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Fraktur Acetabular- Penyebab, Gejala dan Pengobatan

Ringkasan

Kita panggul joint is a ball and socket joint. The ball refers to the head of the femur (the thighbone) and the socket refers to the acetabular notch, part of the hip bone. The term acetabular fracture is used for fractures in the socket of the hip joint.  

Acetabular fractures are much less common than the fractures of the ball of the femur or other femoral fractures. According to some sources, only 10% of the total pelvic fractures are comprised of acetabular fractures. In this article, we will discuss some causes, treatments, and complications associated with acetabular fractures. 

Ilmu urai

Itu panggul sendi adalah sendi besar dan signifikan dari tubuh kita. Ini membantu menstabilkan tubuh kita dan mentransmisikan berat badan ke kaki. Seperti disebutkan di atas, ini adalah sambungan tipe bola dan soket. Acetabulum membentuk soket dan femur (kepala) membentuk bola. 

The bones making the joint are covered by a smooth and slippery articular cartilage that works to reduce the friction between the ball and socket. The joint’s stability or strength comes from the strong ligaments that attach one bone to the other. A lot of our important organs, vessels, and nerves are in close proximity to the pelvic bones and these viscera can get damaged due to an acetabular fracture.  

BodyParts3D dibuat oleh DBCLS, CC BY-SA 2.1 JP https://creativecommons.org/licenses/by-sa/2.1/jp/deed.en, melalui Wikimedia Commons

Tanda dan gejala

Gejala fraktur acetabular bervariasi tergantung pada tingkat keparahan fraktur. Dalam beberapa kasus, hanya ada retakan kecil di acetabulum, dan dalam kasus parah lainnya, acetabulum mungkin pecah menjadi beberapa bagian. Seperti setiap patah tulang lainnya di tubuh kita, gejalanya meliputi: 

  • Nyeri – this could be severe pain that gets aggravated more with movement. At times even a slight movement is impossible to perform due to the immense pain caused by fractures. 
  • Mati rasa atau kesemutan – if a nearby nerve gets damaged due to fractures, bones compressing or stretching the nerve leads to weakness or numbness in the area that the nerve is supplying.

Penyebab dan Faktor Risiko

Fraktur acetabular terjadi ketika kepala femur memberikan kekuatan yang sangat besar pada soket, akhirnya memecahkan soket. Tabrakan otomatis (tabrakan mobil) adalah sumber utama gaya ini. Lutut Anda mengenai dasbor atau roda kemudi selama kecelakaan dapat memberi tekanan pada acetabulum Anda melalui kepala femoralis. Hal ini juga dapat disebabkan oleh jatuh langsung pada sisi pinggul Anda, memaksa kepala tulang paha ke dalam soket mematahkannya. 

Atlet yang bermain olahraga kontak juga dapat mengalami patah tulang jenis ini, terutama atlet yang bermain rugby, sepak bola, dan senam Australia. Beberapa faktor risiko termasuk: 

  • Usia – elderly people have weakened bones and ligaments that can reduce the pressure resisting capacity of these bones, causing them to fracture more easily.  
  • kurang gizi – lacking a good diet, especially lack of calcium and vitamin D can cause you to have weaker bones.
  • Penyakit yang mendasari – disorders that cause weakening of the bones i.e., hyperparathyroidism, osteomyelitis, osteoporosis, etc. can increase the risk of you getting an acetabular fracture. 

Diagnosa

Orang dengan fraktur high-impact hampir selalu datang ke rumah sakit dalam keadaan darurat. Setelah menstabilkan rasa sakit Anda, dokter Anda mungkin mengambil riwayat Anda, melakukan pemeriksaan fisik, dan meminta beberapa teknik diagnostik lain untuk memastikan apakah Anda memiliki fraktur acetabular. Teknik diagnostik ini meliputi: 

  • sinar-X – X-rays for acetabular fractures are taken from various angles to asses the severity of the fracture. 
  • CT-scan – it is a commonly ordered scan that provides a more detailed view of the bones in the pelvis and the fractured bones. 
James Heilman, MD, CC BY-SA 3.0 https://creativecommons.org/licenses/by-sa/3.0, melalui Wikimedia Commons

