- Pelvis - A basin-shaped structure, comprising the pubis in front and the sacrum and coccyx behind, that support the weight of the upper body and transmits weight-bearing to the lower extremities.
- Acetabulum - The cup-shaped cavity at the base of the plevis into which the ball-shaped head of the femur fits (upper portion of the hip joint).
- Fragility Fractures - Fractures that occur in osteoporotic bone, generally affecting elderly patients.
- Polytrauma - A short verbal equivalent used for patients usually with two or more severe injuries in at least two areas of the body.
- Non-union - Failure of a fracture to unite.
- Mal-union - A bone which heals in a non-anatomic position (out of alignment).
- Limb Length Discrepancy - Where one limb is shorter than the other.
- Spine - The series of vertebrae forming the axis of the skeleton that protects the spinal cord.
Plevis and Acetabular Fractures
Fractures of the pelvis and acetabulum are amoung the most serious injuries treated by orthopaedic surgeons. These injuries usually result from high velocity accidents, such as motor vehicle accident or fall from height. People of all ages are vulnerable to these injuries. In addition, some elderly patients with fragile bones, due to osteoporosis, develop pelvic fractues and fractures of the acetabulum with a lower impact fall.
Fracture right acetabulum
As with all fractures, our priority in treating fractures of the acetabulum and plevis is to maximize the patient's ability to return comfortably to daily activities, both work and play. Acetabular fractures are fractures through the socket part of the hip joint. It is an injury of both the bone and cartilage of the joint. These fractures are often displaced (the bones are not in proper position) and require treatment to put the fracture fragments back into place (reduce the fracture). If a joint heals with the bone displaced, the surface of the joint will have irregularities, which may cause excessive wear and result in severe arthritis of the joint, loss of motion, decreased function and pain. To prevent this proper alignment of the bones during healing is essential.
Stable pelvic fracture (without displacement or dislocation) may usually be treated without surgery. Displaced fractures usually realignment of the bones. This may be done by either open (where the orthopaedic surgeon makes an incision to directly manipulated the bone) or closed means. Once the bones are realigned, the surgeon uses internal or external fixation to hold the bone in proper position during healong. Metallic devices including wires, pins, screws, and plates are used.
Patients with pelvic fractures may require one or more surgical procedures. Following reduction of the fracture, the surgeon may use an External Fixation (Ex-Fix) frame to hole the bones in place. Applciation of an external fixator is done by inserting threated pins into the bone on either side of the fracture. These pins are then connected to rods outside the skin to form a frame.
While the Ex-Fix technique is sometimes the only procedure needed to repair a fractured pelvis, some patients require additional surgery or surgeries in which plates and screws are used internally to hold the bones in place. Depending on the site and complexity of the fracture, the surgeon may have to fix the front of the pelvis, the back of the pelvis, or both. Separate operations may be needed for each area that needs treatment.
Patients with acetabular fractures often require Open Reduction with Internal Fixation (ORIF), especially those patients who also have displacement of the joint. The surgeon realigns the bones are precisely as possible to reduce the risk of developing post-injuring related problemes, especially arthritis. The bones are then fixed with plates and screws to prevent future displacement and allow for early rehabilitation.
Fractures of the acetabulum are usually not treated for 5-10 days following the injury. This is to reduce the rick of intraoperative bleeding. During this period the patient may be in traction to prevent additional injury.
Throughout treatment and recovery, doctors and nurses are watchful for the following potential complications:
- Deep Vein Thrombosis and Pulmonary Embolism: Blood clots that may form in the veins of the pelvis, thight and/ or lower legs and may travel to the lungs.
- Pneumonia: An infection of the lungs that may affect any patient whi is confined to bed and cannot expand his or lungs as fully as they normally do.
- Skin Problems resulting from being in one position for a long period of time.
- Muscle Complications due to inactivity.
- - Heterotopic Ossification, a condition in which the body mistakenly forms bone in an area where there is normally muscle; prompt treatment is required to prevent this new bone from interfering with joint movement.
- Damage of the Head of the Femur: if the articular cartilage lining of the joint is affected in an injury to the pelvis, and particularly in fractures of the acetabulum, it's important to keep the surfaces of the joint from rubbing together-and to avoid the risk of future development of arthritis. Preoperatively, traction or a system of ropes, pulleys and weights are used to relieve pressure in the joint. Obviously, surgery with open reduction and internal fixation is performed to realign the joint with enough stability to allow immediate mobilization and hence preserve the smooth lining of cartilage and avoid subsequent arthritis.
- Avascular Necrosis of the Head of the Femur: Patients with dislocated hip and / or fracture of the acetabulum may have disrupted blood flow to the head of the femur (the ball in the hip joint). This can result in death and collapse of bone tissue and hip joint arthritis.
- Nutritional Problems: The body requires more protein and calories during healing.
- Constipation resulting from inactivity.
- Infection at the site of the injury.