One of the most frequent injuries that leads a person to a wheelchair is the acetabular fracture. Today we learn what this part of the hip joint represents, and also what methods of therapy of dysplasia or other problems of this place exist. Also find out where the acetabulum is located and what complications can cause sclerosis or fracture of this depression.
What is the hip joint?
He is the most powerful and large in the human body. In addition to such functions as flexing and extension, retraction of the hips back, forward, to the sides, rotational movements, it also participates during the inclinations of the hull.
The characteristics of this joint are unique - they provide about 40% of human movements.
It is formed by the head of the femur, and also by a depression called the acetabulum. The hip joint is deeper than the shoulder joint. Both its elements are covered with cartilaginous tissue, which is capable of absorbing loads, smoothing movements during walking, running, during jumping, etc.
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 prop and movement. Has hemispherical shape, covered from the inside by cartilage. Doctors distinguish the posterior and anterior walls of the acetabulum, as well as its arch. Given that this part of the pelvic bone provides the movement of a person, it is very important to detect pathologies in this area in a timely manner and to quickly carry out treatment.
The acetabulum is formed by the pubic, ischial and iliac bones at the point of their connection.
Most often, such a breach of bone integrity occurs as a result of an accident. This injury can also occur after falling from a high altitude.
Fracture of the acetabulum can be divided into 2 types:
- Simple damage. These are fractures of the anterior column, posterior and middle walls, transverse trauma.
- Complex damage. This is when the fracture line passes right through several parts of the bone. This includes injuries to the front wall, transverse, both columns, etc.
Symptoms of fracture can serve as:
Pain in the groin and hip joint.
- It is difficult for a patient to rely on a damaged leg.
- A distinct manifestation of shortening of the limb, which is bent in the hip and knee joints. The leg is rotated outward.
Treatment of a fracture
- If the breach of the bone integrity occurred without bias, then the patient is imposed a standard tire, as well as a special adhesive tape stretching for the shin for a period of 1 month. Necessarily appoint a course of physical therapy, electrophoresis.
- If the acetabulum of the pelvic bone is broken in the upper and posterior margins, a hip dislocation results, then the treatment is performed by skeletal traction. The specialist holds a spoke for the epicondyle of the femur. Thanks to this manipulation, the capsule of the joint is stretched, and the fragments of the acetabulum are pressed, that is, compared. Duration of traction is usually 1.5 months.
- If the fragment is large and it can not be compared, then an operation is necessary. It should be performed in the first two weeks after the injury, not later. To fix debris fragments, surgeons use plates and tightening screws.
After the treatment of the fracture, the rehabilitation period is very important.
Possible access methods
Operative therapy of fractures of such a depression, as the acetabulum, is a rather difficult task. The fact is that it is very difficult for a specialist to reach the site of damage.
There are many types of fractures of this depression, and, of course, there is an access method for each species. The following methods are mainly used:
In another way, it is also called the "overseas road". It is used for the open repositioning of all fractures of the anterior column and the wall of the indentation called the acetabulum. Still the forward way can be applied and at operative treatment of transverse fractures.
It is used to open the front and inner surfaces of the acetabulum. It can also be used for the simultaneous fixation of the fracture of the indentation and rupture of the sacroiliac joint. However, this method of access does not allow the specialist to control the back column and the wall of the cavity.
It is used for open repositioning and osteosynthesis if there is damage to the acetabulum of the posterior wall after the elimination of posterior hip dislocation. This method is also used to remove cartilage areas from the joint cavity.
Therapy of the fracture of the posterior edge of the cavity
There is such a pathological transformation during an accident or a fall from a height. For the most part, young people are exposed to this trauma. Fracture is accompanied by displacement of fragments, dislocations of bone, destruction of articular surfaces, cartilage. The margin of the acetabulum of the anterior part is observed in isolated cases. In most episodes, fractures of the posterior column are found.
In a hospital setting, a specialist examines the victim using an overview radiograph of the pelvis. In emergency, under epidural anesthesia or intravenous anesthesia, the doctor corrects the dislocation. After this, the final diagnosis of joint damage is carried out, including X-ray in the iliac, oblique, oblique projection, as well as computed tomography. Such research methods help the specialist to get a complete picture of the damage to such a deepening as the acetabulum.
Put the person on their feet in this case will only help surgical intervention. The doctor makes a cut along the line where the fragment is localized. Further, the doctor fixes it with a screw or allowable compression. It checks the stability of fixation of the fragments, and then sutures the wound.
When the acetabulum of the pelvic bone after the breach of its integrity has been reanimated, it is very important to observe the following rules of rehabilitation:
- Daily engage in special breathing exercises.
- Learn to walk properly on crutches, step on your feet.
- Produce 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 with support on a bent healthy lower limb and two arms.
Osteoarthritis of the hip joint
A sign of this disease is sclerosis of the acetabulum, which is observed only on the x-ray. Such a term is often found in the description of photographs taken by radiologists.
This problem develops due to inflammatory changes in bones with the overgrowth of connective tissue.
Sclerosis of the acetabulum is a condition in which external symptoms of the disease - arthrosis - are not observed. This problem is typical for the elderly. The main causes of sclerosis of the cavity are:
- Infringement of blood supply to legs with ailments associated with metabolism.
