Acetabular Fixation Surgery Procedure

Acetabular fixation surgery is a specialized orthopedic procedure designed to restore the stability of the hip joint following an injury or fracture to the acetabulum the socket portion of the hip joint. This surgery plays a crucial role in preserving mobility, reducing pain, and preventing long-term complications such as arthritis or joint degeneration. Understanding of the Acetabular Fixation Surgery Procedure.

The hip joint is a ball-and-socket joint formed by the head of the femur (thigh bone) and the acetabulum (part of the pelvic bone). The acetabulum provides a deep, stable socket that supports smooth hip movements and weight-bearing functions.

A fracture in the acetabulum is not only painful but can severely disrupt daily movement and balance. These fractures are often caused by high-impact injuries such as motor vehicle accidents, falls from heights, or trauma in elderly patients with osteoporosis. Acetabular fixation surgery becomes essential when the fracture is displaced, unstable, or involves multiple bone fragments.

When Is Acetabular Fixation Surgery Needed?

While some minor fractures may be treated conservatively, surgical fixation is necessary under certain clinical conditions:

• Displaced fractures :- When bone fragments are out of alignment
  
• Fractures involving the joint surface :- Risk of arthritis increases without realignment.
  
• Associated dislocation of the femoral head :- Requires repositioning and stability.
  
• Impaired mobility or weight-bearing :- Indicating severe instability.
  
• Open or complex fractures :- Needing internal stabilization.
  

In general, early surgical intervention leads to better outcomes by restoring the natural anatomy of the hip and allowing early rehabilitation.

Preoperative Evaluation and Planning

Before surgery, patients undergo a thorough diagnostic assessment:

• X-rays and CT scans to understand the complexity of the fracture.
  
• Blood tests and physical evaluation to assess general fitness for surgery.
  
• Anesthetic risk assessment by the anesthesiology team.
  
• Review of medical history, especially any history of osteoporosis, arthritis, or previous surgeries.
  

Based on this evaluation, the orthopedic surgeon develops a customized surgical plan that includes the approach, type of implants, and anticipated outcomes.

Acetabular Fixation Surgery Procedure: Step-by-Step

1. Anesthesia and Patient Positioning :- The procedure is typically performed under general anesthesia. Patients are positioned based on the fracture type either supine (on the back) or lateral (on the side) to allow optimal surgical access.There are multiple surgical approaches depending on the location of the fracture:
   • Ilioinguinal approach :- Common for anterior wall or column fractures.
   • Kocher-Langenbeck approach :- Often used for posterior wall fractures.
   • Extended surgical approaches :- For complex or combined injuries.

   The surgeon selects the approach that provides maximum visibility and access with minimal muscle disruption.

2. Fracture Exposure and Reduction :- The fractured bone fragments are carefully exposed, and specialized instruments are used to realign the bones. This step is crucial to restore the joint surface and ensure proper healing.Temporary fixation may be done using Kirschner wires or clamps to hold the bones in place before definitive fixation.
3. Internal Fixation :- The realigned bones are secured using metal plates and screws, which are biocompatible and designed to withstand mechanical stress. In some cases, a combination of reconstruction plates, locking screws, and lag screws is used depending on fracture geometry.Modern fixation techniques aim to:
   • Restore joint congruity.
   • Provide immediate stability.
   • Allow early mobilization.
4. Wound Closure and Dressing :- After fixation, the surgical area is thoroughly cleaned, and layers of soft tissue are carefully closed. A sterile dressing is applied, and drainage tubes may be inserted to prevent fluid accumulation.

Postoperative Recovery and Rehabilitation

Recovery after acetabular fixation surgery requires a structured and closely monitored rehabilitation plan.

1. Hospital Stay
   • Most patients remain hospitalized for 3 to 7 days.
   • Pain management is administered through IV medications initially, followed by oral medications.
   • Physical therapy often starts within 48 hours post-surgery to prevent stiffness and deep vein thrombosis (DVT).
2. Rehabilitation PhasesPhase 1: Early Mobilization (Weeks 1–6)
   • Non-weight-bearing activities with walker/crutches.
   • Gentle range-of-motion exercises.
   • Deep breathing and leg elevation to reduce swelling.

   Phase 2: Strength Building (Weeks 6–12)

   • Partial weight-bearing begins as per X-ray confirmation of healing.
   • Strengthening exercises for surrounding muscles.
   • Close supervision by physiotherapists.

   Phase 3: Return to Function (After 3 Months)

   • Full weight-bearing is typically allowed.
   • Gait training and balance exercises.
   • Return to daily activities with minimal discomfort.

Potential Risks and Complications

Like any surgical procedure, acetabular fixation carries certain risks:

• Infection at the surgical site
• Nerve or blood vessel injury
• Blood clots (DVT or pulmonary embolism)
• Hardware-related complications
• Post-traumatic arthritis
• Non-union or malunion of bones

However, with skilled surgical technique, strict aseptic precautions, and adherence to rehabilitation, the likelihood of complications can be significantly minimized.

Long-Term Outlook and Benefits

The primary goal of acetabular fixation surgery is to restore the anatomy and functionality of the hip joint. When performed timely and followed by proper rehabilitation, patients can expect:

• Significant reduction in pain.
• Restoration of mobility.
• Return to normal or near-normal activities.
• Delay or prevention of hip replacement.

For younger patients and active individuals, this surgery can be life-changing, allowing them to return to work, sports, and recreational activities.

Conclusion

Acetabular fixation surgery is a critical orthopedic intervention that offers both structural and functional restoration of the hip joint following complex pelvic fractures. Advances in surgical techniques, imaging, and implants have significantly improved outcomes in recent years.

If you or a loved one has sustained a hip or pelvic fracture, consulting with an experienced orthopedic trauma surgeon is essential. Early diagnosis, precise surgical planning, and disciplined rehabilitation are key to regaining a pain-free, active lifestyle.