One of the most common injuries that lead a person to a wheelchair is an acetabular fracture. Today we learn what this part of the hip joint is, as well as what methods of treatment for dysplasia or other problems of this place exist. We also find out where the acetabulum is located and what complications sclerosis or a fracture of this deepening can lead to.
What is a hip joint?
It is the most powerful and largest in the human body. In addition to functions such as flexion and extension, taking the hips back, forward, to the side, and rotational movements, he also participates during the tilting of the body.
The characteristics of this joint are unique - they provide about 40% of human movements.
It is formed by the head of the femur, as well as a recess called the acetabulum. The hip joint is deeper than the shoulder joint. Both of its elements are covered with cartilaginous tissue, which is capable of absorbing loads, smoothing movements when walking, running, jumping, etc.
Anatomy
The acetabulum is a depression in the ilium, which is part of the pelvic bone. It performs important and complex functions in the body, such as support and movement. It has a hemispherical shape, covered with cartilage from the inside. Doctors distinguish the posterior and anterior walls of the acetabulum, as well as its arch. Given that this part of the pelvic bone provides human movement, it is very important to timely detect pathology in this area and quickly carry out treatment.
The acetabulum is formed by the pubic, sciatic and iliac bones at the junction.
Fracture
Most often, such a violation of the integrity of the bone occurs as a result of an accident. Also, this injury may occur after a fall from a great height.
Fracture of the acetabulum can be divided into 2 types:
- Simple damage. These are fractures of the anterior column, posterior and middle walls, transverse injuries.
- Complex damage. This is when the fracture line passes immediately through several parts of the bone. This includes injuries to the anterior wall, transverse, both columns, etc.
Symptoms of a fracture may include:
- Pain in the groin and hip joint.
- It is difficult for the patient to lean on his injured leg.
- A clear manifestation of shortening of the limb, which is bent in the hip and knee joints. Leg rotated outward.
Fracture treatment
- If a violation of the integrity of the bone occurred without displacement, then the patient is imposed a standard splint, as well as a special adhesive tape extension for the lower leg for a period of 1 month. Be sure to prescribe a course of physiotherapy exercises, electrophoresis.
- If the acetabulum of the pelvic bone is broken in the upper and rear edges, a dislocation of the hip is obtained, then the treatment is carried out by skeletal traction. The specialist holds the needle behind the epicondyles of the femur. Thanks to this manipulation, the capsule of the joint is stretched, and the fragments of the acetabulum are pressed, that is, they are compared. Duration of stretching is usually 1.5 months.
- If the fragment is large and cannot be matched, then an operation is necessary. It should be carried out in the first two weeks after receiving an injury, not later. To fix the fragments of the cavity, surgeons use plates and tightening screws.
After the treatment of the fracture, the rehabilitation period is very important.
Possible access methods
Surgical treatment of fractures of such a deepening as the acetabulum is a rather difficult task. The fact is that it is very difficult for a specialist to reach the site of damage.
There are many types of fractures of this deepening, and, of course, each type has its own access method. The following techniques are mainly used:
- Front access.
- Iliac-inguinal tract.
- Rear access.
Front way
In another way, it is also called the "off-road". It is used for open reduction of all fractures of the anterior column and the wall of the recess called the acetabulum. Another front path can be used in the surgical treatment of transverse fractures.
Iliac inguinal access
It is used to reveal the front and inner surfaces of the acetabulum. It can also be used for simultaneous fixation of fracture deepening and rupture of the sacroiliac joint. However, this access method does not allow a specialist to control the rear column and the wall of the cavity.
Back way
It is used for open reduction and osteosynthesis if damage to the acetabulum of the posterior wall is observed after the elimination of the posterior femoral dislocation. This method is also used to remove cartilage from the joint cavity.
Therapy for fracture of the posterior edge of the cavity
This pathological transformation occurs during an accident or a fall from a height. Mostly young people are affected by this injury. Fracture is accompanied by displacement of fragments, dislocations of the bone, destruction of articular surfaces, cartilage. The edge of the acetabulum of the anterior section is observed in isolated cases. Most episodes show fractures of the posterior column.