Perlakuan

Perawatan tergantung pada tingkat keparahan dan pola fraktur Anda bersama dengan status kesehatan Anda secara keseluruhan. Ada beberapa pilihan pengobatan yang tersedia untuk fraktur acetabular: 

  • Perawatan non-bedaht – these include therapies that are non-invasive and mostly conservative. This type of treatment includes walking aids like crutches, positioning aids like knee immobilizers, bed rest along with medications like NSAIDs (non-steroidal anti-inflammatory drugs) which help to reduce swelling and pain 
  • Perawatan bedah – this is the most opted treatment for acetabular fractures. The cartilage around the acetabulum is oftentimes torn which needs to be fixed to avoid complications. During surgery, bones are fixed (joined together if broken into pieces) and aligned into their proper positions. Surgery is also needed if there is a severed vessel that is causing an internal hemorrhage (bleeding) due to the fracture. Your doctor might put metal plates in your joint to keep it fixed until you recover.  
  • Total hip replacement – in cases of severe damage, the acetabulum cannot be fixed. In these cases, total hip replacement surgery is advised. In this procedure, the damaged acetabulum and associated cartilage is removed and replaced by artificial bone and cartilage 

Dr.CJThakkar, CC BY-SA 4.0 https://creativecommons.org/licenses/by-sa/4.0, melalui Wikimedia Commons

Komplikasi

Fraktur acetabular dan perawatannya terkadang dapat menyebabkan komplikasi yang bermasalah. Beberapa komplikasi tersebut adalah: 

  • Cedera saraf siatik – saraf siatik terletak di belakang panggul sendi dan jika cedera parah dan meluas dapat merusak saraf siatik yang menyebabkan kelemahan dan bahkan kelumpuhan paha dan kaki otot 
  • Post-traumatic arthritis – acetabular fractures often damage the smooth surface of the articular cartilage around the acetabulum, and this can cause joint pain and swelling even after successful treatment 
  • Perdarahan internal – if an artery is cut due to the fracture, internal bleeding can cause a lot of damage and even shock if not treated properly. In some cases of hip replacement surgeries, the femoral artery (artery in your thigh) gets lacerated (cut) leading to high amounts of blood loss which can be fatal.  
  • Infeksi – if bacteria enter the body during surgery or through the wound it can lead to infection and even sepsis (an infection spread in the bloodstream) 
  • Nekrosis avaskular – femoral head necrosis (tissue death) is a common complication of hip fractures. It can be associated with acetabular fractures too. It occurs due to blocked blood supply to the femoral head (ball) by arterial damage leading to necrosis of the head of the femur 

Pencegahan

Anda dapat mencegah patah tulang acetabular dengan: 

  • Mengenakan sabuk pengaman dan mengemudi dengan aman 
  • Tempatkan tangga Anda dengan hati-hati saat Anda menaiki tangga 
  • Miliki diet seimbang yang sehat dengan banyak kalsium dan vitamin D 
  • Exercise regularly – this can strengthen your ligaments and joints. This can reduce the severity of fractures 

Kapan harus ke Dokter

If you get into an accident or experience a high-impact fall on your legs resulting in severe pain, you need to get medical treatment right away. Along with the pain, you might experience swelling which might be increasing with time. Your doctor will treat you for the pain first and then manage the fractures you had.  

Your recovery period depends on the severity of the injury you had. In case of minor fractures, you would be advised to rest for some time and then start doing light movements. However, in case of severe fractures, you would need to take bed rest for a longer period of time and along with other therapies. Most of the people recover fully and enjoy a healthy life. 

Referensi

Disumbangkan dan/atau Diperbarui olehJeffrey M. Smith, MD, Robert P. Dunbar, MD,Jason A. Lowe, MD, Jason D. Provus, MD 

· Fraktur Acetabular oleh OrthoInfo - https://orthoinfo.aaos.org/en/diseases–conditions/acetabular-fractures/

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