Acetabular Fractures

What is an acetabular fracture?

An acetabular fracture is a break in your hip socket. Your hip is a “ball-and-socket” joint. Your acetabulum, which is part of your pelvis, forms the socket. Your femoral head, which is the upper end of your femur (thigh bone), forms the ball. The ball-and-socket joint allows movement between your thigh bone and your pelvis. This joint is what lets you walk.

An acetabular fracture can cause a significant loss of motion and function. Acetabular fractures are much less common than most hip fractures. Most hip fractures are in the upper femur or femoral head.

What are the different types of acetabular fractures?

Acetabular fractures can occur on your left or right. Your acetabulum can break in different places and in different ways called patterns. These patterns are based on location, orientation or in a combination. Acetabular fractures include:

• Anterior wall fractures: An anterior wall acetabular fracture is a break in the front column of bone or area around the bony rim (wall) of your hip socket.
• Posterior wall fractures: A posterior wall acetabular fracture is a break in the back column of bone or area around the bony rim (wall) of your hip socket.
• Transverse fractures: A transverse acetabular fracture means your acetabulum broke at a 90-degree angle or perpendicular to the long part of your bone.
• Comminuted fractures: A comminuted acetabular fracture means your acetabulum broke into more than two fragments.
• Stress fractures: An acetabular stress fracture is a small crack in your acetabulum bone. This type of fracture happens because of overuse or repeated stress put on your acetabulum bone.

How is the severity of an acetabular fracture determined?

Sometimes an acetabulum breaks straight across and other times it shatters into pieces. The severity of your fracture depends on the following factors:

• Number and size of bone fragments.
• How much each fragment is out of place.
• Injury to your cartilage.
• Injury to muscle, tendons, nerves and skin around your hip.

Open or compound fractures (when bone fragments stick out of the skin) are particularly severe because infection can occur in both the bone and the wound.

Knowing the pattern and severity of your fracture can help your healthcare provider determine the correct treatment for you.

The bones of your pelvis, including your acetabulum, are very strong. It would take a strong force to break them. Acetabular fractures most commonly occur due to high-energy injuries. These injuries include car and motorcycle accidents and falls from significant heights. Acetabular fractures occur due to weakened bones, too. Some older people with osteoporosis get acetabular fractures after simple falls.

What are the symptoms of an acetabular fracture?

An acetabulum fracture causes severe hip pain. The pain is sometimes worsened with movement. If you’ve damaged any nerves, you may feel numbness or a tingling sensation down your leg. You may also feel weakness in your leg.

How is an acetabular fracture diagnosed?

Your healthcare provider will examine your pelvis, hips and legs. They may:

• Ask you to move your ankles and toes, checking for nerve damage.
• Examine you for other injuries, depending on the cause of your injury.

Your healthcare provider may also request the following imaging tests:

• X-ray: An X-ray can show which bones in your hip are broken and if the bone fragments are in place.
• Computed tomography (CT) scan: A CT scan can show the severity of your injury by producing a cross-sectional image of your hip.

What is the treatment for an acetabular fracture?

Treatment for an acetabular fracture depends on the pattern of fracture and severity of your injury. If your fracture is stable and the bones are in place, surgery may not be necessary. Your healthcare provider may recommend:

• Crutches or a walker: Until your bones are fully healed, you won’t be able to put any weight on your leg. You may be on crutches or a walker for up to 12 weeks.
• Leg-positioning device: Your healthcare provider may want to restrict the positioning of your hip. You may use an abduction pillow or knee immobilizer to keep your hip in place.
• Pain relievers: Your healthcare provider may prescribe a medication to help with the pain.
• Anti-coagulants (blood thinners): Your healthcare provider may prescribe blood thinners to reduce the risk of blood clots forming in the veins of your legs.
• A surgeon needs to repair most acetabular fractures with surgery. Depending on the pattern and severity of your injury, your surgeon may perform:
• Open reduction and internal fixation (ORIF): With an ORIF, your surgeon puts the bone fragments back in place. A surgical anchor holds the fragments together until the bone heals.
• Total hip replacement: If your acetabulum is weak or too damaged to repair, your surgeon may perform a total hip replacement. With a total hip replacement, your surgeon removes the damaged hip and cartilage and replaces them with artificial parts.

What are the complications of an acetabular fracture?

An acetabular fracture can cause difficult complications. These include:

• Posttraumatic arthritis: Cartilage covers your acetabulum bone. When you injure your acetabulum, you also injure the cartilage around it. When your cartilage becomes uneven, it can lead to wear and tear in the joint. This can cause arthritis.
• Avascular necrosis or osteonecrosis: Acetabular fractures can interrupt the blood supply to your acetabulum bone. Without the correct blood supply, your bone cells die. This can make your bone collapse.
• Infection: Infections can occur around the site of your incision or deep within your wound. Deep infections usually require surgery to clean the wound.
• Blood clots: Since you won’t be able to walk right away after surgery, the normal amount of blood flow in your legs will lessen. This increases your chance of blood clots.
• Sciatic nerve injury: Your sciatic nerve passes near the back of your hip socket. Your fracture or the surgery to repair it can cause injury to your sciatic nerve. This injury is called “foot drop,” a condition where you can’t lift your ankle or toes off the floor while walking.
• Heterotopic ossification: This is a condition where bone grows in the muscles, tendons and ligaments around your hip socket.

What can I expect of the recovery process with an acetabular fracture?

After surgery, you’ll experience pain. Your healthcare provider can prescribe a medication to help with the pain. These medications may include non-steroidal anti-inflammatory drugs (NSAIDs) or local anesthetics.

When you start walking again, you may have to use crutches or a walker. You may be able to put partial weight on your leg after six to eight weeks. You won’t be able to put full weight on your leg for a few months. You may have to continue using your walking aid.

Your healthcare provider may recommend early physical therapy to begin moving your hip again. Exercise can help build strength and endurance in your hip. Over time, your healthcare provider may allow additional low-impact exercises such as swimming or riding a stationary bike. You won’t be able to engage in more physical activity for six to 12 months.

What is life like after an acetabular fracture?

Your outcome will depend on the pattern and severity of your injury, as well as other factors such as your age and medical history. Long-term complications are a concern after an acetabular fracture. Arthritis in your hip is of particular concern because of the cartilage surrounding your hip socket. While some people return to normal functioning, many people don’t return to the same level of activity they participated in before.

How long does it take for an acetabular fracture to heal?

It takes eight to 12 weeks for an acetabular fracture to heal. The outcome varies depending on the severity of the fracture, type of fracture, any other injuries sustained, your age, health history and smoking status. (Smoking can hinder the healing process and also increases your risk for complications.)

Can an acetabular fracture heal on its own?

If your fracture is stable and the bones are in place, surgery may not be necessary. However, you will still need non-surgical treatment from a healthcare provider. This may include recommendations for walking aids, positioning aids and medications.

How long is acetabulum surgery?

Surgical time varies by the severity of the fracture and may range from two to six hours.

A note from Cleveland Clinic

An acetabular fracture is a painful injury usually caused by a high-impact accident, but it sometimes occurs due to weakened bones caused by osteoporosis. If you have an acetabular fracture, you should see your healthcare provider right away. Acetabular fractures usually require surgery to repair. Acetabular fractures are severe injuries, and they also come with a likelihood of complications. Talk to your healthcare provider about the best treatment and recovery plan for you. In time, you may be able to get back to the activities you enjoyed before your injury.