Pelvic and Acetabular fractures | Complex fracture management

A small fracture can lead to severe pain and trauma. However, fractures resulting from vehicle accidents or falls from high positions can cause much greater harm. In certain instances, such accidents can lead to severe injuries across the body, including multiple bone fractures occurring in different locations. Treating these ‘complex’ or ‘high-energy’ fractures is a challenging task.

Complex fractures involve bones breaking into pieces, significant damage to the surrounding soft tissues, or the presence of other conditions or injuries that complicate treatment and healing. These fracture types typically demand extra attention, as they require an extended healing period. In most cases, patients will need to remain hospitalised for several days following a complex fracture.

Pelvic Fractures and Acetabular Fractures

Pelvic and acetabular fractures rank among the most severe injuries that orthopaedic surgeons treat. These injuries commonly result from traumatic events such as motor vehicle accidents or falls, necessitating prompt and accurate treatment. Surgery may be required in some cases. These injuries can affect individuals of any age. Additionally, elderly patients with brittle bones due to osteoporosis are at risk of developing pelvic and acetabular fractures even with lower impacts.

Individuals who experience fractures in their pelvis or acetabulum usually sustain severe damage to the surrounding soft tissues, including skin, muscle, and neurovascular tissues. Notably, pelvic fractures can lead to significant damage to adjacent organs. In both scenarios, substantial bleeding and the potential for nerve damage are significant concerns.

How is Complex Fracture diagnosed?

Most patients with complicated fractures are initially evaluated in the emergency room, where doctors assess the extent of their injuries and determine the necessary actions. They perform a clinical diagnostic process to gauge the degree and severity of the injuries, including:

• Blood tests
• Electrocardiogram (EKG), a test that examines the heart’s electrical activity.
• Chest X-ray to ensure there is no lung damage, fluid accumulation, or lung infection.
• Conventional radiographs (X-rays), computerised tomography (CT scans), or magnetic resonance imaging (MRI). Each of these tests aims to provide the surgeon with comprehensive information about the fracture before surgery. CT scans, in particular, are valuable as they allow the physician to visualise the fracture from multiple angles and generate a 3D image on a computer monitor.
• Magnetic resonance venogram (MRV) for assessing the patient’s veins. A significant number of patients with pelvis or acetabular fractures may develop blood clots in the pelvis, thigh, or lower leg veins. If an MRV detects the presence of a blood clot, prompt treatment is initiated.

Goals of the Treatment

Acetabular and pelvic fractures are treated in the same way as any other type of fracture. Ultimately, the goal is for the patient to regain as much of their pre-injury function as possible. An individualised treatment plan will be developed by the Pediatric Orthopaedic Specialist in Bangalore and rehabilitation specialist to restore the patient’s strength and range of motion.

To achieve these objectives, it is essential that the bones properly align during the healing process. A patient with an acetabular or pelvic fracture often experiences bone displacement, meaning the bones are out of place and need to be realigned or returned to their original positions. This process is referred to as reduction.

Non- Surgical methods

There are several factors taken into account when diagnosing pelvic fractures, such as the nature of the fracture, the stability of the pelvis, and the degree of bone displacement. A physical examination, traditional radiographs, and CT scans are used for this diagnosis and assessment by orthopaedic physicians. The most likely candidate for non-surgical treatment is a patient with a stable fracture that has not experienced any dislocation. In some cases, closed reduction under anaesthesia may be necessary, with or without the need for external fixation.

Non-surgical treatment is also an option for some patients with acetabulum fractures. Generally, this approach is chosen for patients without displacement and/or those who are unable to undergo surgery due to severe medical conditions. Closed reduction can be performed through manipulations under general anaesthesia or by placing the patient in traction.

Surgical Methods

The orthopaedic surgeon may realign the bones through either an open reduction, involving an incision to directly manipulate the bone, or a closed reduction, which doesn’t require an incision. Once the bones have been realigned, internal or external fixation is applied to maintain their position during the healing process. Fixation typically involves metallic devices such as wires, pins, screws, and plates. Patients who have sustained a pelvic fracture may require one or more surgical interventions. Depending on the location and severity of the fracture, a surgeon may need to repair the anterior section of the pelvic floor, the posterior section, or both. Separate surgeries may be necessary for each area requiring treatment.

Acetabular fractures typically require an Open Reduction Internal Fixation (ORIF), especially in patients with joint displacement. Acetabular fractures are generally not treated for 5 to 10 days after the injury. This delay is due to the considerable bleeding associated with this type of fracture. The ORIF procedure must be postponed until the patient’s internal clotting mechanisms are activated, typically within 3 to 5 days.

Are there any complications that come up when treating patients with Complex Fractures?

Here are some complications that come up when treating patients with Complex Fractures:

• Deep vein thrombosis and pulmonary embolism: These are types of blood clots that can form in the pelvic area, thighs, or lower legs, and they have the potential to travel to the lungs.
• Pneumonia: This is a lung infection that can affect individuals who are bedridden and unable to breathe as deeply as usual.
• Nutritional Problems: During the healing process, the body requires increased amounts of protein and calories.
• Skin Problems: Prolonged periods of sitting in a fixed position can lead to skin problems.
• Muscle Problems: Complications in muscles can arise due to a lack of exercise.
• Heterotopic Ossification: This occurs when the body mistakenly forms new bone in an area that is typically composed of muscle. Immediate treatment is necessary to prevent this new bone from impeding joint movement.
• Psychological Effects: Patients may experience psychological distress due to changes in their physical appearance or function after an accident or injury.

Recovery after the treatment

The primary focus of post-operative care and recovery is the management of the patient’s pain and any complications resulting from the injury. Initially, pain medication is administered by injection; however, many patients can use a pump to regulate the dosage of pain medication. It’s important for patients to be able to stand and move around right away, as this can help prevent some of the issues that come with these types of injuries. Physical therapy is used to help keep your muscles strong and give you more freedom of movement as you recover.

Patients who have had a pelvic fracture or undergone surgery for an acetabulum fracture may continue to suffer from nerve damage resulting from their traumatic event or surgical procedure. Predicting whether these nerves will recover completely can be difficult; however, the vast majority of patients are able to regain some function and sensation in their limb within 6 to 18 months following their injury.

Apollo Hospital’s orthopaedic trauma service is composed of a team of experienced doctors, skilled nurses, and medical therapists who all work together to provide the best possible care to people who have suffered a major injury. Top Paediatric Orthopaedic Hospital in Bangalore like Apollo Hospitals, Karnataka focuses on patients with complicated injuries like pelvis and acetabulum fractures, as well as other major joint injuries.