Overview

The normal hip is a “ball and socket” type joint. The ball is called the femoral head, the socket is called the acetabulum. The normal movement of the hip depends upon the two surfaces fitting precisely together. The two surfaces are coated with cartilage which is a very low friction surface that is smoother than even the best man made surfaces. 

When a fracture of the hip joint occurs, it commonly involves the femur or ball side of the joint. If forces are severe enough, the fracture may injure the socket. This occurs when the femoral head is forcefully driven into the acetabulum. Sometimes the hip dislocates when the acetabulum fractures. These injuries generally occur as the result of high energy injuries, such as a fall from a ladder, automobile or motorcycle accidents, bicycle crashes, and other forceful injuries of the hip joint. 

High energy injuries of the hip are commonly associated with other injures and problems. The fractured bony surfaces and surrounding injured soft tissues lead to internal bleeding. Major blood vessels may be lacerated or torn. The sharp fractured surfaces can damage the bowel or bladder. The nerves that provide sensation and motor function to the leg and foot can be injured. In some instances the nerves that control bowel and bladder function or sexual function can be impacted by the trauma as well. 

The result of these fractures is disruption of the smooth, congruent surface of the acetabular bone. Stepoffs or gaps in the position of the bones create an irregular surface which prevents smooth gliding of the hip joint. If the bone heals with these irregularities, damage of the cartilage and painful arthritis of the hip is predictable. This usually results in severe functional limitations and significant pain. 

For the majority of patients, surgery is required to restore hip function. The goal of surgery is accurate reconstruction of the fractured bone and cartilage surfaces. The fractured/broken pieces of the acetabulum are precisely placed back into position and secured with screws and/or plates. This reconstruction restores the smooth surface of the acetabulum and its accurate fit to the femoral head. 

In the majority of cases, arthritis can be prevented and there is normal or near normal hip function after the surgery. Prior to surgery, patients undergo a comprehensive evaluation of their overall medical stability. This data is essential to the surgeon, medical specialists, anesthesiologist and other members of the health care team. X-rays and CT (computed tomography) scans enable the surgeon to determine the fracture characteristics and to plan the surgery. For best results, surgery should take place within two weeks from injury. The potential for difficulties and complications increases after three weeks. A small percentage of fractures are eligible for hip replacement in addition to, or instead of, fracture repair surgery. 

The incision(s) are directed by the type of fracture. The operation itself takes between two and six hours. A blood transfusion may be necessary during or after surgery. Mechanical and pharmeceutical measures are prescribed during the hospitalization and after surgery to decrease the chance of blood clots.