• Usually caused by force applied to the femur which is translated to the acetabulum.
• In young adults, acetabular fractures are due to high energy injuries, primarily motor vehicle accidents.
• The majority of patients are evaluated for and have associated injuries that require initial evaluation of the multiple trauma patient.
• There are also minority of patients, which are elderly, and suffer relatively minor trauma causing acetabular fractures.

Pathophysiology

• Fractures maybe caused by direct trauma to the bone.
• Disruption of blood vessel in cortex periostrum.
• Soft tissue bleeding from damage end of bone.
• Hematoma formation
• Bone tissue death
• Necrosis
• Stimulation of inflammatory response vasodilation
• Exudation of plasma
• Increase leukocytes and infiltration of wbc

Signs and Symptoms

• Crepitus
• Deformity
• Pain
• Tenderness at the site
• Swelling
• Loss of function
• Discoloration
• Dislocation of bone
• Bleeding from an open wound with protrusion of bone ends.
• Fever
• Dysfunction
• Hematoma on the site
• Abnormal or decrease sensation of the affected extremity
• Change in size
• Moderate or severe edema joint point
• Dyspnea
• Rapid weal pulse
• Mental confusion apprehension due to hypoxia
• Mental aberration before signs of infection
• Metabolic disturbance

Assessment

1. Remove clothing so that entire extremity may be visualized. Cut clothing along seems when necessary.
2. Assess for neurovascular changes distal to fracture.
3. Assess for change in length, shape or alignment.
4. Support joint extremity at all times; including joints above and below the suspected injury.
5. If fracture is impacted the patient may be able to bear weight and walk for a short period of time after the initial injury.
6. History of simple fall.
7. Decrease range of motion.
8. Affected limb shortened abducted and externally rotated.
9. Greater thochanter may be displaced into the buttock.

Complications

1. Pulmonary embolism
2. Fat embolism
3. Gas gangrene
4. Tetanus
5. Loss of bone substance
6. Soft tissue interposed between bone ends.
7. Infection
8. Loss of circulation
9. Interrupted or improper immobilization
10. Inadequate fixation
11. Necrosis due to fixation devices
12. Metabolic disturbance

Nursing Diagnoses

1. Altered health maintenance
2. Risk for infection
3. Risk for injury
4. Impaired skin integrity
5. Impaired tissue integrity
6. Self-care deficit
7. Impaired physical mobility
8. Activity intolerance
9. Anxiety
10. Pain
11. Fear
12. Disturbed body image

Nursing Interventions

1. Assist the patient or significant others to identify self-care deficits.
2. Develop plan with patient for self-care, adapting, and organizing care as necessary.
3. Assist the patient to maintain and manage usual health practices during period of wellness or when progressive illness.
4. Provide for communication and coordination between the healthcare facility team.
5. Monitor lesion or wound daily for changes.
6. Promote good nutrition with increase protein intake to facilitate healing.
7. Encourage adequate period of rest and sleep.
8. Provide devices that aid in comfort or healing.
9. Discuss importance of early detection and reporting of changes in condition or any unusual physical discomforts and changes.
10. Identify required changes in lifestyle.
11. Encourage verbalization of feeling about pain.
12. Provide comfort measure like backrubbing.
13. Encourage patient to do deep breathing exercises during pain.