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Pelvic acetabular fractures may not be obvious candidates for rapid recovery surgery – but this is how it went!

Some months ago – one of our founding surgeons at Ballarat OSM had the misfortune of a bicycle crash – sustaining an acetabular fracture. The is the pelvic side of the hip joint, the fracture was comminuted, but effectively undisplaced. Surgery was not required fortunately, but the injury is severe none the less. There were three goals of care: rapid recovery, a lack of long term sequele, and a biking event in the Italian Alps, in only 3 months!

Mr Shaun English and Mr David Mitchell on their recent cycling trip


Rapid recovery concepts are to understand what is biologically possible, then having the right rehabilitation plan, and medication plan to allow. Rapid recovery includes the concept of cognitive function – so our approach minimised the use of Narcotics. Anti-inflammatories are key – Mobic 7.5mg twice daily does not affect bone healing, Paracetamol is a useful background. If Narcotics are to be used – slow acting is essential – and the Norspan (buprenorphone) patches again do the trick. 5ug/hour is equivalent to 0.5mg morphine/hr, or four Endone tablets in a day. The problem with Endone though is highs and lows of dosage, and disrupted sleep. Patient independence and having the ability to take something extra is again a key concept – Tramal 50mg-100mg as necessary achieves top up analgesia, and through its serotonergic effects – other psychological improvements in the recovery from injury. We are cognisant of other corollaries of injury – constipation, peptic ucleration have historically been a problem – we address these too.

So – what did it look like for our intrepid orthopaedic surgeon? Four weeks off work, on crutches. Then back onto the bike trainer – just spinning to start with. At six weeks – ramp up the amount of weight placed through the broken pelvis – partial weight bearing. At eight weeks – on the road bike (although needed to be carried to the coffee shop), at ten weeks discard the crutches. At twelve weeks – riding in Italy. At 13 weeks – competed in the Coppi Fausto Gran Fondo – 120km, 2500m of climbing.