The hip joint is a ball-and-socket joint where the upper end (head) of the thigh bone (femur) joins with the socket (acetabulum) of the pelvis. It allows for motion and gives the stability needed to bear body weight.
The hip is the area located on each side of the pelvis. The pelvis bone is made up of 3 sections:
- Ilium- The broad, flaring portion of the pelvis.
- Pubis- The lower, rear part of the pelvis.
- Ischium- One of the bones that helps form the hip
The hip is one of the most stable joints in the body. As it bears your body weight, it is more likely to develop arthritis because of the extra pressure. Pain in the hip may be caused by injury to muscles, tendons, or the small fluid-filled sacs (bursae) that cushion and lubricate joints.
WHAT IS A PELVIC FRACTURE?
The pelvis is the sturdy ring of bones located at the base of the spine. The pelvis mainly consists of the ilium, pubis and ischium bones which are held together by tough ligaments
Fractures of the pelvis are uncommon—accounting for only about 3% of all adult fractures. There are 2 types of fractures:
- Stable fracture
There is only one break point in the pelvic ring with limited bleeding. Bones are staying in place.
- Unstable fracture
There are two or more breaks in the pelvic ring with moderate to severe bleeding. Bones do not line up correctly.
WHAT ARE THE SYMPTOMS OF A PELVIC FRACTURE?
A pelvic fracture has the following symptoms:
- Abdominal pain that increases with movement of the hip or attempting to walk
- Numbness or tingling in the groin or legs
- Swelling or bruising in the hip area
- Difficulty urinating
- Inability to stand or walk
WHAT ARE THE CAUSES AND RISK FACTORS OF A PELVIC FRACTURE?
Common causes of a pelvic fracture include:
- High impact force/trauma such as a motor vehicle collision and falling from a significant height.
- Bone structure- people with weaker or lesser bones in their body have higher risk of a pelvic fracture, such as osteoporosis in older people where a simple fall can result in a fracture.
A piece of the ischium bone may tear away where the hamstring muscles connect with the bone. This is known as an avulsion fracture, and is most common among children and teenagers who do sports as they are still growing.
WHAT IS THE DIAGNOSIS OF A PELVIC FRACTURE?
A history of the injury and a physical examination of the pelvis, hips and legs will be conducted by the Doctor.
Imaging tests may be taken. An x-ray will allow the doctor to see the pelvic fracture in detail, and for more complicated cases a CT scan will be taken as well. Rarely, an MRI scan may also be ordered to help the doctor discover a fracture that cannot be captured using an x-ray or CT scan.
WHAT ARE THE TREATMENT OPTIONS FOR A PELVIC FRACTURE?
Depending on the extent of the fracture, nonsurgical and surgical options are considered. If you have sustained a stable fracture, nonsurgical treatment is sufficient. This includes:
- Anti-inflammatory medications
- Walking aids such as a walker or crutches
If your fracture is an unstable fracture, surgery will be required. Surgery involves putting the pelvic bones back together and hold them in place with the following:
- Metal pins or screws (External Fixation)
Small incisions are made and your doctor will insert metal pins or screws into the bones. Carbon fiber bars then get attached to these pins or screws on the outside the skin. This external fixator helps to hold the broken bones in proper position, acting as a stabilizing frame
In some cases, an external fixator is used to stabilize the bones until healing is complete. In patients who are unable to tolerate a lengthy, more complicated procedure, an external fixator may be used as a temporary treatment until another procedure can be performed.
- Metal pins and weights (Skeletal Traction)
Metal pins are inserted into the thighbone or shinbone to help position the leg. Weights will then be attached to the pins to gently pull on the leg, ensuring the broken bone fragments remain in as normal a position as possible.
- Plates and screws (Open Reduction and Internal Fixation)
Displaced bone pieces will be reduced into their original positions. These pieces are then held together with metal plates and screws attached to the outer surface of the bone.
WHAT IS THE RECOVERY PROCESS AFTER A PELVIC FRACTURE SURGERY?
The recovery process depends on the severity of the fracture.
Medications will be prescribed to help with managing the pain. This includes NSAIDs, acetaminophen and local anaesthetics. An anticoagulant or blood thinner may be prescribed as well to reduce the risk of blood clotting in the deep veins of your pelvis and legs.
Walking is recommended as early as possible, and the patient should perform some foot and leg exercises. Do expect to be using a walker or crutches for some time. Physiotherapy is also recommended to help you restore muscle strength, decrease stiffness and restore mobility in your leg. As your slowly recover from your injury and regain muscle strength, you will be able to put on more weight on your leg, which is usually around 3 months after the surgery.