- Hereditary predisposition to arthrosis, osteochondrosis.
- Dislocations when walking.
- Sedentary lifestyle.
- Congenital malformations of the joints.
- Injuries during sports loads with damage to the ligament apparatus.
- Fractures inside the joints.
Treatment of arthrosis of the hip joint, sclerosis
- Exercises (extending the bent legs in the supine position).
- Physiotherapy (ozocerite, magnetotherapy).
- Adoption of special baths with radon, hydrogen sulphide.
- Treatment of the problem with non-steroidal anti-inflammatory drugs "Diclofenac", "Nimesulide", etc.
Also, you should limit weight lifting, it is forbidden to stay in a sitting position for a long time. Jumping, running is also prohibited.
In another way, this ailment is called "acetabular dysplasia." And this name, like Otto's disease, was obtained by the name of the author who first described it in 1824. It is an innate disease that is observed exclusively in women. The problem is the limitation of movements in the hip joints (lead, reduction, rotation, shortening of the lower limbs). In this case, no pain representatives of the fair sex do not feel.
To confirm the diagnosis of "dysplasia of the cavity" it is necessary to conduct a survey:
Acetabulum: Treatment of Otto's Disease
Therapy consists of surgery, which may include:
- Closed direction of dislocation.
- Corrective operation on Chiari.
Open dislocation of the dislocation.
Additional methods of treatment are also used:
- A special kind of swaddling.
- Physical therapy, gymnastics.
- Treatment with medication.
Fracture with complication
Displacement of the acetabulum can occur when a large object falls onto 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 broken. At rear dislocations, the large spit moves forward. If the dislocation is central, then the spit is plunged into the depths. To understand that a fracture with a displacement, it is necessary to make an x-ray in two projections, since the problem can be both in the forward and backward directions.
- 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 spokes are held over the epicondyle of the thigh with a thrust of 4 kg.
- The leg is placed in the position of flexion and reduction in the hip and knee joints.
- To determine the head in the desired position, specialists extend the axis of the neck using a loop or skeletal traction with an initial load of 4 kg.
- After repositioning the goods are transferred to the skeleton traction with the leaving of the initial weight along the axis of the neck.
- The leg is removed to a 95 degree angle for 1 week.
The duration of the stretching is from 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. A work capacity is restored after 7 months.
This disease is of a dystrophic nature, which affects people of elderly and middle age. The disease develops gradually, for several years.
The signs of coxarthrosis are:
- Pathological relationship between the head of the femur and the joint cavity.
- The medial quadrant of the head is on the side.
- The roof of the acetabulum tiles hanging above the pit, resembling a beak.
- The length of the pit and the roof is broken.
- Cortical layer in the roof of the cavity is thickened.
Coxarthrosis is accompanied by pain and restriction of movements in the joint.
At later stages of the disease, atrophy of the hip muscles is observed.
The causes of this disease are divided into 2 types:
- Primary coxarthrosis. It occurs due to unknown medicine reasons.
- Secondary coxarthrosis. It is found due to other ailments.
The latter type of disease can result from such problems as:
- Congenital dislocation of the hip.
- Hip dysplasia.
- Aseptic necrosis of the femoral head.
- Postponed trauma (fracture of the neck of the hip, pelvis, dislocations).
The course of coxarthrosis is progressive. If you start treatment at an early stage, then you can do with conservative therapy. At a later stage, only surgical intervention will be an effective method.
Treatment of coxarthrosis
Orthopedics treat this disease. The choice of method of treatment depends on the stage of the disease.
1. At the 1 st and 2 nd 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 (such drugs as "Arteparon", "Rumalon", "Chondroitin", "Structum".)
- Vasoconstrictors ("Trental", "Cinnarizine").
- Medications to relax the muscles.
- Intra-articular injections with the use of hormonal means, for example, "Kenalog", "Hydrocortisone".
- Use of warming ointments.
- Passage of physiotherapeutic procedures (laser, light therapy, UHF, magnetotherapy), as well as massages, special gymnastics.
2. At the third stage, the only way to get rid of coxarthrosis is surgery. The patient is replaced by a broken joint with an endoprosthesis. The operation is performed under general anesthesia in a planned manner. Sutures are removed on the 10th day, after which the patient is sent to an outpatient treatment. Rehabilitation after a surgery is a necessity. Almost in 100% of cases, surgery to replace the joint provides a complete restoration of the function of the injured leg. At the same time, a person can work later, actively move and even play sports. He can wear a prosthesis up to 20 years, subject to all the doctor's recommendations. After the expiration of this long period, a re-operation is necessary to replace the worn-out endoprosthesis.
Complications of acetabular fracture
Problems, incidentally, are rare, but still people need to know about them. Postoperative complications include:
- Aseptic necrosis of the femoral head or acetabular wall.
- Paralysis of small and middle gluteus muscles.
To prevent such complications, many doctors immediately offer their patients endoprosthetics.
With the displacement, the fracture of such a deepening as the acetabulum, early diagnostics, including X-ray, ultrasound, MRI, is very important. Based on these studies, the doctor must choose the appropriate method of treatment: either strictly conservative or aggressive - operation. It is also very important after therapy and rehabilitation period, because in the complex of measures produced, a person will quickly rise to his feet.