While it is always easier to get good results with an initial repair of a fracture, previous surgery does not necessarily mean that you will not experience significant improvement.

Q: Why is it sometimes necessary to have more than one operation to fix a pelvic fracture? Can't the surgeon fix everything at once?

In many cases, the surgeon must approach the pelvic bones from different directions in order to complete the repair. Each of these approaches can require a separate surgery.