Navigating Pelvic Fracture: Causes, and Treatments, and the Role of Physiotherapy
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on July 3, 2024
Pelvic fractures are serious injuries involving a break in one or more of the bones in the pelvis. These fractures can result from high-energy trauma such as car accidents or falls from significant heights, and in some cases, low-energy trauma in individuals with weakened bones due to conditions like osteoporosis (Koval & Zuckerman, 2016). Understanding pelvic fractures is crucial for effective treatment because they often involve complex anatomical structures and can lead to significant complications, including internal bleeding, organ damage, and mobility issues (Manson et al., 2015).
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Early diagnosis and appropriate management of pelvic fractures are essential to prevent complications and ensure optimal recovery. Proper understanding of these injuries allows healthcare providers to develop effective treatment plans, which may include surgical intervention, rehabilitation, and ongoing care to restore function and mobility (Tile et al., 2003). By staying informed about the mechanisms, symptoms, and treatment options for pelvic fractures, clinicians can improve patient outcomes and enhance the quality of life for those affected by these injuries (Ganz et al., 2003).
What is a pelvic fracture?
Definition of a Pelvic Fracture
A pelvic fracture is a break in one or more of the bones that make up the pelvis. These bones include the ilium, ischium, pubis, and sacrum. Pelvic fractures can range from minor, stable fractures to severe, unstable breaks that may involve multiple bone fragments and extensive damage.
Overview of the Pelvis Structure and Its Function in the Body
The pelvis is a ring-like structure located at the base of the spine. It connects the spine to the lower limbs and supports the weight of the upper body. The pelvis also protects vital organs such as the bladder, intestines, and, in women, reproductive organs. Additionally, it serves as an attachment point for various muscles that assist in movement and stability.
Causes of pelvic fractures
Trauma from accidents: High-energy impacts from car accidents or falls from significant heights are common causes of pelvic fractures. Such traumas can exert substantial force on the pelvis, leading to breaks (Koval & Zuckerman, 2016).
Sports-related injuries: Activities involving high impact, sudden twists, or heavy falls can also cause pelvic fractures. Sports like football, hockey, and rugby are associated with a higher risk of these injuries (Tile et al., 2003).
High-impact activities: Engaging in activities that put excessive stress on the pelvis, such as long-distance running or heavy lifting, can lead to fractures, especially in individuals with weakened bones.
Osteoporosis and other bone-weakening conditions: Conditions that reduce bone density, such as osteoporosis, make bones more susceptible to fractures even from low-energy impacts or minor falls (Ganz et al., 2003).
Signs and symptoms of pelvic fractures
Severe pain in the hip or groin area. Individuals with a pelvic fracture often experience intense pain in the hip or groin region. This pain can be exacerbated by movement or pressure on the affected area.
Difficulty walking or standing. Walking or standing may become difficult or impossible due to the pain and instability caused by the fracture. This can significantly impact mobility and daily activities.
Swelling and bruising in the pelvic region. Swelling and bruising around the pelvis are common signs of a fracture. These symptoms result from the trauma and internal bleeding associated with the injury.
Numbness or tingling in the legs or feet. Nerve damage or compression caused by a pelvic fracture can lead to numbness, tingling, or a "pins and needles" sensation in the legs or feet.
Changes in bladder and bowel functions. A pelvic fracture can affect the organs protected by the pelvis, leading to changes in bladder and bowel functions. This can include difficulty urinating, incontinence, or bowel movement issues.
Prevention of pelvic fractures
1. Safety measures to prevent falls and accidents
Remove tripping hazards at home, such as loose rugs and cluttered walkways.
Install handrails and grab bars in bathrooms and stairways.
Ensure proper lighting both indoors and outdoors.
Use nonslip mats in the bathtub and shower.
2. Proper techniques in sports and physical activities
Learn and practice correct techniques for sports and activities to minimize the risk of falls and collisions.
Use appropriate protective equipment, such as helmets and padding, when engaging in high-risk activities.
3. Bone health maintenance
Ensure an adequate intake of calcium and vitamin D through diet or supplements to maintain strong bones.
Avoid smoking and limit alcohol consumption, as they can weaken bones.
4. Regular exercise to strengthen bones and muscles
Engage in weight-bearing exercises like walking, jogging, or dancing to improve bone density.
Incorporate strength training exercises to build and maintain muscle strength, which supports bone health.
5. Use of protective gear during high-risk activities
Wear seat belts while driving or riding in a vehicle.
Use appropriate safety gear, such as helmets, knee pads, and wrist guards, when cycling, skating, or participating in contact sports.
By following these preventive measures, individuals can reduce the risk of pelvic fractures and maintain overall bone health and safety
Diagnostics of pelvic fractures
Physical examination by a healthcare professional
A thorough physical examination by a healthcare professional is crucial in diagnosing pelvic fractures. The examination may include assessing the pelvic area for tenderness, swelling, and deformities. Additionally, the healthcare provider may check for signs of nerve damage or vascular injury.
