1) Pelvic fractures are potentially life-threatening injuries that are increasing in incidence due to high-velocity trauma. Mortality rates are 10-15% and increase to 50% if the patient is hypotensive on initial presentation.
2) Surgical stabilization is usually indicated for rotationally or vertically unstable fractures (Tile B/C injuries). Non-operative treatment may be appropriate for stable fractures (Tile A) if displacement is minimal.
3) Anterior pelvic ring injuries involving >2.5cm of symphysis displacement are typically treated with open reduction and internal fixation. Posterior injuries are stabilized through approaches to the sacroiliac joint or ilium, using techniques like iliosacral
Sacroiliac(SI) Joint Dysfunction,Evaluation and Treatment Dr.Md.Monsur Rahman
Dr.MD.Monsur Rahman,PT
MPT-Musculoskeletal Disorders
Maharishi Markandeshwar Institute Of Physiotherapy And Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana - Ambala,133-207 (Haryana)
Sacroiliac(SI) Joint Dysfunction,Evaluation and Treatment Dr.Md.Monsur Rahman
Dr.MD.Monsur Rahman,PT
MPT-Musculoskeletal Disorders
Maharishi Markandeshwar Institute Of Physiotherapy And Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana - Ambala,133-207 (Haryana)
This presentation is very beneficial for those who are in the field of prosthetics & orthotics. I have covered the basics of prosthetic foot, its mechanisms & its types. I have mentioned advanced prosthetic foot also. Hope this will help you all.
Student's elbow, or 'Olecranon Bursitis' is a condition where a small sack of tissue over the tip of your elbow becomes inflamed and swollen. The pointy bit of bone at the end of your elbow is called the 'olecranon' and the small sack which sits between the bone and the skin is called a 'bursa'.
Bhaskar Health News and Medical Education is leading source for trustworthy health, medical, science and technology news and information. Providing world health information Medical Education.
Bhaskar Health News and Medical Education is dedicated to medical students, physiotherapists, doctors, nurses, paramedics, physician associates, dentists, pharmacists, midwives and other healthcare professionals.
We're committed to being your source for expert health guidance. Bhaskar Health and Medical Education.
Source : https://www.bhaskarhealth.com
Health Shop: https://www.bhaskarhealth.org
@drrohitbhaskar @bhaskarhealth
#DrRohitBhaskar #BhaskarHealth
#Health #Medical #News #Physiotherapy
Deformities observed with Pes cavus includes :
*clawing of the toes
*posterior hind foot deformity (described as an increased calcaneal angle)
*contracture of the plantar fascia
*cock-up deformity of the great toe
Following References were used to prepare this powerpoint presentation which makes the slides accurate and relaible for studying purpose; Therapeutic Exrercise – Carolyn Kisner
Orthopaedic Physical Assessment – Magee
Orthopaedic Medicine – L. Ombregt
Campbell’s Operative Orthopaedics
Slides includes following headings;
DEFINITION
TYPES
ORTHOPAEDIC ASSESSMENT
MEDICAL MANAGGEMENT
PHYSIOTHERAPY MANAGEMENT
SURGICAL MANAGEMENT
This presentation is very beneficial for those who are in the field of prosthetics & orthotics. I have covered the basics of prosthetic foot, its mechanisms & its types. I have mentioned advanced prosthetic foot also. Hope this will help you all.
Student's elbow, or 'Olecranon Bursitis' is a condition where a small sack of tissue over the tip of your elbow becomes inflamed and swollen. The pointy bit of bone at the end of your elbow is called the 'olecranon' and the small sack which sits between the bone and the skin is called a 'bursa'.
Bhaskar Health News and Medical Education is leading source for trustworthy health, medical, science and technology news and information. Providing world health information Medical Education.
Bhaskar Health News and Medical Education is dedicated to medical students, physiotherapists, doctors, nurses, paramedics, physician associates, dentists, pharmacists, midwives and other healthcare professionals.
We're committed to being your source for expert health guidance. Bhaskar Health and Medical Education.
Source : https://www.bhaskarhealth.com
Health Shop: https://www.bhaskarhealth.org
@drrohitbhaskar @bhaskarhealth
#DrRohitBhaskar #BhaskarHealth
#Health #Medical #News #Physiotherapy
Deformities observed with Pes cavus includes :
*clawing of the toes
*posterior hind foot deformity (described as an increased calcaneal angle)
*contracture of the plantar fascia
*cock-up deformity of the great toe
Following References were used to prepare this powerpoint presentation which makes the slides accurate and relaible for studying purpose; Therapeutic Exrercise – Carolyn Kisner
Orthopaedic Physical Assessment – Magee
Orthopaedic Medicine – L. Ombregt
Campbell’s Operative Orthopaedics
Slides includes following headings;
DEFINITION
TYPES
ORTHOPAEDIC ASSESSMENT
MEDICAL MANAGGEMENT
PHYSIOTHERAPY MANAGEMENT
SURGICAL MANAGEMENT
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. Introduction
• Pelvic fractures are potentially life threatening
injuries with an increased incidence due to
high velocity RTAs.
