MINORS MANUAL
An acetabular fracture is an injury to the cavity where the femur articulates with the pelvis (acetabulum). These fractures typically occur due to high-energy trauma, such as traffic accidents or falls from height. In elderly patients with osteoporosis, acetabular fractures can also result from simple falls.
Due to the proximity to the hip joint, these fractures can compromise joint stability and mobility, requiring specialised management.
Diagnosis
Diagnosis is based on a history of significant trauma, accompanied by severe hip pain, difficulty moving or walking, and possible deformity. Physical examination may reveal a shortened limb or external rotation.
Confirmation is made through anteroposterior X-rays of the pelvis and hip, but computed tomography (CT) is essential to assess the extent and complexity of the fracture, especially if there is intra-articular involvement.
Differential Diagnosis
Pathology | Key Characteristics |
|---|---|
Hip dislocation | Obvious deformity, severe pain, leg in external or internal rotation |
Femoral neck fracture | Hip pain, no visible damage to the acetabulum |
Pelvic contusion | Pain without evidence of fracture on X-rays |
Advanced hip osteoarthritis | Chronic, progressive pain with stiffness, no recent trauma history |
Emergency Management
Initial evaluation (ABC): In polytrauma patients, ensure haemodynamic stability. High-energy trauma may be associated with significant visceral or vascular injuries.
Immobilisation: Keep the hip immobilised to prevent further displacement and manage pain.
Pain control: Administer strong analgesics (NSAIDs or opioids) to relieve pain.
Diagnostic imaging: Request initial X-rays and a CT scan for a detailed assessment of the fracture, determining if it is intra-articular or affects hip stability.
Neurovascular evaluation: Examine the neurovascular function of the affected limb to rule out sciatic nerve injury or vascular compromise.
Antithrombotic prophylaxis: Due to the risk of prolonged immobilisation, initiate prophylaxis to prevent deep vein thrombosis, preferably with low molecular weight heparin or compression devices.
Definitive Treatment
Definitive treatment depends on the type and displacement of the acetabular fracture:
Non-displaced fractures: Can be managed conservatively with rest, non-weight-bearing use of crutches for 6 to 8 weeks, and periodic radiological follow-up. It is essential to ensure that the hip joint remains stable.
Displaced or complex fractures: Require surgical intervention, which may include open reduction and internal fixation (ORIF) to realign bone fragments and restore the articular surface. In severe fractures or those with significant joint destruction, especially in older patients, total hip arthroplasty (hip replacement) may be necessary.
Postoperative Complications: Monitor for potential complications, such as avascular necrosis of the femoral head, post-traumatic arthritis, or hip instability. Early rehabilitation with physical therapy is crucial to restore mobility and function.
In all cases, postoperative rehabilitation is essential for functional recovery, focusing on progressive mobility and muscle strengthening. Weight-bearing is introduced gradually based on the stability of the fracture and the surgeon’s recommendation.
Comments