Imaging tests (X-rays, CT Scans, MRI)
Imaging tests are commonly used to confirm the diagnosis of a pelvic fracture and assess its severity. X-rays provide detailed images of the bones and can reveal fractures or dislocations. CT scans offer more detailed images and can help determine the extent of the fracture and any associated injuries. MRI scans may be used to evaluate soft tissue damage and nerve involvement.
Detailed patient history and symptom discussion
A detailed patient history is essential in diagnosing pelvic fractures. The healthcare provider will inquire about the circumstances of the injury, the onset of symptoms, and any previous medical conditions that may affect treatment. A discussion of symptoms, such as pain, difficulty walking, or changes in bowel or bladder function, can provide valuable information for diagnosis.
Blood tests to check for underlying conditions
Blood tests may be performed to check for underlying conditions that may affect bone health or healing, such as osteoporosis or infection. These tests can help guide treatment decisions and ensure optimal care for the patient.
Treatment options for pelvic fractures
Initial stabilization and pain management
Immediate treatment for pelvic fractures focuses on stabilizing the patient and managing pain. This may include immobilization with a pelvic binder or traction to realign the bones and reduce pain.
Non-surgical treatments
For stable pelvic fractures, non-surgical treatments such as bed rest, pain medication, and physical therapy may be sufficient. Physical therapy can help improve mobility and strength while reducing the risk of complications such as blood clots and pressure sores.
Surgical interventions
In cases of unstable pelvic fractures or when non-surgical treatments are ineffective, surgery may be necessary. Surgical options include internal fixation with screws, plates, or rods to stabilize the bones and promote healing.
Rehabilitation programs tailored to individual needs
Rehabilitation plays a crucial role in recovery from pelvic fractures. A tailored program may include exercises to improve strength, flexibility, and balance, as well as gait training and functional activities to regain independence.
Physiotherapy for pelvic fractures
Explanation of how physiotherapy helps in recovery
Physiotherapy plays a vital role in the recovery process by promoting healing, reducing pain and inflammation, and restoring function and mobility. Physiotherapists use various techniques to address specific needs and challenges associated with pelvic fractures.
Types of physiotherapy exercises and treatments used
Physiotherapy for pelvic fractures may include passive range of motion exercises, gentle stretching, strengthening exercises for the pelvic floor and surrounding muscles, and modalities such as heat or ice therapy to reduce pain and inflammation.
Benefits of physiotherapy in improving mobility and strength
Physiotherapy can help improve mobility, strength, and balance, which are essential for regaining independence and preventing future injuries. By addressing muscle imbalances and compensatory movements, physiotherapy can also reduce the risk of long-term complications.
Success stories or case studies demonstrating physiotherapy’s effectiveness
Numerous success stories and case studies highlight the effectiveness of physiotherapy in helping patients recover from pelvic fractures. These stories often emphasize the importance of early intervention and the benefits of a comprehensive rehabilitation program tailored to individual needs.
Conclusion
Pelvic fractures can have serious implications for mobility and overall health. It is crucial to recognize the signs and symptoms of pelvic fractures early and seek appropriate treatment to prevent complications and promote optimal recovery.
Prompt recognition and treatment of pelvic fractures can significantly improve outcomes and reduce the risk of long-term complications. If you experience any symptoms suggestive of a pelvic fracture, such as severe pain, difficulty walking, or changes in bladder or bowel function, seek professional help immediately.
At our physiotherapy clinic, we offer specialized care and rehabilitation programs tailored to your individual needs. Our experienced physiotherapists can help you recover from a pelvic fracture, improve your mobility, and regain your quality of life. Contact us today to schedule a consultation and start your journey to recovery.
References:
Ganz, R., Gill, T. J., Gautier, E., Ganz, K., Krügel, N., & Berlemann, U. (2003). Surgical dislocation of the adult hip: a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. The Journal of Bone and Joint Surgery, 83(8), 1119-1124.
Manson, T., O'Toole, R. V., Whitney, A., Duggan, B., Sciadini, M., Nascone, J., & Archdeacon, M. (2015). Young-Burgess classification of pelvic ring fractures: does it predict mortality, transfusion requirements, and non-orthopaedic injuries? Journal of Orthopaedic Trauma, 29(6), 307-312.
Routt, M. L. C., Simonian, P. T., Agnew, S. G., & Mann, F. A. (1997). Radiographic recognition of the sacral alar slope for optimal placement of iliosacral screws: a cadaveric and clinical study. Journal of Orthopaedic Trauma, 11(7), 507-515.
Tile, M., Helfet, D. L., Kellam, J. F., & Vrahas, M. S. (2003). Fractures of the Pelvis and Acetabulum. Lippincott Williams & Wilkins.
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.