• Survivors are at a significant risk for morbidities
like chronic pain, LLD, Sexual dysfunction etc
• 3-4 % of all fractures usually associated with
significant trauma
3. Introduction
• Adult mortality 10-15%
• Mortality is ~50% if hypotensive on initial
presentation.
• Mortality is ~30% in open fractures
• Significant decrease in mortality and morbidity
if prompt stabilization of an unstable #
6. The bony pelvis lies in close proximity to various vascular
neural and soft tissue structures making these structures
vulnerable in the event of pelvic ring disruptions
7. Historical perspective
• These #s were historically managed conservatively
and many authors reported poor results.
• Holdsworth (1948) in first described that pts with
pure SI dislocations fared worse than
Illium/sacrum#.
• Slattis reported mortality as high as 17%
• Several publications popularized use of external
fixators.
• But later it became clear that Ex-Fix may be
adequate for anterior/lateral injuries but not for
posterior injuries.
8. Clinical Evaluation
SUSPECT
Start with ABCDs
Evaluate for other injuries to head,
chest, abdomen and spine
INSPECTION
• Skin around the perineum
• Bleeding PV/PR/PU
• LLD and abnormal extremity rotation
• Neuro-vascular status
9. Associated signs:
- Roux's sign:
- a decrease in the distance from the
greater trochanter to the pubic crest on the
affected side in lateral compression frx;
- Earle's sign:
- a bony prominence or large hematoma
as well as tenderness on rectal examination;
16. 3. Plain Radiography Outlet view
Adequate image when pubic
symphysis overlies S2 body
17. Imaging
CT scan
Gold standard for pelvic fractures. Detailed
information about anterior and posterior ring
MRI
Limited role.
GU and Vascular structures
18. CLASSIFICATION of pelvic fractures
Young and Burgess Classification
Most common classification used
Based on the mechanism of injury
29. Principles of Initial Management
• Suspect if high velocity RTA(car vs pedestrian;
Motorcycle) or a fall from height(usually
>15feet)
• Pelvis has no inherent stability and relies on
ligamentous supports.
• Vascular structures are intimately associated
with ligaments and are often injured.
31. Circumferential Pelvic wrapping
• First patient; teague 1993,CA
• CORR 1995
• ATLS provider manual in 1997
• Can be done with a bedsheet or a Pelvic
binder.
32. • Where to wrap??
At the level of the Greater Trochanters
•How much force????
150-170N
33. Pneumatic Anti-shock Garment
• Inflatable device traditionally used by the
armed forces.
• Great value in transport and initial
stabilization of patient; acts as a air splint
34. Disadvantages of PASG
• Risk of displacement in LC injuries
• Restricts access to patient
• Increased risk of compartment syndrome
35. External Fixation
• Indications
– pelvic ring injuries with an external rotation
component (APC, VS, CM)
– unstable ring injury with ongoing blood loss
• Contraindications
– ilium fracture that precludes safe application
– acetabular fracture
36. Technique
– theoretically works by decreasing pelvic volume
– stability of bleeding bone surfaces and venous
plexus in order to form clot
– pins inserted into ilium
• single pin in column of supracetabular bone from AIIS
towards PSIS
– obturator outlet or "teepee" view to visualize this column of
bone
– AIIS pins can place the lateral femoral cutaneous nerve at risk
• multiple half pins in the superior iliac crest
– place in thickest portion of anterior ilium, gluteus medius
tubercle or gluteal pillar
– should be placed before emergent laparotomy
37.
38. Angiography / Embolization
• Indications
– controversial and based on multiple variables
including:
– protocol of institution, stability of patient,
proximity of angiography suite , availability and
experience of staff
– CT angiography useful for determining presence or
absence of ongoing arterial hemorrhage (98-100%
negative predictive value)
39. Non-Operative Management
• Lateral impaction type injuries with minimal
(< 1.5 cm) displacement
• Pubic rami fractures with no posterior
displacement
• Minimal gapping of pubic symphysis
– Without associated SI injury
– 2.5 cm or less, assuming no motion with stress or
mobilization
– This number is not absolute, so other evidence of
instability (like SI injury) must be ruled out
40. Non-Operative Management
• X-rays are static picture of dynamic situation
– It may be that the deformity is worse than seen on
X-rays taken
– Stress radiographs may be helpful
– Other evidence of instability should be sought
• Lumbar transverse process fractures
• Avulsions of sacrotuberous/sacrospinous ligaments
41. Non-Operative Treatment
• Tile A (stable) injuries can generally bear
weight as tolerated
• Walker/crutches/cane often helpful in early
mobilization
• Serial radiographs followed during healing
• Displacement requires reassessment of
stability and consideration given to operative
treatment
42. Non-Operative Treatment
• Tile B (partially stable) injuries can be treated
non-operatively if deformity is minimal
• Weight bearing should be restricted (toe-
touch only) on side of posterior ring injury
• Serial radiographs followed during healing
• Displacement requires reassessment of
stability and consideration given to operative
treatment
43. Principles of Operative Treatment
• Posterior ring structure is important
• Goal is restoration of anatomy and enough
stability to maintain reduction during healing
• Most injuries involve multiple sites of injury
– In general, more points of fixation lead to greater
stability
– This does NOT mean that all sites of injury need
fixation
44. Principles of Operative Treatment
• Anterior ring fixation may provide structural
protection of posterior fixation
• If combined open and percutaneus techniques
are used, the open portion is often done first to
aid in reduction of the percutaneusly treated
injury
• LETOURNEL’s Golden rule: Posterior stabilization
to be done before anterior as posterior is the
main weight bearing part.
