Pelvi-acetabulum Surgery

Pelvis and Acetabulum surgeries are orthopedic surgeries performed by doctors at Bone and Joints. The pelvis and acetabulum fractures are one of the most serious and challenging orthopedic injuries to treat. They are caused by traumatic events like vehicular accidents, fall from height or other life threatening accidents. Injuries or fractures in the pelvis and acetabulum demand prompt and proper treatment. The injuries in these areas often require one or more surgeries.

These injuries are often painful and are known for giving rise to serious complications such as hip arthritis, and sacro-iliac joint instability among others. Pelvis and acetabulum injuries can affect people of all ages. Although more common in the younger adult, certain older individuals with osteoporosis who experience lower impact falls might sustain pelvic and/or acetabulum fractures.

Pelvic Fracture Surgery

Pelvis fracture surgery is a surgery conducted on the pelvis region of the human body. Pelvic surgeries are considered one of the most difficult and challenging surgeries among orthopedic treatments. They are less common orthopaedic injuries, making up just around 3% of all adult fractures.

The pelvis is a firm ring made of various bones i.e ilium, ischium and pubic bone. It is located at the base of the spine between the abdomen and the thighs. The bones of the pelvis along with some ligaments and some muscles are responsible for supporting the upper body weight.

Pelvic fractures are brought about by severe, high energy accidents like vehicular accidents and falls from height. Any fractures or injuries in the pelvis demands instant treatments or medical attention as many of the important nerves and organs are located in its vicinity.

Elderly people with frail bones may occasionally be susceptible to a pelvic fracture from a lower-impact incident, such as a fall from standing height. The course of treatment for a pelvic fracture depends on how serious the damage is. While low-energy pelvic fractures can be treated conservatively, surgery is typically required to repair the pelvis and regain stability in a high energy trauma for better patient outcomes.Adults and elderly people with frail bones may occasionally be susceptible to a pelvic fracture from a lower-impact incident, such as a slight fall. The course of treatment for a pelvic fracture depends on how serious the damage is. While low-energy pelvic fractures can be treated conservatively, surgery is typically required to repair the pelvis and regain stability so that patients can continue their normal activities.

Prof. Dr. Shishir Lakhey

Dr. Daman Jha

Common Causes Behind Pelvis Fractures

While fractures and injuries in the pelvis are relatively rare than other bones and joints, it doesn’t mean they cannot happen. The causes are:

High Energy Impact:

Unlike fractures in other bones and joints, which can happen from the smallest of forces, pelvic fractures result from a high energy force impact such as: Vehicular accidents and collision Getting crushed Serious slip or fall from a tall place Carrying heavy load These injuries may be life-threatening and necessitate surgery depending on the direction and intensity of the force.

Insufficiency in Bone

People with weaker bones are prone to pelvic fractures. Older adults whose bones are weakened by osteoporosis are more likely to experience pelvis fractures.

Common Causes Behind Pelvis Fractures

While fractures and injuries in the pelvis are relatively rarer than other bones and joints, it doesn’t mean they cannot happen. The causes are:

High Energy Impact:
Unlike fractures in other bones and joints, which can happen from the smallest of forces, pelvic fractures result from a high energy force/impact such as Motor-vehicle accidents, collision or fall from height. These injuries may be life-threatening and often require surgery.

Insufficiency in Bone:
People with weaker bones are prone to pelvic fractures. Older adults whose bones are weakened by osteoporosis are more likely to experience pelvis fractures.

Rarely, the ischium bone might fracture when the fragment where the hamstring muscles are attached to the bone separates. These avulsion fractures, as they are often known, are most frequently seen in young athletes whose bones are still developing.

What are the Symptoms of Pelvic Fracture?

Symptoms of pelvic fracture can be identified from awful pain in the hip region. The hip movement or trying to walk makes this pain worse. To prevent the discomfort from becoming worse, the patient may frequently strive to maintain a particular position with their hip or knee bent. Some people may get bruising or edema around their hips.

pelvic pain

What are the Treatments for Pelvis Fracture?

Following a number of essential examinations such as clinical and physical examinations and imaging studies (CT scan and MRI scan), orthopedic specialists make the necessary planning required for the treatment. Treatment is usually based on factors such as the pattern of fracture, displacement of bones, and associated injuries.

Orthopedic specialists at Bone and Joints then decide between the two treatment methods for pelvic injuries: non-surgical method and surgical method.

