Acetabular fracture fixation is a complex operation to reconstruct a fracture of the hip socket (acetabulum). Accurate restoration of the joint surface is essential to prevent early hip arthritis.
The surgical approach depends on the fracture pattern and may involve an incision at the front of the hip (ilioinguinal approach), back of the hip (Kocher-Langenbeck), or both. The fracture fragments are anatomically realigned under direct vision and fixed with plates and screws. The operation is technically demanding and takes two to four hours.
Surgery is recommended for displaced acetabular fractures to restore the hip joint surface. Without accurate reconstruction, the incongruent joint surface leads to rapid arthritis and the need for early hip replacement.
Undisplaced fractures with a congruent hip joint may be managed with restricted weight-bearing for six to twelve weeks. In elderly patients with comminuted fractures, acute total hip replacement may be a better option than attempted fixation.
CT scan with 3D reconstruction for planning. Surgery ideally within five to ten days, after swelling settles. These operations are performed at specialist centres.
Accurate restoration of the hip joint surface giving the best chance of a good long-term outcome. Approximately 70-80% of patients with anatomic reduction achieve a satisfactory result.
Common after acetabular surgery.
Unwanted bone formation around the hip. Preventive medication or radiotherapy may be used.
Significant. Transfusion usually required.
These are major injuries with six to twelve month recovery.
The sciatic nerve is at risk, particularly with posterior approaches. Occurs in approximately 5% and usually recovers.
Despite good reduction, arthritis may develop. Up to 20% of patients eventually require hip replacement.
Loss of blood supply to the femoral head.
High risk with pelvic surgery.
Deep infection.
The fracture may not be perfectly reduced despite best efforts.
General anaesthesia. Significant blood loss requires transfusion capability. Cell salvage may be used.
Non-weight-bearing or partial weight-bearing for six to twelve weeks. DVT prophylaxis for several weeks. Physiotherapy for hip range of motion and strengthening. Return to desk work at six to eight weeks. Full recovery six to twelve months. Long-term monitoring for arthritis.
Regular X-rays at six weeks, three months, six months, and one year. Long-term surveillance for arthritis.
Approximately 20% of patients with acetabular fractures eventually require hip replacement, even after good surgical reduction. The risk depends on the original cartilage damage.
Acetabular surgery is technically demanding and requires specialist training and equipment. Outcomes are better at high-volume centres.