45. Anterior Pelvic Ring Injuries
Indications for ORIF
• Symphyseal dislocation >2.5cm(static or
dynamic)
• Toaugment posterior fixation in vertically
dislaced fractures.
• Locked symphysis.
46. Surgical Approach to the
Anterior Pelvic Ring
Pfannenstiel Approach
•Supine Position
•8 cm incision
•A Foley catheter and
nasogastric tube are inserted
47.
48. •The cut edges of the
rectus abdominal
muscles superiorly to
reveal the symphysis
and pubic crest.
•If access to the back of
the symphysis is
required, use the
fingers to push the
bladder gently off the
back of the bone
49. Symphyseal Dislocations
• Ant Ex Fix = Internal Fixation for controlling
rotation but Internal fixation >>> for resisting
vertical displacements
• Ex fix particularly useful in open injuries or pts
requiring GI/GU procedures.
50.
51. ORIF of Symphyseal disruptions
• Apply circumferential wrap at the level of the
GT.
• Internally rotate the legs and tape them.
• Ant approach to pubic symphysis.
• Place reduction forceps anteriorly so that
plate can be put on the superior surface.
52.
53.
54. • Inlet view: judge the alignment of the plate;
• Outlet view judge the length of screws;screws
should have a bicortical purchase.
55. Fractures of the Pubic ramus
• Fractures medial to insertion of inguinal
ligament should be treated like symphyseal
dislocations.
• Comminuted fractures: ORIF
• Minimal comminution: Ramus screw (ante
vs retro)
56. Fractures of the Pubic ramus
• Reduction technique
Secure a precontoured plate in the supra-
acetabular bone.
One tine of the reduction forceps on the medial
fragment and another on the most medial hole
of the plate.
57.
58.
59. Posterior Pelvic Ring Injuries
• Indications for ORIF:-
1. Displaced illiac wing fractures that enter and exit
both the crest and GSN/SIJ.
2. Multiplanar instability(disruption of ligaments)
3. Non impacted comminuted displaced sacral
fractures.
4. Vertical or cephalad displacement.
5. U shaped fractures with spino-pelvic
dissociation
60. Approaches to posterior pelvic ring
Posterior approach to SIJ
• Pt is placed prone with logitunal traction.
• In severely displaced fractures we can rigidly fix the
contralateral pelvis
63. Anterior Approach to the Sacroiliac Joint
• Make a curved incision over
the iliac crest, beginning 7 cm
posterior to the anterior
superior iliac spine. Curve the
incision anteriorly and
medially along the line of the
inguinal ligament for 5 cm.
64. • Subperiosteally dissect the illiacus muscle and
retract medially to reach the anterior part of
the SIJ.
• Care should be taken not to injure L5 nerve
root.
67. Sacroilliac Joint Dislocations
• Posterior approach----Only inferior joint
visualised
• Anterior approach----Superior Ala visualized
• Longitunal traction is the single most
important maneuvre.
• Important to let the pelvis hang free as
pressure on ASIS will lead to ext rotation
69. Illio-Sacral screw Placement
• Inlet projection—screw
towards anterior aspect
of promontory
• Outlet ---screw is above
the S1 foramen
• Screw to be directed
anteriorly; superiorly
and medially. Lateral Projection
71. Illiac wing fractures and fracture
dislocations( Crescent fractures)
• Illiac wing fractures exiting through the SIJ are crescent #.
• Crescent fragment is the variable sized that contains the
PSIS and PIIS and remains attached to the sacrum.
• Smaller the “CRESCENT” fragment > damage to posterior
structures
73. SACRAL Fractures
• Can be regarded as a pelvic injury, spinal injury
or both.
Indications for fixation:-
Ant and post ring disruption with vertical sheer
sacrum fracture.
