Patients who suffer a fracture of the acetabulum usually have an additional serious injury to the surrounding skin and muscles and nerves, arteries and veins; in some cases, adjacent organs can also be damaged, and there is significant risk of nerve damage and bleeding.
For patients with multiple injuries, including acetabular hip fracture, treatment will begin on scene and then later in the emergency room; in this early phase, the surgeon may try to stabilize the fracture using what’s called a temporary external fixation, an external frame that temporarily holds the bones in place while other injuries are attended to.
Later, the acetabular hip fracture is treated by a team that includes orthopedic surgeons, a trauma team, anesthesiologists and nurses—and because this surgery is often very complex, patients are often transferred from their community hospital to a facility that specializes in this type of care for the procedure. In fact, treatments for acetabular hip fractures usually do not begin for five to 10 days after the trauma, so as to allow patients to recover from the bleeding associated with the original trauma.
Treatment options are either surgical or nonsurgical. In either case, the goal is to realign the bones—a process called reduction. Nonsurgical treatments are usually recommended for patients who may not be able to tolerate surgery because of medical problems, infections or osteoporosis, and/or patients who have not suffered joint displacement. These patients are treated by a process known as closed reduction, which is realignment without surgery that is performed is through manipulation while the patient is under general anesthesia or by putting the patient in traction.
The surgery to realign the bones is called an open reduction. The orthopedic surgeon makes an incision to directly manipulate the bone. After realigning the bones, either internal or external fixation is used to hold the bones in place while they heal.
Open reduction with internal fixation (ORIF) is especially common for patients with an acetabular fracture and displacement of the joint. In this procedure, the surgeon aligns the bones as precisely as possible and then rigidly fixes them with plates and screws to prevent future displacement and allow for rehabilitation.
Surgery is most often performed in younger patients. The fractures of older individuals are sometimes allowed to heal on their own, even if the alignment isn’t perfect.