One of the most common wheelchair injuries is acetabular fractures. Today we will find out what this part of the hip joint is, as well as what methods of treating dysplasia or other problems of this place exist. We will also find out where the acetabulum is located and what complications sclerosis or a fracture of this depression can lead to.
What is the hip joint?
He is the most powerful and largest in the human body. In addition to such functions as flexion and extension, abduction of the hips back, forward, to the sides, rotational movements, it also participates during body tilts.
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 depression called the acetabulum. The hip joint is deeper than the shoulder joint. Both of its elements are covered with cartilaginous tissue, which is able to absorb loads, smooth out movements when walking, running, while 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 from the inside with cartilage. Doctors distinguish the posterior and anterior walls of the acetabulum, as well as its fornix. Given that this part of the pelvic bone provides human movement, it is very important to detect pathology in this area in a timely manner and quickly treat it.
The acetabulum is formed by the pubic, ischium and ilium bones at their junction.
Fracture
Most often, such a violation of the integrity of the bone occurs as a result of an accident. Also, this injury can occur after falling from a great height.
Acetabular fracture can be divided into 2 types:
- Simple damage. These are fractures of the anterior column, posterior and middle wall, transverse injuries.
- Complex damage. This is when the fracture line passes through several parts of the bone at once. This includes injuries to the anterior wall, transverse wall, both columns, etc.
Symptoms of a fracture can be:
- Pain in the groin and hip area.
- It is difficult for the patient to lean on the injured leg.
- A distinct manifestation of shortening of the limb, which is bent at the hip and knee joints. Leg rotated outward.
Fracture treatment
- If the violation of the integrity of the bone occurred without displacement, then a standard splint is applied to the patient, as well asspecial adhesive plaster traction 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, the hip is dislocated, then the treatment is carried out by skeletal traction. The specialist holds the pin for the epicondyle of the femur. Thanks to this manipulation, the joint capsule is stretched, and the fragments of the acetabulum are pressed, that is, compared. Traction duration is typically 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 the injury, no later. To fix the fragments of the cavity, surgeons use plates and lag screws.
After the treatment of a 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 place of damage.
There are many types of fractures in this recess, and, of course, each type has its own access method. The following techniques are mainly used:
- Anterior access.
- Ilioinguinal tract.
- Rear access.
Front path
In another way, it is also called "ofemoral road". It is used for open reduction of all fractures of the anterior column and the wall of the recess called the acetabulum. Still frontthe path can also be used in the surgical treatment of transverse fractures.
Ilio-inguinal access
It is used to open the anterior and inner surface of the acetabulum. It can also be used for simultaneous fixation of a fracture of the deepening and rupture of the sacroiliac joint. However, this access method does not allow the technician to control the posterior column and cavity wall.
Back way
It is used for open reduction and osteosynthesis, if there is damage to the acetabulum of the posterior wall after the elimination of the posterior hip dislocation. Also, this method is used to remove cartilage from the joint cavity.
Therapy for fracture of the posterior margin of the cavity
There is such a pathological transformation during an accident or a fall from a height. Mostly young people are affected by this trauma. The fracture is accompanied by displacement of fragments, dislocations of the bone, destruction of the articular surfaces, cartilage. The edge of the acetabulum of the anterior section is observed in isolated cases. Most episodes show posterior column fractures.
In a hospital environment, a specialist examines the victim using a plain radiography of the pelvis. On an emergency basis, under epidural anesthesia or intravenous anesthesia, the doctor sets the dislocation. After that, the final diagnosis of joint damage is carried out, including radiography in the iliac, panoramic, oblique projection, as well as computed tomography. Such research methods help the specialist to get a complete picture of the damage to suchdepressions like an acetabulum.
In this case, only surgery will help put a person on his feet. The doctor makes an incision along the line where the fragment is localized. Next, the doctor fixes it with a screw or acceptable compression. Checks the stability of the fixation of the fragment, and then sutures the wound.
Recovery
When the acetabulum of the pelvic bone was resuscitated after a violation of its integrity, it is very important to observe the following rehabilitation rules:
- Practice special breathing exercises daily.
- Learn to walk properly on crutches, step on your feet.
- Perform 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 based on a bent he althy lower limb and two hands.
Osteoarthritis of the hip joint
A sign of such a disease is sclerosis of the acetabulum, which is observed only on x-rays. This term is often used in describing images taken by radiologists.
This problem develops due to inflammatory changes in the bones with overgrowth of connective tissue.
Acetabular sclerosis is a condition in which there are no external symptoms of the disease - arthrosis. This problem is typical for the elderly. The main causes of sclerosis of the cavity are:
- Thinning cartilage.
- Violationblood supply to the legs in diseases associated with metabolism.
- Hereditary predisposition to arthrosis, osteochondrosis.
- Dislocations while walking.
- Sedentary lifestyle.
- Congenital malformations of the joints.
- Injuries during sports activities with damage to the ligamentous apparatus.
