Acetabular Fracture

What is a Fracture of the Acetabulum?

A fracture of the acetabulum is a fracture in the socket of the hip. The hip joint is a type of “ball and socket” joint. The acetabulum is the round, cup-shaped concavity that is located on the outer side of the pelvis and makes up the “socket” of the hip joint. The “ball” of the hip joint is represented by the spherical, upper end of the femur or thigh bone, also known as the femoral head. Acetabular fractures occur less commonly than other hip fractures such as femoral head fractures or femoral neck fractures of the hip.

Click here to learn more about the Anatomy of the Hip.

Acetabulum Socket

How do Acetabular Fractures (Broken Hip Socket) Happen?

In an acetabular fracture, an outside force causes the head of the femur(“ball”) to collide into the acetabulum(“socket”) thus breaking the bone of the acetabulum. Acetabular fractures are usually caused by high velocity trauma to the hip. Falls from greater heights and motor vehicle accidents are high impact events that can cause acetabular fractures.

The smooth cartilage that lines the femoral head and the acetabulum may also be injured during the fracture. Other structures surrounding the hip joint may also be injured in an event of an acetabular fracture, including:

Muscle
Labrum
Ligament
Bone
Nerves
Skin

Less common causes of acetabular fractures may involve weak bones, as in the elderly and osteoporotic population. These fractures may be caused by falls from lower heights or other lower impact traumatic episodes.

What are the Symptoms of an Acetabular Fracture (Hip Socket Fracture)?

Hip pain- A high amount of pain is present in the affected hip of an acetabular fracture. The pain also may worsen with hip movement.
Weakness- Sometimes, nerves in the region of an acetabular fracture can be injured by fractured bone, pinched by bone, or stretched during the injury. This can cause muscle weakness in the muscles that the damaged nerves innervate.
Numbness or tingling- Adjacent nerves can be injured due to an acetabular fracture which can result in abnormal sensation in regions of the hip/pelvis and lower extremity.
Pain that is spread throughout the groin and leg on the side of the acetabular fracture.

Diagnosis of Acetabular Fractures

Medical emergency care- individuals who sustain an acetabular fracture are usually transported to a hospital ER to control the severe pain and injury, especially if the mechanism of injury involved high impact trauma. Injuries to other body parts, blood loss, and shock related to the fracture event are also stabilized in the ER.

Physical Exam by physician- once the severe pain after an acetabular fracture has been managed and stabilized in the ER, the doctor will acquire a thorough medical history from the patient and will conduct a detailed physical, medical examination of the injured hip and all other body parts.

Diagnosis of Fracture of the Acetabulum

X-Rays- provide images of bony anatomy of the hip. Various views are taken to determine if the fracture is displaced and reveals fracture pattern.
CT Scan- gives an in-depth, three-dimensional image of the bones and soft tissue of the hip/pelvis.

What are the Treatments for a Hip Acetabular Fracture?

The doctor determines acetabular fracture treatment/management with the following considerations:

Fracture pattern
Severity of fracture displacement
Total health condition of the patient.

Non-Surgical Treatment of Acetabular Fracture

Non-surgical intervention for acetabular fractures is recommended for patients with stable, non-displaced fractures and for patients who have medical conditions that put them at risk for problems with surgery. Examples of non-surgical intervention include:

Assistive devices for walking- like crutches or walker to limit weight-bearing on the affected leg. These are used for up to 3 months until the bones are healed completely.
Positioning Devices- keeps the ball of the hip joint from moving to much within the socket, prevents the hip from dislocating, and are also used to limit motion at the hip. Examples include post op knee/leg immobilizer and abduction pillow.
Bed rest
Medications- Anti-inflammatory medications for swelling and pain; Blood thinners to decrease risk of blood clots in the legs due to decreased activity after surgery.

Surgery for Acetabular Fractures

Surgical Treatment is recommended for most acetabular fractures. Acetabular surgery is performed to:

Line up and smooth out the damaged cartilage and bone of the acetabulum
Remove the broken bony fragments from inside the hip joint
Re-establish hip joint stability by positioning the femoral head properly in the acetabulum (socket)

Skeletal traction may be performed prior to acetabular fracture surgery to immobilize and stabilize the fracture in preparation for surgery.

What Types of Surgery are Performed for an Acetabular Fracture?

Open Reduction and Internal Fixation– out of place bone fragments are re-arranged into normal position. Then, the surgeon uses metal plates and screws and fastens them to the bones to hold the broken pieces together in proper alignment.
Total hip replacement – Performed in severe cases where an open reduction or internal fixation is not enough to repair the damage to the hip joint. During this surgical procedure the fractured bone, bony fragments, and torn cartilage are taken out and replaced with a prosthesis made of artificial material.

What are Some Recovery Expectations after Acetabular Fracture Surgery?

Post operative pain in hip, pelvis, and leg- will be managed with medications prescribed by the doctor.
Weight bearing status restrictions- usually partial weight-bearing on affected side with use of assistive device for walking for 6-8 weeks after surgery. Full weight bearing in approximately 3 to 4 months after surgery when the bone is fully healed. Use of cane or other assistive device for ambulation may still be required.
Physical Therapy– is prescribed by doctor to restore functional hip range of motion, strength, endurance, and functional capacity for daily living activities.
Sports and Fitness activities- return to these activities will be determined by the doctor. Return to more active/aggressive sports may take place up to 6 months to 1 year after surgery. (rare in most cases)

What is the Healing Time for an Acetabular Fracture?

Complete healing and recovery may take 9 to 12 months after surgery, but this can vary from individual to individual. Complete recovery may depend on:
The fracture pattern or severity of fracture.
Other injured body structures associated with the trauma that caused the fracture, the patient’s age, and the quality/integrity of the patient’s bones.
The general health condition of the patient may influence healing time. Studies show that smoking limits bone healing and contributes to complications during the healing process.

Related Links:

If you have a hip injury or are concerned about a possible hip fracture, the Jacksonville Orthopaedic Institute can help. To see a JOI Orthopedic Doctor, call (904)JOI-2000, schedule online, or click the link below. To see a JOI Rehab Therapist in 1 of our 12 locations, call (904)858-7045.