Pelvic and acetabular fractures: A detailed guide to surgery and recovery

A fracture in one of the bones of pelvis or of the acetabulum (the socket of the ‘ball and socket’ hip joint) requires careful management in order to ensure the best chances of recovery a full range of motion and flexibility in the hip joint. In this informative article, highly respected consultant trauma and orthopaedic surgeon Mr Ibraheim El-Daly sheds light on what surgical treatment of pelvic and acetabular fractures entails and also explains when further interventions are required.

How does a pelvic or an acetabular fracture occur?

Generally, there are two categories of patients that sustain a pelvic or acetabular fracture. One group is patients who have sustained a high energy injury, which may involve a car, motorbike or cycling accident, for instance.

The other group of patients have what we call ‘a fragility fracture’. These are typically patients who are elderly and have more fragile bones, meaning they can sustain a fracture either from a fall or simply due to the weakness of their bony architecture.

In treating pelvic or acetabular fractures, we most often see major trauma patients who are involved in serious accidents. However, with the population getting older, we are seeing fragility fractures more frequently.

Do pelvic or acetabular fractures require urgent surgery?

The recommendations are that we should be operating on these patients within seventy-two hours because the longer you wait, the harder the operation becomes and the greater the risks are to the patient.

Although we ideally operate within seventy-two hours, this can sometimes be difficult to achieve due to the pressures and the complications within the environment that we see and treat these patients. However, we are highly trained surgeons and we know the right time to operate and how to guide our patient throughout their journeys to recovery.

What are the different surgical options available?

There are various ways in which you can reduce a fracture - meaning that you put the broken bits back where they belong. This can be done through an open surgical approach by making an incision over the fracture site so that the broken bone end can be put back to where it belongs. Alternatively, this can be done using a closed approach, where the limb is manipulated in order to pull the fragments back to where they belong.

In terms of fixation, this can either by performed with an open or percutaneous approach (using a small incision). In some cases, the two approaches are mixed in order to get the fragments back to where they belong.

Personally, I am trained in CT guided navigation, which was the subject of my fellowship in Paris, and is something I perform quite routinely. Once the fracture is reduced, I'm able to utilise intraoperative CT to guide the fixation. This is an extremely accurate way to fix the fracture because you can pinpoint exactly where each screw is going. As opposed to using the more traditional 2D X-rays, CT gives the surgeon a 3D overview.

Do patients usually need more than one operation?

With regards to pelvic and acetabular fracture surgery, sometimes patients require more than one intervention, particularly if it's what we call a ‘fix and replace’ case. In other words, we combine fixing the acetabulum and a hip replacement, performing them at the same time. This is indicated when the joint is no longer reconstructible and is generally offered to patients who are slightly older because the evidence tells us that these patients will do better with a hip replacement.

If we think that quite a big operation is required, we sometimes stage it, meaning that we perform surgery on one day and then continue it a week later. In other cases, however, we do everything in the same sitting. The decision about whether to stage surgery depends on the patient, how they are doing and how medically fit they are to undergo a big operation.

How long does it take for a pelvic or an acetabular fracture to heal?

Generally, it takes a minimum of six weeks before a patient can start to put all their weight through their leg and it takes about three to six months for them to fully recover from the surgery. Some patients recover quicker than others, depending how serious the injury is, but this can vary between one person and another.

We guide the patient through their recovery journey and take regular imaging (X-rays or CT scans) to see how the fracture is healing and how quickly the patient can get back to normal again.

Will patients regain their flexibility, strength and range of motion?

The majority of patients will regain their strength, range of motion and flexibility and this is always a key part of the treatment strategy of fixing a broken bone. The treatment journey begins with ensuring that you reduce the fracture (putting it back to where it belongs) and then immobilising the fracture (fixing it with something to hold it together whilst it heals). Following this, you can start early mobilisation and eventually this leads to a return to normal function.

When you employ these management principles, generally speaking, the vast majority of patients will achieve regain full function, flexibility and strength. Unfortunately, in some patients, this may not be achievable due to the level of injury that they have sustained. In these cases, we guide patients to make the best recovery possible and inform them of where we expect they will be at the end of their treatment plan.

If you wish to schedule a consultation with Mr El-Daly, you can do so by visiting his Top Doctors profile.