Chronic (persistent, ongoing) pain around the pelvis region is a common complaint and can be debilitating. Acute (sudden or severe) pelvic pain is normally due to a fracture caused by some kind of major impact, such as a car accident. However, older patients who have osteoporosis (weakened bones) may fracture their pelvis simply from falling. The acetabulum is cup part of the hip. An acetabular fracture is far less common than fractures of the upper femur or femoral head.
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Causes
Chronic pelvic pain can be due to a number of different factors – having given birth, damage to the pelvic joints, muscle and ligament strain, infection, bursa inflammation and pain coming from the spine. If the pain is acute, it is likely to be caused by a fracture of the pelvis or acetabulum – the ball and joint part of the hip.
Symptoms
Pelvic (girdle) and acetabular (hip socket) fractures are among the most serious injuries treated by orthopaedic surgeons. They require rapid and precise surgery to rebuild the normal anatomy and stabilize the hip joint. In some cases, they may require more than one operation.
Acetabular fractures vary in type and severity. Sometimes the bone can break straight across the socket or it can shatter into several pieces. When the acetabulum is fractured, the femoral head may no longer fit firmly into the socket, and the cartilage surface of both bones may be damaged. Ongoing cartilage damage can lead to arthritis.
Sometimes you may experience a compound fracture, which means the bone is sticking out through the skin, or the wound penetrates down to the bone. There is a high risk of infection with compound fractures.
The severity of the fracture is also influenced by:
- the number and size of bone fragments
- the extent of injury to the cartilage
- damage to the soft tissues (skin, muscles, tendons, ligaments, nerves)
- the extent to which the bones have become displaced
Diagnosis
Whether you are suffering from chronic or acute pelvic pain, the doctor will want to carry out a thorough examination of your pelvis, hips and legs. Sometimes nerves can become damaged when the acetabulum fractures and the doctor will ask if you can move your ankles and toes, as well as checking if you can feel sensation in the soles of your feet.
You will be referred for an X-ray, which will show the pattern of the fracture and how out of place the bones are. You are also likely to have a CT scan, which will provide a more detailed assessment of the fracture and cross-section of your hip.
Treatment
Non-surgical:
If you have sustained a stable fracture in which the bones are not displaced, it may be possible to allow the bones to heal naturally. In this case, you will be given crutches or a walker so you avoid putting weight on the damaged bones. It can take up to three months for the bones to heal.
If there is a risk of the ball of your hip popping out of the socket or sliding within it, you may be given a leg-positioning device such as a knee immobilizer. You will be given medication to help to control the pain as well as anti-coagulants to reduce the risk of blood clots.
Surgical:
Most acetabulum fractures will require surgery to restore a smooth, gliding hip surface. The surgery will restore and rebuild the normal anatomy of the hip joint and refit the femoral head into the hip socket.
Surgery does not normally take place immediately as the doctor will want to allow time for your condition to stabilise. You may be given skeletal traction for a few days to relieve the pain and prevent further hip damage. A metal pin will be implanted into the femur or tibia and weights attached to it to gently pull on the leg and keep the broken bones in the most normal possible position.
In some cases you may need to have a total hip replacement if the acetabulum is damaged beyond repair. This will usually allow you to fully weight bear immediately. After surgery you will be given medication to help to relieve the pain. If the fracture is fixed, without the need for a hip replacement, it is important not to put full weight on the hip after surgery until the bones are fully healed, which normally takes three months. This doesn’t mean you will have to remain immobile however as it is good for healing for you to move around. You will be given exercises to do to help build your strength and resilience.
Risks
The risks of pelvic and acetabulum surgery include:
- infection in the wound or incision site
- blood clots
- post-traumatic arthritis due to damage to the cartilage that protects the joint
- injury to the sciatic nerve which could leave weakness or numbness in the leg
- growth of bone in the muscles, tendons and ligaments around the hip socket
- avascular necrosis – death of bone cells leading to the crumbling and collapse of bone in the femoral head and acetabulum
FAQ’s
Will I make a full recovery?
The serious nature of acetabulum fracture, coupled with the risk of complications, means you may not be able to achieve the same level of activity after surgery that you had before your injury.
Why won’t the surgeon operate immediately?
You need time to stabilise after injury and to prepare for surgery. During this time you may be placed in skeletal traction to immobilise the fracture and prevent further injury.
Why do I need a CT scan as well as an X-ray?
The pelvis is a complex structure. A CT scan allows the surgeon to see a detailed cross-section of the pelvis and enables them to plan your operation beforehand.
Personal outcomes – what to expect
Our patient-care process
- Once all of your diagnostic procedures are completed, we will be able to explain whether surgery is recommended.
- We will go through the procedures with you, covering the operation itself, the recovery process and the future prospects.
- Your orthopaedic surgeon will also explain the risks: these are small, but it is important for you to understand them.
- You can feel reassured that you will receive expert care from the start of the process, including your after-care.
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If you are experiencing pain in your pelvis, hip, knee or ankle, or are suffering from a sports injury, seek specialist help to get you back to living your life. Contact can be made direct, or through your GP.
Email:
enquiries@carrothersorthopaedics.co.uk
Phone:
+ 44 (0) 1223 667 376.