Placing full weight on the injured side prior to bone healing can cause the screws or plates which hold the broken bone together to bend or break. During the first eight weeks following surgery, the injured hip should bear no more than a limited weight of 30 pounds. Patients begin physical therapy as soon as possible to improve hip motion and muscle function and to learn to use appropriate assistive devices such as crutches or a walker. Included among the team’s post-surgical priorities are pain management, preventing infection, and the prevention of deep vein thrombosis (blood clots in large veins), and pulmonary embolus (blood clots traveling through veins to the lungs). The same team of medical specialists cares for each patient pre- and post-operatively. The first night after surgery is typically spent in the intensive care unit to facilitate close monitoring and after that, the patient is returned to the normal hospital ward. Patients spend the two hours following surgery in the recovery room where nurses closely monitor them. Patients wear compression boots and anti-embolus stockings to prevent blood clots from forming in the large veins or veins traveling to the lungs. The dressing covering the incision will be checked on a regular basis and changed or removed two to three days after surgery. During surgery, drains will be placed in the surgical site, which will be removed two to three days post-operatively. A device will be utilized during surgery to collect blood lost by the patient and to return it to their circulation. A blood transfusion may be necessary during or after surgery. The operation itself takes between two and five hours, with a blood loss ranging from 250 to 2,000 cc’s. The patient is placed on a special operating table that applies traction to the leg during surgery and assists in reducing the fracture. Extended iliofemoral approach (lateral approach).Ilioinguinal approach (simultaneous access to both anterior & posterior portions of the pelvic ring).Kocher-Langenbeck approach (posterior approach).The potential for difficulties and complications increases after three weeks.ĭepending on the fracture pattern, usually one of the following three surgical approaches will be chosen which will give the best access for reconstruction of the acetabulum: These x-rays enable the surgeon to determine the fracture pattern and precise degree of displacement and to plan the surgical approach.įor best results, surgery should take place between two and seven days of injury. Sophisticated computer software allows the technologist to make cross-sectional CT scans into three-dimensional images. X-rays are also obtained, including 5 standard pelvis views and CT (computed tomography) scans. This data is essential to the surgeon, medical specialists, anesthesiologist and other members of the health care team. Prior to surgery, patients undergo a comprehensive evaluation of their medical stability. This patient has returned to playing American football. This usually results in severe functional limitations, and significant pain.ĪP radiograph 2 years after open reduction internal fixation of posterior column plus posterior wall acetabular fracture in a 39 year old competitive athlete. If the bone heals with these irregularities, damage of the cartilage and painful arthritis of the hip is a predictable result. Stepoffs or gaps in the position of the bones prevent the smooth articulation of the hip joint. The result of these fractures is disruption of the smooth, congruent surface of the acetabular bone. This classification is called the Letournel Classification and is presented below. The fractures generally fall into categories of patterns which were put into a classification system which generally dictates the approach to surgery. In some instances the nerves that control bowel and bladder function or sexual function can be injured by the trauma as well. The nerves that provide sensation and motor function to the leg and foot can be injured. The sharp fractured surfaces can damage the bowel or bladder. Major blood vessels may be lacerated or torn. The fractured bony surfaces and surrounding injured soft tissues lead to internal bleeding. High energy injuries of the hip are commonly associated with other injures and problems. These injuries generally occur as the result of high energy injuries, such as a fall from heights, automobile or motorcycle accidents, bicycle crashes, and other forceful injuries of the hip joint. Sometimes the hip dislocates as the acetabulum fractures. This may occur as the femoral head is forcefully driven into the acetabulum. Rarely if forces are severe enough, the fracture injures the socket. When a fracture of the hip joint occurs, commonly it involves the femur or ball side of the joint.
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