In a hospital, a specialist examines the victim, using a survey radiography of the pelvis. In an emergency, under epidural anesthesia or intravenous anesthesia, the doctor corrects the dislocation. After this, the final diagnosis of joint damage is carried out, including radiography in the iliac, panoramic, oblique projections, as well as computed tomography. Such research methods help the specialist to get a complete picture of the damage of such a recess as the acetabulum.
Putting a person on his feet in this case will only help surgical intervention. The doctor makes an incision along the line where the fragment is localized. Next, the doctor fixes it with a screw or an acceptable compression. Checks the stability of fixation of the fragment, and then sutures the wound.
Recovery
When the acetabulum of the pelvic bone after a violation of its integrity was resuscitated, it is very important to observe the following rules of rehabilitation:
- Daily engage in special breathing exercises.
- Learn to walk on crutches correctly, step on your feet.
- To make a special set of exercises under the supervision of an orthopedist: flexion and extension of the toes, rotation of the feet, raising and lowering the pelvis with support on a bent healthy lower limb and two arms.
Hip Arthrosis
A sign of this disease is sclerosis of the acetabulum, which is observed only on x-rays. Such a term is often found in the description of images taken by radiologists.
This problem develops due to inflammatory changes in the bones with overgrowing of the connective tissue.
Sclerosis of the acetabulum is a condition in which the external symptoms of the disease, arthrosis, are not observed. This problem is characteristic of elderly people. The main causes of sclerosis of the cavity are:
- Thinning of cartilage.
- Violation of the blood supply to the legs with ailments associated with metabolism.
- Hereditary predisposition to arthrosis, osteochondrosis.
- Dislocations when walking.
- Sedentary lifestyle.
- Congenital malformations of the joints.
- Injuries during sports loads with damage to the ligamentous apparatus.
- Fractures inside the joints.
- Obesity.
Treatment of arthrosis of the hip joint, sclerosis
Therapy includes:
- Massage.
- Exercise (spreading bent legs while lying on your back).
- Physiotherapy (ozokerite, magnetotherapy).
- The adoption of special baths with radon, hydrogen sulfide.
- Treatment of the problem with non-steroidal anti-inflammatory drugs "Diclofenac", "Nimesulide", etc.
It is also necessary to limit weight lifting, it is forbidden to be in a sitting position for a long time. Jumping, running is also prohibited.
Otto's disease
In another way, this ailment is called "acetabular dysplasia." And such a name as Otto's disease, this pathology was named after the author who first described it back in 1824. This is a congenital ailment that is observed exclusively in women. The problem manifests itself by limiting movements in the hip joints (abduction, adduction, rotation, shortening of the lower extremities). At the same time, the fair sex does not feel any pain.
To confirm the diagnosis of "dysplasia of the cavity" it is necessary to conduct an examination:
- X - ray of the hip joint in the necessary projections.
- MRI.
- Ultrasound.
Acetabulum: treatment of Otto's disease
Therapy consists in surgery, which may include:
- Closed reduction of dislocation.
- Corrective operation on Hiari.
- Open reduction of dislocation.
- Skeletal traction.
- Hip replacement.
Additional treatment methods are also used:
- A special type of swaddling.
- Physiotherapy exercises, gymnastics.
- Massage.
- Treatment with medication.
Complicated Fracture
Acetabular displacement can occur when a large object falls on the pelvis, squeezing it in the frontal plane or, for example, in a car accident.
With such complicated fractures, the contours of the hip joint are disrupted. With posterior dislocations, the greater trochanter is shifted forward. If the central dislocation, then the skewer plunges deep into. To understand that the fracture is displaced, it is necessary to make an x-ray in two projections, since the problem can be both in the front and in the back direction.
Symptoms of complications:
- Active leg movements are sharply limited.
- The affected lower limb is in a vicious position.