Comminuted # with rotation
Spinal-pelvic dissociation
Rarely in impacted # with Internal rotation
deformity
75. Spinal-Pelvic fixation
1. Spinal point of fixation- L5(usually)
2. Illiac screw just inf to PSIS
3. Illiac screw is connected to pedicle screw with appropriate
rods and screw-rod clamps
This bypasses the lines of force transmission from spine to illium
through the construct instead of the sacrum
76. Post-Operative Care
• Mobized to chair 1st day post-op
• Toe touch weight bearing upto 10 weeks
(unstable injuries)
• Stable injuries immediate post-op FWB.
• DVT prophylaxis.
• Prophylaxis for hetereropic ossification.
77. Complictaions
• Intra-operative haemorrhage
• Inability to achieve reduction
• Wound infection.
• Newly recognized post-op neurologic deficits
• Loss of fixation and reduction
• Sexual dysfunction
78. Physiotherapy Management
PT is an important part of the rehabilitation in both, low-
energy and high-energy pelvic fractures.
Low-energy injuries are usually managed with conservative
care.
This includes bed rest, pain control and PT.
High-energy injuries, especially the unstable fractures must be
reduced by surgical treatment.
Afterwards PT includes the same treatment as in low-energy
fractures.
Early mobilisation is very important because prolonged
immobilisation can lead to many complications, including
respiratory and circulatory dysfunctions.
PT helps the patient to get out of bed as soon as possible.
79. The goals of the PT program should provide the patient with
an optimal return of function by improving functional skills,
self-care skills and safety awareness.
The main goals are to improve the pain level, strength,
flexibility, speed of healing, and the motion of the hip, spine
and leg.
Another important goal is to shorten the time needed to
return to activity and sport.
The intensity of the rehabilitation depends on whether the
fracture was stable or unstable.
80. In people with surgical treatment, PT starts after 1
or 2 days of bed rest.
It is initiated with training of small movements,
transfers and exercise training.
The following exercises can start immediately after
surgery and should be done at least four times a day
(unless told otherwise).
The number of repetitions are guidelines and can
vary with every patient.
81. Plantar flexion and
dorsiflexion of the feet
Sit up or lie down. Keep your
legs straight and move your
feet up and down at the ankles,
pointing your toes and then
relaxing.
Repeat 10 – 15 times every
hour.
82. Abduction of the hip
Move your leg out to the
side and then back to the
middle.
Repeat both sides 10
times.
83. Contraction of the
quadriceps
Keep your legs flat on the
bed. Push the knee down
so that your leg is straight
and then tighten your thigh
muscle and hold for five
seconds.
Repeat 5 – 10 times.
84. Extension of the knee:
lying
Lie on your back. Put a rolled
towel under your knee.
Tighten your thigh muscles and
straighten your knee, lifting
your heel off the bed. Hold your
leg straight for five seconds and
lower it gently.
Repeat both sides 10 times.
85. Extension of the knee: In
sitting
Once you can sit in a chair or
wheelchair comfortably: Pull
your foot up towards you,
tighten your thigh muscle and
straighten your knee. Hold this
position for five seconds.
Repeat 10 – 15 times every
hour.
86. Short-term goals for patients after surgery are:
independence with transfers and wheelchair
mobility.
Depending on the medical status of the patient
these goals can be achieved in 2 to 6 weeks.
The physical therapy program can be continued in
the hospital or at home.
The home-based program includes basic range of
motion, stabilising and strengthening exercises
intended to prevent contracture and reduce
atrophy.
87. During the non-weight bearing status the
patient performs isometric exercises of
the gluteal muscle and quadriceps femoris
muscle, range of motion exercises and upper-
extremity resistive exercises (for
example shoulder and elbow flexion and
extension) until fatigued.
The number of repetitions can vary with the
patient.
88. Once weight-bearing is resumed, PT consists of gait
training and resistive exercises for the trunk and
extremities, along with cardiovascular exercises (for
example treadmill).
Stabilisation exercises and mobility training should
also be remained in the program.
Aquatherapy is also good and helpful when
available.
89. Mobility training is useful to regain the range of motion in
the hip, knee and ankle after immobilisation.
Gait training should start with walking between parallel bars.
Afterwards the patient should learn how to walk with a
walker or with a cane.
Balance and proprioception training should also be included
in the rehabilitation.
Resistive training should be progressive to improve the
muscle strength in the hip and leg.
In the final stage functional exercises should be included to
provide the patient with an optimal return of function.
90. In pelvic fractures in the elderly population, the
rehabilitation process will be focused on optimising
their quality of life.
Rapid mobilisation and sufficient pain relief are the
main objectives of treatment and appointment of
the home to assess the need for eg rails, ramps,
increased lighting, removal of loose mats.
Appropriate walking aids should also be supplied.
A falls prevention outpatient program could be of
benefit.