- Fractures inside the joints.
- Obesity.
Treatment of arthrosis of the hip joint, sclerosis
Therapy includes:
- Massage.
- Exercises (spreading bent legs in the supine position).
- Physiotherapy (ozocerite, magnetotherapy).
- Taking special baths with radon, hydrogen sulfide.
- Treatment of the problem with nonsteroidal anti-inflammatory drugs "Diclofenac", "Nimesulide" and others.
Also, you should limit the lifting of weights, 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 disease is called "acetabular dysplasia". And this pathology received such a name as Otto's disease by the name of the author who first described it back in 1824. This is a congenital ailment that occurs exclusively in women. The problem is manifested by limitation of 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 cavity dysplasia, an examination is necessary:
- X-ray of the hip joint innecessary projections.
- MRI.
- Ultrasound.
Acetabulum: treatment of Otto's disease
Therapy consists of surgery, which may include:
- Closed reduction of dislocation.
- Chiari corrective surgery.
- Open reduction of dislocation.
- Skeletal traction.
- Hip arthroplasty.
Additional treatments are also used:
- A special kind of swaddling.
- Physiotherapy exercises, gymnastics.
- Massage.
- Medical treatment.
Fracture with complications
Displacement of the acetabulum 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 violated. With posterior dislocations, the greater trochanter moves forward. If the dislocation is central, then the trochanter plunges deep. To understand that a fracture is displaced, it is necessary to take an x-ray in two projections, since the problem can be both in the anterior and posterior directions.
Complication symptoms:
- Active foot movements are sharply limited.
- The affected lower limb is in a vicious position.
Treatment in this case is as follows:
- Application of the skeletal traction system. The needle is held behind the supracondylar region of the thigh with a pull of 4 kg.
- Leg is laid in flexion positionand adduction in the hip and knee joints.
- To determine the head in the desired position, experts carry out traction along the axis of the neck using a loop or skeletal traction with an initial load of 4 kg.
- After reduction, the weights are transferred to skeletal traction, leaving the original weight along the axis of the neck.
- The leg is abducted to a 95-degree angle for 1 week.
Duration of traction is 8 to 10 weeks. After another 2 weeks, movements in the joint are allowed. Full load on the leg is allowed only after six months. And the ability to work is restored after 7 months.
Coxarthrosis
This is a dystrophic disease that affects elderly and middle-aged people. The disease develops gradually, over several years.
Signs of coxarthrosis are:
- Abnormal relationship between the femoral head and glenoid cavity.
- The medial quadrant of the glans is on the side.
- The roof of the acetabulum tile-like hangs over the fossa, resembling a beak.
- The length of the pit and the roof is broken.
- The cortical layer in the roof of the depression is thickened.
Coxarthrosis is accompanied by pain and limited movement in the joint.
In the 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. He shows updue to other ailments.
The latter type of disease can be the result of problems such as:
- Congenital dislocation of the hip.
- Hip Dysplasia.
- Aseptic necrosis of the femoral head.
- Arthritis of the hip joint.
- Perthes disease.
- Past trauma (fracture of the femoral neck, pelvis, dislocations).
The course of coxarthrosis is progressive. If you start treatment at an early stage, then you can get by with conservative therapy. At a later stage, only surgery will become an effective method.
Treatment of coxarthrosis
Orthopedists deal with 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 (drugs such as Arteparon, Rumalon, Chondroitin, Structum.)
- Vasoconstrictor drugs (Trental, Cinnarizine).
- Medications to relax muscles.
- Intra-articular injections using hormonal agents, such as Kenalog, Hydrocortisone.
- Using warming ointments.
- Passing physiotherapeutic procedures (laser, phototherapy, 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 replaceddestroyed joint by endoprosthesis. The operation is performed under general anesthesia in a planned manner. The stitches are removed on the 10th day, after which the patient is sent for outpatient treatment. Rehabilitation measures after the operation are a necessity. In almost 100% of cases, joint replacement surgery provides complete restoration of the function of the injured leg. At the same time, a person can continue to work, actively move and even play sports. He can wear a prosthesis for up to 20 years, subject to all the recommendations of the doctor. After the expiration of this long period, a second operation is necessary to replace the already worn endoprosthesis.
Complications of acetabular fracture
Problems, by the way, are rare, but still people should know about them. Postoperative complications include:
- Sepsis.
- Festering wounds.
- Thromboembolism.
- Nerve damage.
- Aseptic necrosis of the femoral head or wall of the acetabulum.
- Paralysis of the gluteus minimus and medius.
To prevent such complications, many doctors immediately offer their patients arthroplasty.
Conclusion
In case of displacement, fracture of such a deepening as the acetabulum, early diagnosis is very important, including X-ray, ultrasound, MRI. Based on these studies, the doctor must choose the appropriate method of treatment: either strictly conservative or aggressive - surgery. It is also very important after therapy andrehabilitation period, because in the complex of measures taken, a person will get back on his feet faster.
