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Child Orthopedics
Spine - Cervical
Spine - Lumbar
Spine - Thoracic

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What is a comminuted acetabular fracture? That's what my brother just texted me that his wife has. What do they do for that?

To help you understand your brother-in-law's condition, let's define an acetabular fracture. The acetabulum is the socket side of the hip joint. It is made of cartilage over bone just like every other joint. The reason it breaks is because the person falls (and lands) in such a way that the head of the femur (thigh bone) is driven up into the hip socket (acetabulum) with enough force to break bone. When that happens, there can be a single break or fracture line but more often the acetabular bone breaks into many tiny pieces. That type of break is called a comminuted fracture. Older men are affected more often than women by this type of damage. Their femoral bones are thicker, stronger, and transfer a greater destructive force into the acetabulum. Women tend to develop a break in the neck of the femur -- long before there is any force up into the socket. Until recently, this type of fracture was always treated conservatively (without surgery). And many times, this is still the most appropriate treatment. The presence of dementia, poor health, severe bone loss, and nonambulatory status before the fracture are reasons why surgery may not be possible. So long as the fracture isn't displaced (shifted), those patients who could walk before the injury are allowed to walk with the support of a walker. But only minimal weight through the hip is allowed until healing occurs. A physical therapist helps move the hip through its motions but with some limitations to protect it. Bedrest (even for displaced fractures) with tracton was once prescribed. But this is no longer recommended due to the many complications that arise with immobility in this age group (e.g., blood clots, bed sores, pneumonia, deconditioning). For those patients who will have to have surgery, there are several options. A procedure called open reduction and internal fixation (ORIF) pretty much describes what happens. The surgeon makes an incision to open up the hip, lines everything back up as much as possible, and uses plates, screws, pins, and/or wires to hold it all together until it heals. The more closely the hip is restored to its normal shape and configuration, the better the results will be. The more bone fragments and the farther apart the bone fragments separate, the poorer the prognosis. If the patient is not a good candidate for ORIF (or if the ORIF procedure fails), then a total hip replacement may be the next step.


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