3. Fracture - the separation of an object or
material into two or more pieces under
the action of stress.
Pelvis – three bones make up each side
of the pelvis. (ilium, ishium, and pubis).
They are connected to the sacrum by
ligaments.
4. Growing teens involved with sports have a
higher risk for a pelvic fracture.
› Undetected avulsion fractures of the pelvis are
many times mistaken for many “pulled muscles.”
› Most often this fracture will occur with sudden
muscle contractions.
› The muscles will tear away a small piece of bone
from the ischium where the hamstring muscles
attach
* This type of fracture does not make the
pelvis unstable or injure internal organs
5. Elderly people with
osteoporosis.
› May fracture pelvis during a fall.
These injuries do not usually
damage the structural integrity
of the pelvic ring, but may
fracture an individual bone.
6. High- energy forces – what most
fractures involve
› MVA
› Crush accident
› Falls
Surgical treatment may need to be
done, depending on the direction and
degree of the forces
Injuries can possibly be life-threatening.
11. E-stim
› EMS
› HVPC
› NMES
› TENS
Thermotherapy
Rom and stretching
Exercises-GS, LAQ,
Ab sets, SLR
Balance,
Coordination and
agility
Relaxation
12. Stable vs. non-stable
Gait
Subsequent Problems
› Pain
› Impaired mobility
› Sexual dysfunction
13. 1. "Google Images." Google. Web. 24 Nov. 2010.
<http://www.google.com/imghp?hl=en&tab=wi>.
2. "Fracture." Wikipedia, the Free
Encyclopedia. Web. 24 Nov. 2010.
<http://en.wikipedia.org/wiki/Fracture>.
3. "Fracture of the Pelvis." AAOS - Your Orthopaedic Connection.
American Academy of Orthopaedic Surgeons, Sept. 2007.
Web. 24 Nov. 2010.
<http://orthoinfo.aaos.org/topic.cfm?topic=a00223>.
4. Moffat, Marilyn, Andrew Guccione, and Jayne Snyder.
"Impairments/ Fracture." Guide to Physical Therapist Practice.
Second ed. Alexandria, Virginia: American Physical Therapy
Association, 2001. S233-248. Print.
Editor's Notes
Today we are going to talk about some definitions, causes, symptoms, diagnosis, treatment plans and interventions, along with the outcomes of a pelvis fracture.
*A fracture is the separation of an object or material into two or more pieces which is caused by stress on those objects.
*The pelvis is made up of three bones on each side that are formed together. The ilium, the ishium, and the pubis. These connect to the sacrum bone by ligaments, which are strong connective tissues.
* Through the pelvis runs many important structures such as nerves and internal organs which may be effected by a pelvis fractures.
One of the main causes of pelvis fractures happen in growing teens. Teens who are involved with sports are at a higher risk for pelvis fractures. This type of fracture is caused by an undetected avulsion (a- vul-tion) fracture, which is a fracture that takes place where a tendon or ligament is attached to the bone. This is usually mistaken for many pulled muscles, but is actually a small piece of bone that is torn away from the ischium where the hamstring muscles is attached. This fracture does not injure the internal organs or make the pelvis unstable.
Elderly people are also at risk, especially those with osteoporosis. Take caution when going down steps and getting out of the bathtub as this will help prevent falls from happening.
These injuries do not usually damage the structural integrity of the pelvic ring, but they may fracture an individual bone.
Most fractures involve a high-energy force; such as a Motor Vehicle Accident, a crush accident, or falls.
Surgical treatment may need to be done if these injuries are life-threatening. It depends on the direction and degree of the forces.
These injuries can possibly be life-threatening.
Some symptoms that are seen with a pelvis fracture include pain, swelling and bruising. If a high-energy injury has occurred there is a possibility of other injuries to the head, chest, abdomen and legs that also cause pain. With this there may be significant bleeding which may lead the patient to go into shock.
Body positioning is also a sign of a pelvis fracture. The patient may flex the hip or knee in a certain way in order to decrease the aggravating pain.
Fractures of the pelvis are determined by using x-rays. Multiple x-rays are taken at different angles to show how much the bone has moved out of place.
A CT scan might also be used to see if there are any other injuries in the pelvis such as the internal organs. It can also show how bad these injuries are.
The blood vessels and nerves which go to the legs are also examined to see if any damage has occurred during the injury.
With a nonsurgical treatment, the fracture is considered stable. The patient should not fully weight bear on both or even one of his or her legs for up to 3 months so the bones can properly heal. In some cases it may take longer. The patient will need to use crutches or a walker for ambulation.
Pain medications will be prescribed to the patient to reduce the pain. Blood thinner medication will be prescribed to decrease the risk of a blood clot that may form in the legs due to lack of mobility.
Surgical treatments for a pelvis fracture take place when there is an unstable fracture. These usually occur when there has been a high- energy traumatic event, such as a car accident, crush accident, or fall like we mentioned earlier. These are considered life-threatening injuries due to the excess amount of bleeding that occurs.
An external fixator may be used in the pelvic area to allow surgeons to address the internal organs, blood vessels and/ or nerves that have been injured. To do this, long screws are inserted into the bones on each side and then connected to a frame on the outside of the body. In the picture you are able to see the long screws and the frame on the hips.
The next step is determined by assessing the fracture individually. Keep in mind all fractures are different. Some of these unstable fractures may need a surgical insertion of plates and screws and some fractures require traction to be done.
Interventions that may be used for a pelvis fracture include electrical stimulation, such as electrical muscle stimulation, high voltage pulsed current, neuromuscular electrical stimulation, or transcutaneous electrical nerve stimulation. Thermotherapy such as dry heat or hot packs.
Passive range of motion exercises along with stretching exercises may be used to help tissues heal and prevent contractures.
Some important exercises to do are glut sets, abdominal sets, long arc quads and short arc quads to help keep muscles tone.
We can also work on Balance, coordination and agility by posture awareness training, neuromuscular education and retraining of motor functions. While the patient is working on exercises make sure they are using the correct breathing and movement strategies along with relaxation techniques so they do not make things worse.
Also make sure to remember your hip precautions: No adduction past midline, no internal rotation, and no hip flexion past 90 degrees.
Outcomes. Pelvis fractures which are stable usually end up healing well. Unfortunately non-stable pelvis fractures do not always end up that way. They can have significant complications due to the internal organ damage and severe bleeding. They are also prone to get infections which would decrease the healing time for the bone itself.
The patient’s gait can be effected for several months, as you notice them limping, this is due to the muscle damage around the pelvis area.
Subsequent problems such as pain and impaired mobility may result after a pelvis fracture because of the associating nerve damage. Organ damage may cause sexual dysfunction as well.
Here are the resources that we used. We hope you’ve enjoyed our presentation, Thank you for listening!
