Acetabular Fractures

By: Mallory RoelkeAshley Van Genderen

Lisa Vander Plaats

Overview

• Acetabulum fractures are one of the most serious injuries treated by orthopedic surgeons

• Requires rapid and precise treatment and sometimes surgical procedures

• All ages are vulnerable

Causes

• Result of a motor vehicle accident• Bad fall • Osteoporosis in elderly patients

pathophysiology• The femoral head is driven through the acetabulum

due to traumatic injury and the femoral head ends up outside the acetabulum which is also known as a hip dislocation which most patients will have along with a fracture

• More difficult to treat do to the fact the access to the bone is more difficult to get at and the proximity to the major blood vessels and nerves that innervate the lower extremities

• Fracture of the cup where the femoral head sits in pelvis

Signs and Symtoms

• Intense pain in injured area• Swelling• Obvious deformity • Difficulty with ROM• Inflammation signs• Contusions• Leg length discrepancies

Facts

• Almost all patients always experience serious injury to surrounding soft tissue and neurovascular structures

• There is usually significant bleeding and risk of nerve damage

Treatment• Most patients will require and

open reduction with internal fixation.

• Surgeon realigns the bone precisely as possible to prevent post op issues

• Usually not treated until 5-10 days following injury due to the patient experiencing significant bleeding they wait for the patients own clotting mechanisms take effect

• During this time may be in traction to prevent additional injury

Complication Concerns• DVT or Pulmonary embolisms• Pneumonia • Skin problems• Muscle complications due to inactivity• Heterotrophic ossification• Damage to head of femur• Avascular necrosis of the head of the femur• Nutritional problems• Constipation• Infection at the site of injury

Modalities for non-operative care

• Traction• Early mobilization• Progressive weight bearing• Soft tissue massage• Passive range of motion

Therapeutic Exercises

• Aerobic capacity/ endurance conditioning or reconditioning– Gait training– Increase workload overtime– Walking and wheelchair propulsion programs

Therapeutic Exercises

• Balance, coordination and agility training– Neuromuscular education or reeducation– Perceptual training– Posture awareness training

• Body mechanics and postural stabilization– Body mechanics training– Posture awareness and control training– Postural stabilization activities

Therapeutic Exercises

• Flexibility exercises– Muscle lengthening– Range of Motion– Stretching

• Gait and locomotion training– Developmental activities training– Gait training– Implement and device training

Therapeutic Exercises

• Relaxation – Breathing strategies– Movement strategies– Relaxation techniques

• Strength, power, and endurance exercises– Active assistive, active, and resistive exercises

(including concentric, dynamic/isotonic, eccentric, isokinetic, isometric, and plyometric)

– Task specific performance training

ADL Training

• Bathing• Bed mobility and transfer training• Developmental activities• Dressing• Eating• Grooming• Toileting

Bibliography• American Physical Therapy Association, First. Guide to Physical

Therapist Practice. Second Edition. Alexandria, Virginia: American Physical Therapy Association, 2001. 4-H. Print.

• Fracture, Pelvic: eMedicine Emergency Medicine. N.p., 2010. Web. 19 Nov 2010. http://www.emedicine.medscape.com/article/825869-overview .

• Novick, Nancy. "Hospital for Special Surgery." Pelvic Fractures/Fractures of the Acetabulum. N.p., 09/16/2009. Web. 22 Nov 2010. http://www.hss.edu/conditions_pelvic-acetabulum-fractures.asp .

• Thacker Mihir M. "eMedicine." Acetabulum Fractures. N.p., 08/07/2009. Web. 20 Nov 2010. http://emedicine.medscape.com/article/1246057-overview .

• All pictures retrieved from www.google.com