Fractured Pelvis

Pelvic fractures can be classified as either :-

• stable (the pelvic ring is intact)

Stable fractures can involve other bony areas of the pelvis such as the ischial tuberosity, ramus and iliac without affecting the pelvic ring.

• unstable where the pelvic ring is disrupted and
• Unstable fractures which do involve the pelvic ring can result in a number of complications:
• Injury to major nerves
• Damage to internal organs including the intestines, bladder and urethra
• Serious haemorrhaging if nearby major blood vessels are damaged

• A history of a road traffic accident or fall from a height
• You may be in a state of shock due to the large amount of blood loss (hypovolaemic shock)
• Severe abdominal pain
• Cold and clammy skin
• Inability to walk
• Sweating
• A raised heart rate
• Injuries and/or fractures to other areas

This depends on the type and severity of the fracture. There are a range of treatment options including:

• Conservative (non surgical) treatment for stable fractures includes bed rest to allow healing, physiotherapy, traction (a device used to realign the broken bones) and pain control modalities
• Unstable fractures need to be treated surgically. Most are treated by open reduction internal fixation (ORIF) which realigns the broken bones and metal screws, plates or pins are then used to hold the bones in the correct position.
  
  External fixators (a metal device outside the body) may be used if the unstable fracture is in a number of areas (comminuted)

 Stable fractures can be treated conservatively (non surgical)

Treatment options at this point will include:

• Static (isometric) exercises to strengthen the surrounding hip muscles including gluteal, hamstring and quadriceps muscles
• Range of movement exercises at other joints including knee, ankle and foot
• Maintaining upper limb activity.
• Soft tissue techniques such as massage and frictions on muscles that may be tight due to bed rest.
• Hydrotherapy to increase range of movement and reduce any muscle spasm.

After 4-6 weeks you should be able to gradually return to weight-bearing activities including walking and stair climbing with the appropriate walking aid to suit you (e.g. crutches, zimmer frame)

Unstable fractures are treated with one of the surgical procedures listed above and physiotherapy rehabilitation will take a lot longer due to the severity of the injury. 

Initial phase  physiotherapy programme may include the following:

• Cyrotherapy and elevation exercises
• Simple range of movement exercises in all unaffected joints
• Strengthening exercises for surrounding muscles
• Gentle massage on tight muscles
• Pain modalities

After 3 weeks -7 weeks

• Gradual strengthening
• range of movement exercises around the pelvic area
• Partial weight bearing and gait (walking) re-education in parallel bars for support
• Upper limb strengthening and cardiovascular activity
• Continuing with soft tissue techniques such as tissue release
• Pain and swelling control
• Progress to stair climbing if appropriate