Non Surgical treatment

Orthopedic specialists at Bone and Joints usually recommend nonsurgical treatment methods for pelvic fractures to patients with non-displaced, stable pelvic fractures. Non-displaced stable pelvic fracture includes conditions such as avulsion fractures, isolated sacral fractures, isolated pubic ramus fractures, and a few iliac wing fractures. This treatment method is often offered to treat elderly individuals with insufficient fractures. If non-surgical treatment is chosen for someone, patients must follow up with physical examination and imaging regularly to ensure the fractures remain in the right place and are healing properly.

Stopping unhealthy habits such as smoking is advised by orthopedic specialists as smoking is known to hinder and sometimes stop the bone healing process. Similarly, patients with diabetes should keep good control of their blood sugar levels during the bone healing process. A single fall during the treatment process or a non-compliant patient who doesn’t follow medical advice and starts to walk too soon might also cause the fracture to displace necessitating surgery.

Bearing heavy weight puts pressure on the fractured bones, hampering the healing process. Rest is necessary until the bone union process is well underway and only then will a patient be allowed to walk or bear weight. During the healing period, patients are required to have walking aids like a walker or crutches. These will help in maintaining a good posture and load management at the fracture site.

Pelvis bone can recover without surgery in 3–4 months, depending on the health of the individual and the nature of the fracture. Once the bone has healed sufficiently, physical therapy for the hip and knee range of motion is initiated approximately six weeks after the injury. For six weeks, the majority of patients will be put on a blood thinner to prevent clots.

Surgical Method

The surgical method of treatment for pelvis fractures is recommended for patients with unstable pelvic fractures. It can utilize three different methods of treatment:
External Fixation
Skeletal Traction
Open Reduction and Internal Fixation

1. External Fixation:

Orthopedic surgeons use external fixation to stabilize the pelvic area. During this procedure, through small incisions in the skin, surgeons insert metal pins into the bone. The metal pins protrude out from skin on the both sides of the pelvis, where they are fastened to connecting bars. The external fixator serves as a stabilizing frame to maintain the appropriate alignment of the broken bones.

In certain cases, an external fixator is used just to keep the bones stable until they recover from hemorrhagic shock associated with pelvic fractures. An external fixator may also be used as a temporary treatment in patients who cannot endure a drawn-out, more lengthy operation until another procedure can be done.

2. Skeletal Traction

Skeletal traction is another surgical method of correcting pelvis fracture. Skeletal traction is a pulley system of weight and counterweight that helps to straighten or realign the broken fragments of the pelvis bones. This process is carried out right after an accident and removed following open reduction internal fixation surgery. Sometimes, an acetabulum fracture is treated using just skeletal traction.

During the surgery, metal pins are inserted into the shinbone or thigh bone which assists in positioning the legs. To retain the shattered bone pieces as close to their normal place as possible, weights linked to the pins gently apply sustained traction on the leg. Skeletal traction also offers some pain relief.

Open Reduction and Internal Fixation (ORIF)

Open reduction/Internal fixation (ORIF) is one of the important surgical methods used by orthopedic surgeons to stabilize pelvis and acetabulum fractures.

While conducting an open reduction surgery, surgeons make an incision to get a hold of the broken bones and realign it, fixing the broken bone pieces ("internal fixation") using hardware such as pins, plates, rods, screws, or a combination of these so that the bones can heal well.

What are the complications of Pelvis Fracture Surgery?

While pelvic surgeries conducted by orthopedic surgeons are safe and reliable, we cannot ignore some risks/complications that arise with every kind of surgery. Like every other surgery, surgeons will walk you through all the risks associated with pelvic surgery. Some of the risks that might come with a pelvic fracture are:

Problems healing wounds
Infections
Blood clots in the leg (venous thrombosis)
Pulmonary Embolism (blood clot in the lungs)
Sexual dysfunctions

Recovery following pelvic fracture surgery

The average recovery time for a fractured pelvis bone is 4-6 months. If anatomical alignment is accomplished during surgery and there are no complications at the time of surgery, patients can resume their previous activities and functions. By six weeks, patients feel comparatively at ease. However, patients who undergo pelvic fractures must wait around four months before being allowed to participate in activities like physical work. Early and aggressive activity resumption increases the risk of re-fracture, hardware damage, and non-union of bones, creating the possibility for revision surgery.

Where Can I Get the Best Pelvic Fracture Surgery in Nepal?

If you are looking for a trusted orthopedic specialist, schedule an appointment with a specialist at Bone and Joints today. Bone and Joints offers consultation and treatment of everything related to bones thanks to our group of highly experienced doctors and orthopedic specialists. Contact Bone and Joints today to get the best orthopedic service in Kathmandu Nepal.

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