An acetabular fracture is a break or fracture of the hip socket portion of the pelvis (the acetabulum), where the femoral head (ball of the hip) fits into the socket. These fractures often result from high-energy trauma - car accidents, falls from height - but in older patients with weaker bones (osteoporosis), even a lower-impact event, like a trip and fall, may cause one.The normal hip is a “ball and socket” type joint. The ball is called the femoral head, and the socket is called the acetabulum. The regular movement of the hip depends upon the two surfaces fitting precisely together. The two surfaces are coated with cartilage, a low-friction surface that is smoother than even the best artificial surfaces. 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.
Because the acetabulum holds the femoral head in place and supports weight bearing, these fractures can have serious implications for joint stability, cartilage surface integrity, and long-term hip health. Untreated or poorly aligned fractures often lead to post-traumatic arthritis, ongoing pain, and functional limitation. 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 happens when the femoral head is forcefully driven into the acetabulum. Sometimes the hip dislocates when the acetabulum fractures. These injuries generally occur as a 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. 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.
Surgery is most often needed for acetabular fractures when:
The fracture is displaced (bone fragments are out of alignment) or unstable.
The hip joint surface (socket) is involved or cartilage damage is present.
A hip dislocation has occurred or is associated with the fracture.
The patient is otherwise medically stable and safely able to undergo surgery.
The goal is to restore normal anatomy, preserve hip motion and joint function, and prevent long-term complications.
In some cases, especially in older patients or those with medical comorbidities, non-surgical management may be considered if surgery risks are too high and the fracture is stable.
Open Reduction & Internal Fixation (ORIF) is the main surgical method for acetabular fractures. The steps often include:
Detailed imaging (X-rays, CT, MRI) to assess the fracture pattern, displacement, labrum damage, cartilage damage, and associated injuries.
Planning the surgical approach(es): front (anterior), back (posterior), combined, or extensile approach depending on fracture location.
Reduction: realigning of the broken bone fragments.
Stabilization using plates, screws, and possibly bone grafts if needed.
Repair of any soft tissue / cartilage damage if possible when present.
Some fractures may benefit from a surgical hip dislocation or specialized exposure to allow full visualization for reconstruction. In some cases, an acute total hip replacement may be beneficial.
Recovery depends heavily on the severity of the fracture, the type of surgical repair, and patient health. General phases:
Hospital stay: Usually several days post-op in the hospital, depending on complexity, pain, early mobility goals.
Early rehab (first 2 or 3 months): Limited weight bearing on the operated side (30 lbs), pain and swelling management, gentle motion, perhaps using crutches or walker.
Intermediate rehab (2 - 6 months ): Gradual increase of weight bearing, more aggressive physical therapy, restoring range of motion, strengthening surrounding muscles.
Late rehab (6+ months): Continued strengthening, gait training, functional retraining, and transition to everyday activities.
Long-term recovery: Possible return to higher demand activities depending on healing, anatomy, and surgeon’s evaluation. Some residual stiffness or pain may persist, especially if cartilage was damaged or fracture was severe. Delayed hip replacement once the fracture is healed is sometimes performed.
Surgery on acetabular fractures is demanding and carries risks. Some include:
Infection, bleeding, blood clot formation (DVT/PE)
Vascular (blood vessel) or nerve injury, especially sciatic nerve or others depending on surgical approach
Malalignment or imperfect reduction leading to arthritis
Avascular necrosis (bone death) of part of the femoral head if blood supply is disrupted
Stiffness, joint contracture, heterotopic ossification
Additional surgeries such as hardware removal or hip replacement
Board-certified hip and orthopedic surgeon with specialized training and experience managing hip problems including acetabular and pelvic trauma.
Access to advanced imaging and surgical planning tools right in Chicago to assess fracture patterns and plan optimal reconstruction.
Collaboration with multidisciplinary teams (trauma, vascular, rehab) for comprehensive care.
Personalized approach balancing anatomical restoration, minimizing complications, and focusing on functional recovery.
Serving not just Chicago, but patients from surrounding metro and regional areas seeking experienced contemporary hip and pelvis surgical care.
If you’ve been diagnosed with an acetabular fracture or suspect a hip socket injury in Chicago or nearby areas, schedule a consultation with Dr. Williams. He will review your imaging, explain surgical vs non-surgical options, set realistic recovery expectations, and guide you toward treatment that restores stability, preserves the joint, and helps return you to mobility.
If your doctor suggests hip treatment, seek a second opinion and explore the best option.
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