A person in a motor vehicle accident can sustain an acetabular fracture, spinal fracture, or both. Acetabular fractures involve fractures to the socket of hip joints in the pelvis. It takes a great deal of automotive force to push the ball of the joint into the acetabulum, fracturing the acetabulum, the head of the femur, or both. Such fractures often need to be healed by surgically replacing the acetabulum so that the ball of the joint rests and rides smoothly within the new acetabulum.
Spinal fractures involve forces that compress the spinal vertebrae or put shear forces on the vertebrae so that the small round vertebrae get crushed or the spinous processes or transverse processes attached to the vertebrae. This can cause pressure on the spinal cord and can result in paralysis at or below the level of the fracture.
Some people have both the acetabulum fractured and the spinal vertebrae fractured. This is certainly uncommon. A recent research study looked at the presence of the two of them together. The study looked retrospectively at 307 acetabular fractures over five years. The information about the patient, the injury demographics, the degree of neurological injury, and the degree of spinal injury were looked at.
They were able to find complete information on 90 percent or 275 patients involved in the study. A total of 55 patients sustained an acetabular fracture and a spinal fracture. In actuality, 54 patients suffered a fracture, and one patient suffered a traumatic disc herniation. This amounted to 13 percent of patients who suffered both a spinal injury and an acetabular fracture. Four percent of the total number of patients sustained a severe thoracolumbar injury, including a burst fracture, a dislocation, or a flexion distraction fracture. Because of the severity of the acetabular fracture, it took an average of 8.6 days to diagnose the spinal aspect of the injury. One of these patients suffered from progressive neurological paralysis during that time.
The researchers suggested that trauma specialists share a high index of suspicion for a spinal injury, especially one to the thoracolumbar area, in those patients who suffer from an acetabular fracture. While the risk of both injuries is 13 percent, these are patients who can suffer from severe neurological sequelae if not picked up at the time the acetabular fracture is picked up. The best way to determine the presence of a spinal injury is to do a CT scan of the thoracolumbar spine along with the pelvic CT scan to rule out the presence of injuries to both areas.
In some cases, the spinal injury will need surgery and may need surgery before the acetabular fracture is fixed. This is so the patient can be moved safely because the spinal injury can cause worsening spinal cord trauma if not repaired and stabilized surgically before handling the acetabular injury. In cases of simultaneous acetabular and spinal injuries, both problems need urgent repair to bring the patient back to a state of healing.