Pelvi Acetabular Fracture
Pelvi-acetabular fractures are complex injuries involving the pelvis and the acetabulum, which is the socket of the hip joint. These fractures are often caused by high-energy trauma, such as motor vehicle accidents, falls from significant heights, or crush injuries. Due to the critical structures within and around the pelvis, including blood vessels, nerves, and organs, these fractures are serious and often require specialized medical and surgical management.
Anatomy Involved
Pelvis:
- The pelvis is a bony ring formed by the sacrum (at the back), the ilium, ischium, and pubis bones (on the sides and front).
- It supports the weight of the upper body when sitting or standing and provides attachment for various muscles.
Acetabulum:
- The acetabulum is a deep, cup-shaped cavity that forms the socket of the hip joint, where the head of the femur (thigh bone) fits.
Types of Pelvi-Acetabular Fractures
Pelvic Fractures:
- Stable Fractures: These involve one break in the pelvic ring and typically do not displace the bones. The pelvic ring remains intact.
- Unstable Fractures: These involve two or more breaks in the pelvic ring, leading to bone displacement. These fractures are more severe and can be life-threatening.
Acetabular Fractures:
- Simple Fractures: Involves a single break in the acetabulum.
- Complex Fractures: Involves multiple breaks, often associated with dislocation of the femoral head from the acetabulum.
Causes
- High-Energy Trauma: Motor vehicle accidents, falls from heights, industrial accidents.
- Low-Energy Trauma: In older adults with osteoporosis, even minor falls can cause fractures.
- Sports Injuries: High-impact sports can lead to these fractures, especially in contact sports or activities with a high risk of falls.
Symptoms
- Severe Pain: In the hip, groin, or lower back, exacerbated by movement.
- Inability to Bear Weight: Difficulty or inability to stand or walk.
- Deformity: Visible deformity if the fracture is displaced, especially in cases of hip dislocation.
- Swelling and Bruising: Around the pelvis, hip, or groin.
- Numbness or Tingling: Due to nerve injury associated with the fracture.
- Internal Bleeding: Symptoms may include shock, low blood pressure, and pale skin if there is significant internal bleeding.
Treatment
Initial Stabilization:
- Emergency Care: Immediate attention to control bleeding, prevent shock, and stabilize the patient.
- Pelvic Binder or External Fixator: Temporary measures to stabilize the pelvis and control hemorrhage.
Non-Surgical Treatment:
- Indications: For stable fractures or patients who are not surgical candidates.
- Immobilization: Bed rest, use of a pelvic binder, or traction.
- Pain Management: Medications to manage pain and discomfort.
- Physical Therapy: Gradual rehabilitation to restore function.
Surgical Treatment:
- Indications: Unstable fractures, displaced fractures, acetabular fractures, or fractures involving the hip joint.
- Open Reduction and Internal Fixation (ORIF): Surgery to realign the bones and fix them with plates, screws, or rods.
- External Fixation: An external frame used to stabilize the bones in certain types of fractures.
- Hip Replacement: In cases where the acetabulum or femoral head is severely damaged, partial or total hip replacement may be necessary.
Rehabilitation
- Physical Therapy: Critical for regaining strength, range of motion, and mobility.
- Weight-Bearing Restrictions: Gradual reintroduction of weight-bearing activities based on the healing progress.
- Long-Term Monitoring: Regular follow-up to monitor healing, address complications, and adjust rehabilitation.
If you would like to have additional information contact Dr. Vipul Shet, serving communities and people from all walks of live.
