(Disclaimer: This article is for general use only, and the information in the following content has been processed to protect patient privacy)
Abstract: This patient, a 25-year-old young man, presented to our department after a basketball game with lower back pain and limited movement of one hip joint. Through examination, the patient was diagnosed with acetabular fracture, and conservative treatment was given. Through bed rest, oral medication to reduce swelling and pain, traction and physiotherapy for the affected limb, the patient recovered the function of the hip joint and the pain disappeared.
Basic information】Male, 25 years old
Disease Type】Acetabular fracture
Hospital】Hunan Provincial Brain Hospital
Date of consultation】May 2021
Treatment plan】Bed rest + oral medication (flurbiprofen extended-release tablets, mai zhi ling tablets) + physical therapy (traction of the affected limb, electroacupuncture, shock wave, low frequency wave)
Treatment period】1 month of inpatient treatment, regular outpatient follow up
Effectiveness】Recovery of hip joint function and relief of pain symptoms
I. Initial consultation
The patient was 25 years old, a college student with a fat body. He reported that he did not stand firmly when he landed after playing basketball in the morning, and landed on one foot, and when he landed, he felt a flash on his left side of the waist, and felt a sensation like holding air in his left hip. After resting at noon, he felt obvious pain in his left lower back and had obvious pain when walking. Since the school was going to hold a basketball game soon, he was very anxious and came to our department.
We examined the patient and found that there was no pressure pain along the spinous process of the lumbar spine, and the mobility of the lumbar spine was normal, but the flexion and extension activities of the left hip joint were limited, and the internal and external rotation and abduction activities were limited, and the four-letter test was positive. The patient’s pelvic X-ray examination showed a discontinuous shadow at the posterior edge of the left hip, which was considered to be an acetabular fracture, and further 3D CT examination of the left hip was performed.
II. Treatment process
The patient was only 25 years old, and the acetabular fracture was caused by excessive weight-bearing on the acetabulum during the landing movement, resulting in a violent injury to the hip joint. We examined the patient’s hip joint, including pelvic X-ray and pelvic CT, and found fracture signs on the posterior edge of the acetabulum, but the fracture fragment was not significantly displaced. After considering all the circumstances, we recommended the patient to undergo conservative treatment by bed rest, applying flurbiprofen extended-release tablets for pain relief, and giving oral Mizarin tablets to reduce swelling, and local physical therapy such as electroacupuncture, shock wave and low frequency wave to promote fracture healing, and traction on the affected limb for 2 weeks, to which the patient agreed.
III. Treatment effect
After a series of treatments, including limb traction, medication to reduce swelling and pain, and prohibition of weight-bearing on the affected limb, the patient was treated. After 1 month of conservative treatment, the patient’s hip pain was significantly relieved, and he was able to turn over in bed properly.
Two months after discharge, the patient came to the follow-up clinic and reported that the hip pain had been completely relieved and the function of the hip joint had improved significantly.
IV. Notes
We are glad that after conservative treatment, the patient’s acetabular fracture healed and did not affect the function of the hip joint, but the patient still needs to pay attention to the following points in daily life.
1. after the patient is discharged from the hospital, he should appropriately perform quadriceps contraction exercise and ankle pump exercise to promote blood return and prevent deep vein thrombosis.
2. After complete recovery, patients should pay attention to sufficient warm-up in exercise to move the muscles around the open joints. Since the patient is fat, it is better to land on both feet at the same time when landing to reduce the unilateral load stress. In addition, when unexplained pain occurs after exercise, it is best to rest in place and not to rush into activities to prevent secondary injuries.
V. Personal insight
In clinical practice, patients with acetabular fractures mostly present with limited movement of the hip joint accompanied by significant pain, but because such fractures are not common sports medicine disorders in young patients, patients often do not notice that there is a problem in the first place. In addition, because of the proximity of the injury site to the lower back, this patient is often mistakenly thought to have flashed his back and only comes to the doctor when he does not get relief after resting on his own, which is exactly what happened to this patient. Fortunately, however, there was no significant displacement in this patient, so conservative treatment was sufficient.
In young patients with symptoms of acetabular fracture, acute lumbar muscle strains need to be identified. Acute lumbar muscle strains have significant pressure pain at the lumbar muscle stops and limited lumbar movement. Promoting fracture rehabilitation has a very important role in this patient’s recovery, and we always encourage the patient to strengthen the static exercise of the muscles around the knee to prevent stiffness of the joint.