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The Complex Fracture: Figuring Out What's Broken
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| Clif Turen's experience with complicated pelvic fractures has helped him reduce mobility problems and pain in patients like Sarah Ben. |
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Sarah Ben was driving in College Park, Maryland one day last August when she was hit broadside by another car at an intersection. Not only did the 21-year-old college student suffer serious head injuries that caused seizures, but her hip and pelvis were shattered. It seemed unlikely that she would walk normally or without pain again.
Then Clif Turen, M.D., a Hopkins orthopaedic surgeon who specializes in treating trauma to the pelvis from accidents like Ben's, was asked to evaluate her injuries. What he saw in her X-rays astounded him. She had a serious two-column fracture of her acetabulum -- the most complex of complex fractures. In most fractures of this hip socket, some part of the joint is still attached to the pelvis, which surgeons use to begin rebuilding. But in two-column fractures, the socket is disconnected, free-floating fragments of bone. Ben's fracture was one of the worst Turen had seen.
Turen knew he had to operate fast as the pelvis tends to heal quickly, making it difficult to move fragments from connective tissue and muscle -- and reducing the chances for a successful surgery. He also had to choose an approach that would expose as much of the pelvis as possible to see what imaging didn't reveal. In these fractures, he explains, the challenge is determining the damage: "The hard part isn't knowing how to get to the pelvis, but figuring out what's broken."
In Ben's case, Turen got a good view of the wreckage, and it was extensive. He began what would be five hours of painstaking work in which he pieced and screwed the fragments together as he visualized how the reset pieces would work in a moving hip. The surgeon, Turen explains, must constantly think about the relationship of the hip ball and socket as it sits within the pelvis, which is more complex than the mechanism of joints like the knee or ankle: "And we also have to anticipate how work on one side of the pelvis will affect function on the other side of the pelvis. You're working very much on indirect maneuvers in strange territory, and you don't have that same control as you do operating on other joints."
Throughout the procedure the goal is to eliminate or reduce any friction between the bones. If the surgeon leaves any boney bends or ridges, the patient's risk of painful, post-traumatic arthritis -- and another operation -- increases. Under the hands of Turen, Ben came through well.
"I'm walking fine, and I don't have any pain at all," she reports. "I get a little more tired, but that's about it." |
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