Q. Why should I have the surgery ?
A. If your surgeon recommends surgery it is because you have a displaced fracture and there is an incongruity in the acetabulum. Normally the acetabulum is a smooth cup, congruent with the femoral head, allowing for frictionless motion of the femoral head. If the fracture heals in the displaced position and there is a "step off" then the cartilage on the femoral head will wear away causing posttraumatic arthritis. This is painful, can be very debilitating, and possibly may lead to a hip fusion or total hip replacement. The goal of the surgery is to:
- Restore the normal shape of the acetabulum
- Decrease pain and allow for early ambulatory function
- Decrease the chance of post-traumatic arthritis
- Delay or avoid the necessity for a total hip replacement
Q. How long will I be in The Hospital for Special Surgery ?
A. The typical inpatient stay for acetabular fracture surgery is 7-10 days.
Q. Will I have a brace or cast after surgery ?
A. No. The fracture is reduced and stabilized internally with plates and screws.
Q. Will I have a limp after the surgery ?
A. Most patients that undergo aggressive rehabilitation to restore muscle strength and flexibility do not have an abnormal gait.
Q. When do my sutures or staples come out ?
A. The patient returns to the surgeon for a post-operative check-up after Ten to fourteen days of surgery. At this time, the wound is examined and the sutures or staples are removed. The patient may shower or bathe after they are removed.
Q. Do I have to go to a rehabilitation facility after my stay at The Hospital for Special Surgery ?
A. No. Most of our patients do return home after their surgery. Physical therapy in the hospital insures that each patient is independent on a walker or crutches and is able to manage stairs. However, there are certain situations where a patient prefers to go to a rehabilitation facility post-operatively and this can be worked out in the hospital with the trauma social worker.
Q. When can I return to work ?
A. Typically patients, with these injuries who do manual labor are on temporary disability for 6-9 months following surgery. Those individuals that have jobs that are physically less demanding, ie. Desk jobs return to work much earlier (some even after a few weeks). However, each case is evaluated on an individual basis.
Q. How much pain will I be in after surgery ?
A. Pain is very subjective, however, at HSS, a complaint of pain is taken very seriously and every effort is made to adequately control the pain. Most patients do go home with oral medication.
Q. How long do I need to go to physical therapy ?
A. Strengthening and flexibility exercises are very important components of the rehabilitative process. Most of the exercises necessary to increase strength such as running on the treadmill and or using the stationary bicycle do not commence until full weight bearing at 8 weeks. Most patients will continue with physical therapy for 6-12 months after surgery.
Q. How long will I be under the care of my surgeon ?
A. Initially you will see your surgeon every couple of weeks and have conventional radiographs. At about 6 months you will return approximately every 3 months for x-rays followed by annual check-ups. Additional visits are unnecessary unless a problem arises.
Q. Is there any medication I can take or anything I can do to expedite the healing process ?
A. No. A fractured bone typically takes 8 weeks to heal. There is no medication to speed up the healing. A healthy diet and adequate sleep are always recommended. Of note, smoking has been known to delay healing and sometimes arrest healing all together.
Q. My family member was brought to the hospital today with a fracture of the acetabulum, but we were told that surgery to repair the broken bone won't take place for at least a week even though she doesn't have other injuries. Shouldn't she be treated right away?
A. This delay will actually protect your relative. A fracture of the acetabulum is accompanied by a significant amount of bleeding. Over the course of the next 3-5 days bleeding will stop with the help of the body's own clotting mechanisms. Only after this happens is it safe to proceed with surgery.
Q.I will be undergoing repeat surgery for a pelvic fracture that happened 3 years ago. What are my chances for improved function and good recovery?
A. Unfortunately, there's no precise answer to this question. The success of the surgery depends on the potential for improving the alignment of the broken bones, your overall health, and ability to adhere to a rehabilitative program. While it is always easier to get good results with an initial repair of a fracture, previous surgery does not necessarily mean that you will not experience significant improvement.
Q. Why is it sometimes necessary to have more than one operation to fix a pelvic fracture? Can't the surgeon fix everything at once ?
A. In many cases, the surgeon must approach the pelvic bones from different directions in order to complete the repair. Each of these approaches can require a separate surgery.
Q. I understand that I will have to start taking a blood-thinning drug before undergoing surgery for an acetabular fracture. Will that put me at greater risk for excessive bleeding ?
A. Your physician has prescribed this medication for you to guard against the development of a blood clot in the veins of your pelvis, thighs or lower legs. Should such a clot develop and travel to your lungs, it can interfere with breathing and pose a significant danger. You will be taking a very low dose of this medication and will be watched carefully to ensure that no excess bleeding occurs.
Q.My grandmother broke her acetabulum after a simple fall in her home. How could this happen ?
A. Your grandmother probably has osteoporosis, a condition in which the bone density decreases and the bones become more fragile and likely to break on impact. If she has not been assessed for this condition before, her physician will certainly do so and recommend a course of treatment to help prevent future fractures.