The Parathyroid hormone (PTH) is of benefit in fragility fractures of the pelvis in reducing the healing time and also the pain reduction. The role of ORIF and Arthroplasty also needs to be considered to be approachable with elderly acetabular fractures with the aim of early rehabilitation and the return of preinjury. The main objective of managing these geriatric injuries is early mobilization, pain reduction, and good functional outcomes. The surgical implants and the techniques of reduction also hold great potential for improvement with the possibility of arthroscopic assisted fixation of acetabular columns and also prospects of laparoscopic/endoscopic of the medially displaced acetabular fractures.
Acetabulum fractures are pelvis fractures that involve the articular surface of the hip joint and may involve one or two columns, and one or two walls, or roofs within the pelvis. These hip socket fractures are not common, as they occur much less frequently than fractures of the upper femur or femoral head. The majority of them are caused by some type of events like car accidents, many times they do have major injuries that need immediate treatment.
These fractures occur in a bimodal distribution, where high-energy trauma can be seen in younger patients in incidents like motor vehicle accidents, whereas low-energy trauma can be seen in elderly patients in situations such as falls from standing heights. To determine the cause, fracture patterns are predominately determined by force vector, the position of the femoral head at the time of the injury, and the bone quality. Bone quality is defined by the age. The associated conditions are lower extremity injuries, nerve palsy, and spine injury. Some of the systematic injuries are head injuries, chest injuries, and abdominal and genitourinary injuries. If the joint remains irregular or unstable, ongoing cartilage damage to the surface may lead to arthritis.
The severity of the injury depends on many factors, some of which are;
- The number and size of the fractured fragments
- The amount of each displaced piece, in other severe fractures, there may be a large gap between the broken pieces, or the fragments may overlap each other.
- If there is an injury to the cartilage
- The injury that surrounds soft tissues, such as muscles, tendons, nerves, and skin.
Open fractures are usually rare as the pelvic area is covered with soft tissues. When fractures do occur, they are usually the result of high-energy trauma events. Knowing the severity and the specific pattern of the fracture will help the doctor determine the treatment.
Types of Acetabular Fractures;
- Anterior wall fractures
- Posterior wall fractures
- Transverse fractures
- Comminuted fractures
- Stress fractures
Symptoms and causes;
The bones in the pelvis, along with the acetabulum are very strong, as it needs a high force energy for the bones to break like car accidents or fall from heights. Sometimes the weakened bones can be the reason as well. Some older or elderly people with osteoporosis get acetabular fractures after a simple fall. The symptoms include severe hip pain, numbness, and a tingling sensation down your leg if the nerves are damaged. The weakness in the leg. These are some of the symptoms and causes of pelvic-acetabular trauma.
Diagnostic tests include X-rays (as X-rays can show which bones on the hip are broken and if the bone fragments are in place) a computed tomography (CT) scan (it can show the severity of the injury by producing a cross-sectional image of the hip).
Treatment for an acetabular fracture/trauma
- Crutches or a walker
- Leg-positioning device
- Pain-reliever medication
- Anto-coagulants (blood thinners)
- Surgery can be required depending on the severity and pattern of the injury
- Open reduction and internal fixation (ORIF)
- Total hip replacement surgery
Complications you might face with acetabular trauma/fracture
- Post-traumatic arthritis
- Avascular necrosis or osteonecrosis
- Infections
- Blood clots
- Sciatic nerve injury
- Heterotopic ossification