Acetabular Fracture: Causes, Symptoms, and Management

The acetabulum is the joint structure formed on each side of the Pelvis (each Hemipelvis or Innominate Bone) by the central union of three different bones: the Ilium, the largest bone located at the top; the Pubis, the pelvic bone located at the front; and the Ischium, the lower pelvic bone located at the back. The acetabulum plays a fundamental role in our movement, as it contains the Femoral Head and allows for activities such as walking, jumping, and sitting.

An acetabular fracture normally involves a high-energy mechanism, such as a severe impact or trauma—for example, a flexed knee hitting the dashboard in a car accident. This impact forces the Femur backward, causing it to dislodge from its socket and strike the edges or columns of the acetabulum, resulting in a fracture. The joint cartilage also sustains damage, which, combined with the fracture, can lead to Osteoarthritis in the future.

Symptoms:

After receiving a high-energy impact, the patient loses the ability to move, as this fracture is usually accompanied by a hip dislocation. The pain is acute and intensifies with movement. The most important recommendation is to avoid having the patient's hip or leg manipulated by anyone without the necessary medical expertise.

Management:

The management of this fracture must be very meticulous as it requires precise timing and sequencing. The best and usually necessary option is Osteosynthesis (fixation surgery with implants). It is recommended to wait between 5 to 7 days after the fracture to allow for the improvement of clinical parameters related to the polytrauma the patient typically suffers. This ensures the surgery does not cause further inflammatory damage and gives the tissues around the hip time to reduce swelling, allowing for better management of the injury.

To reconstruct the cavity, implants called plates and screws are used, strategically placed according to the fracture patterns to ensure the socket can once again hold the femoral head without further displacement.

Acetabular fracture