The treatment in this case is as follows:
- Application of a skeletal traction system. The needle is held behind the supracondylar region of the thigh with a thrust of 4 kg.
- The leg is laid in the position of flexion and adduction in the hip and knee joints.
- To determine the head in the right position, specialists carry out traction along the axis of the neck using a loop or skeletal traction with an initial load of 4 kg.
- After setting, the loads are transferred to skeletal traction with the initial weight being left along the axis of the neck.
- The leg is bent for 1 week to an angle of 95 degrees.
Duration of stretching is from 8 to 10 weeks. After another 2 weeks, movements in the joint are allowed. Full load on the foot is allowed only after six months. And disability is restored after 7 months.
Coxarthrosis
This is a disease of a dystrophic nature that affects elderly and middle-aged people. The disease develops gradually over several years.
Signs of coxarthrosis are:
- The pathological relationship between the femoral head and the articular cavity.
- The medial quadrant of the head is on the side.
- The roof of the acetabulum is overhanging over the pit, resembling a beak.
- The length of the pit and the roof is violated.
- The cortical layer in the roof of the cavity is thickened.
Coxarthrosis is accompanied by pain and limited movement in the joint.
At later stages of the disease, atrophy of the thigh muscles is observed.
The causes of this disease are divided into 2 types:
- Primary coxarthrosis. It occurs for reasons unknown to medicine.
- Secondary coxarthrosis. It is detected due to other ailments.
The latter type of disease can result from problems such as:
- Congenital dislocation of the hip.
- Hip dysplasia.
- Aseptic necrosis of the femoral head.
- Arthritis of the hip joint.
- Perthes disease.
- Trauma (fracture of the femoral neck, pelvis, dislocation).
The course of coxarthrosis is progressive. If treatment is started at an early stage, then conservative therapy can be dispensed with. At a later stage, only surgery will become an effective method.
Coxarthrosis treatment
Orthopedists are involved in the treatment of this disease. The choice of treatment depends on the stage of the disease.
1. At the 1st and 2nd stages, the following therapy is prescribed:
- Taking anti-inflammatory drugs. True, they are not used for a long time, since they can have a negative effect on internal organs.
- The use of chondroprotectors (such drugs as Arteparon, Rumalon, Chondroitin, Structum.)
- Vasoconstrictor drugs (Trental, Cinnarizine).
- Medications for muscle relaxation.
- Intra-articular injections using hormonal agents, such as Kenalog, Hydrocortisone.
- Use of warming ointments.
- Passage of physiotherapeutic procedures (laser, light therapy, UHF, magnetotherapy), as well as massages, special gymnastics.
2. At the 3rd stage, the only way to get rid of coxarthrosis is surgery. The patient is replaced by a damaged joint with an endoprosthesis. The operation is performed under general anesthesia in a planned manner. Sutures are removed on the 10th day, after which the patient is sent for outpatient treatment. Rehabilitation after surgery is a necessity. In almost 100% of cases, joint replacement surgery provides complete restoration of the function of the damaged leg. At the same time, a person in the future can work, actively move and even play sports. He can wear a prosthesis for up to 20 years, subject to all doctor's recommendations. After this long period has elapsed, a second operation is necessary to replace an already worn endoprosthesis.
Complications of an acetabular fracture
Problems, by the way, are rare, but still people should know about them. Postoperative complications include:
- Sepsis.
- Suppuration of wounds.
- Thromboembolism.
- Nerve damage.
- Aseptic necrosis of the femoral head or acetabulum wall.
- Paralysis of the small and medium gluteal muscles.
To prevent the occurrence of such complications, many doctors immediately offer their patients endoprosthetics.
Conclusion
With displacement, fracture of such a deepening as the acetabulum, early diagnosis, including x-ray, ultrasound, MRI, is very important. Based on these studies, the doctor must choose the appropriate method of treatment: either strictly conservative or aggressive - the operation. After the therapy, the rehabilitation period is also very important, because in the complex of measures taken a person will quickly get to his feet.