Fractures of bones about the hip and pelvis

The pelvis is the biggest bone within the human body. In fact, it is formed from two symmetrical bones which are linked by a cartilage, the symphysis pubis. Each one of these “hemi-pelvises” is built up of three bones which consolidate at the age of 12 – 14 years: the ilium, the ischium and the pubis.

The pelvis is the mechanical link between the spinal column and the lower limbs. The articulation to the spine is called the sacro-iliac joint and the articulation to the thigh is called the hip joint.

Although fractures in this region are exceptional in children, they are common fractures in the elderly, mainly due to osteoporosis. The severity of these fractures goes together with displacement of the fragments which causes harm to the soft tissues, blood vessels, nerves etc.

Complex pelvic fractures are life-threatening conditions which need immediate surgical care.

These fractures do not involve the joint surface, or cartilage, of the hip joint. Hip fractures are very frequent and represent an important socio-economic factor in view of our ever-increasing elderly population.

Depending on the localization of the fracture, the hip joint is either replaced by prosthetic implants or the fracture is fixed and splinted by an osteosynthetic device.

The ever present aim in fracture care remains fast recovery of the ability of the injured to walk.

If a fracture involves a joint, the joint surface and its cartilage layer may be displaced, producing a step.

If this is the case, the joint will not work properly anymore (even after the fracture has healed!) and it is quite likely that the joint will degenerate prematurely, becoming painful and impairing function.

In the pelvis, fractures which involve the hip joint are called acetabular fractures. The acetabulum is the “cup” which accomodates the upper extremity of the bone of the thigh: the femur. As acetabular fractures per se do not require immediate surgical care, they are best repositioned anatomically and fixed operatively to allow early mobilization of the joint and walking.

In the femur, fractures which involve the hip joint surface (femoral head fractures) are rare. These fractures are difficult to treat and sometimes have a poor prognosis due to the disturbed blood supply of the femoral head.

It is better to light a lamp than to curse the darkness (Lao Tseu)