Complex Trauma

Complex Trauma

Pelvic - Acetabular Trauma

Pelvic-acetabular fractures are often very complicated and are usually caused by a road traffic accident. To treat these fractures, sometimes more than one surgery might be necessary. In patients suffering from osteoporosis, even a fall might cause this fracture.

Many bones make up the pelvis which, other than supporting the upper body, also protects the intestines and bladder. When one of the pelvic bones suffers a break, it is called a pelvic fracture. The joining point of the pelvis with the femur is called the acetabulum, which is a ball and socket joint. When the fracture is in the socket, it is called an acetabular fracture. An acetabular fracture is difficult to treat because of its position close to major organs and important blood vessels.

During surgery, the bones are positioned properly and then held by screws and plates, etc. Pain and complications after surgery will be treated by the surgeon and his team. The patient will be encouraged to not remain immobile as immobility may lead to complications. If many nerves are damaged, recovery may take from 6 months to more than a year.

Intraarticular & Comminuted Fractures

When a fracture occurs across a joint, it is called an intraarticular fracture. Such fractures are very complex as they involve bones inside the joints unlike fractures involving only bones that are relatively simpler to treat. The condition could be made more complex by bone fragments, which will slow down healing. Mostly caused by road traffic accidents, these fractures usually affect the wrist, the elbow, the shoulder, the hip, the knee and the ankle. The patient will experience immediate pain, inflammation and inability to move the affected part. Treatment starts with immobilizing the injured area. The surgeon will decide on open surgery or an arthroscopic procedure. During surgery, the bones will be repositioned and held in place by screws, wires, etc. The doctor will guide the patient on post-operative care and rehabilitation.

A comminuted fracture is one in which the bone has been broken at three or more places. It is further classified as open and closed. In an open comminuted fracture, the skin is cut, while in a closed comminuted fracture there is no visible injury to the skin. Sustained as a result of an accident or bad fall, diagnosis involves x-ray, CT, MRI, etc. Surgery involves repositioning the bones and holding them in place with rods, plates and screws, etc. Following surgery, immobilization with casts and pain management with medications will begin. In some cases, traction might also be needed. For an open fracture, the doctor will also take care to clean the wound to prevent infection.

Osteotomies and Realignment Surgeries for Malunion Fractures

A malunion happens when a fracture heals but with bones positioned improperly. The symptoms of a malunion are pain, rigidity of the part, limited movement, and in some cases the bone looks visibly deformed. It is necessary to treat a malunion as a failure to do so may cause arthritis, instability, and ultimately loss in functionality. Diagnosed with imaging tests, a malunion can be corrected through surgery. A procedure called osteotomy is done to realign the bone. During surgery, depending on individual conditions, the surgeon may shorten the bone and reposition it or may use a graft to fix the malunion. Surgery will be followed by physiotherapy to increase range of movement of affected part. This surgery can restore functionality of affected part and also prevent deterioration in bone health.

Bone Grafting & Revision Surgeries for Fracture Non-Unions

In normal circumstances, after surgery, the bones will heal with time and new tissue will form and reconnect. In some cases, however, even when a surgical procedure is carried out successfully, the fracture might not mend/join. This condition is called a non-union. The reasons for non-union vary from diabetes and hypothyroidism to lack of healthy food and old age. Another possible cause is the lack of blood supply needed for the fracture to heal.

The doctor may suggest a bone graft to treat a non-union. The graft could be taken from another part of the patient’s body. When the graft is introduced, it launches new bone cells and chemicals needed for healing to take place. Sometimes, a bone graft can be taken from a cadaver too. In such cases, surgeons are extra careful to prevent infections from occurring. In addition to a bone graft, metal plates and screws will be used to hold the bones in place.

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