1) Pelvic fractures usually result from high-velocity trauma like car accidents or falls and involve bones in the pelvis joining at the pubis, ischium, and ilium.
2) Initial assessment focuses on stabilizing the patient's airway, breathing, and circulation before examining for signs of pelvic fracture like pelvic hematomas.
3) Imaging like x-rays and CT scans are used to classify the fracture using systems like Young's, Tile's or Apley's to guide treatment.
4) Physical therapy plays an important role in pelvic fracture recovery by reducing pain, improving hip and leg movement, strength, and balance through a personalized home exercise program to help return to normal activities
2. Anatomy
Pelvis contains one pair of fused bone.
Each half contains: ilium,pubis and ischium.
Joined together in posterior by sacrum.
Joined in anterior by symphysis pubis.
9. HISTORY
Pelvic fractures usually occur due to high-velocity
trauma following a road traffic accident or due to
fall from a height.
RTA-80.7%
FALL-16.1%
16. Primary survey
Airway Maintenance with c-spine protection
Breathing and ventilation
Circulation with hemorrhage control
Disability :neurologic status
Exposure –undress patient but prevent
hypothermia.
17. Physical Examination
Stress exams on initial evaluation should be
avoided as it has low sensitivity, adds little
to treatment planning, and can cause further
bleeding.
Examine perineum for open wounds
Perform manual examination
look for blood at urethral meatus
Leg length inequality or external rotation of
one extremity.
18. Neurologic examination
including perineal sensation, rectal tone
Myotomes of lower extremity-
L1-hip flexors
L3-4 –quadriceps/knee extension
L4-5- Ankle and toe dorsiflexion
S1-Ankle plantarflexion
S2-3-toe plantarflexion
19.
20. Destots sign: Clinicial finding suggestive of pelvic
fracture. Positive findings include a superficial
hematoma above inguinal ligament or involving the
scrotum, perineum, or upper thigh
Roux's sign: decreased distance from greater
trochanter to pubic tubercle
Earle's sign: hematoma or bony prominence and
tenderness on rectal examination
Imaging
X-Rays
During primary evaluation:
Standard AP
21. After patient is resuscitated:
Inlet view (X-Ray beam tilted 40
o
caudal) : shows
anteroposterior displacement, rotational deformity,
and crescent fractures
Outlet view (X-Ray beam tilted 40
o
cranial) : shows
vertical displacement and provides face view of the
sacrum.
CT scan
Angiography
Indications:
nonresponders who have been mechanically stabilized
extravasation of contrast on CT
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45. Physiotherapy management
Physical therapists can help to recover from a
pelvic fracture by improving :
Pain level
Hip, spine, and leg motion
Strength
Flexibility
Speed of healing
Speed of return to activity and sport
46. When patient are cleared by physician to begin
physical therapy, physical therapist will
design a specific home treatment program to
speed recovery, including exercises and
treatments. This program will help to return to
normal life and activities and reach recovery
goals.
47. The First 24-48 Hours
Physical therapist –Teach crutch walking,so
patient can move around home without
walking on the leg of the injured side. This
will more commonly apply to low-impact
pelvic fractures, as in athletes. More severe
pelvic fractures will require a wheelchair, in
which your physical therapist can instruct your
safe usage.
48. Reduce Pain- with ice, heat, ultrasound,
electrical stimulation, taping, exercises, and
special hands-on techniques called manual
therapy that gently move your muscles and
joints.
49. physical therapist will choose specific activities
and treatments to help restore normal
movement in the leg and hip.These might start
with passive motions that he or she applies to
patients leg and hip joint, and progress to active
exercises and stretches that perform itself.
Treatment can involve hands-on manual therapy
techniques called "trigger point release" and
"soft tissue mobilization," as well as specific
stretches to muscles that might be abnormally
tight.
50. Improve Strength
Certain exercises will benefit healing at each
stage of recovery, and physical therapist will
choose and teach you an individualized exercise
program that will restore your strength, power,
and agility. These exercises may be performed
using free weights, stretch bands, weight-lifting
equipment, and cardio exercise machines such as
treadmills and stationary bicycles. For pelvic
fractures, muscles of the hip and core are often
targeted by the strength exercises.
51. Improve Balance
The hip area contains many muscles that are
vital for balance and steadiness when walking.
Speed RecoveryTime
Your physical therapist is trained and
experienced in choosing the treatments and
exercises to help you heal, get back to your
normal life, and reach your goals faster than
you might be able to on your own.
52. Return toActivities
Physical therapist will collaborate with you to
decide on your recovery goals, including return to
work and sport. Your treatment program will be
designed to help you reach these goals in the
safest, fastest, and most effective way possible.
Your physical therapist will use hands-on therapy
and teach you exercises and work re-training
activities. Athletes will be taught sport-specific
techniques and drills to help achieve sports-
specific goals.
53. Prevent Future Problems
Physical therapist can recommend a home exercise
program to strengthen and stretch the muscles
around your hip, upper leg, and core to help prevent
future problems, such as fatigue and walking
difficulty.This program may include strength and
flexibility exercises for the hip, thigh, and core
muscles.Your physical therapist will also review with
you and your family ways to prevent falls in your
home.These fall-prevention strategies may include
clearing the floors of loose obstacles (throw rugs,
mats), using sticky mats or chairs in the shower,
preventing pets from walking near your feet, and
using non-slippery house shoes, as well as installing
grab bars or rails for the shower, toilet, and stairs.
54. Exercises for a pelvic
stress fracture
The following exercises are commonly
prescribed to patients with a stress fracture of
the pelvic. Generally, they should be
performed 3 times daily once indicated it is
safe to do so and only provided they do not
cause or increase symptoms.
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56. Hip & Knee Bend to Straighten (left
leg)
the opposite Hip & Knee Bend to Straighten
Take your knee to your chest as far as
possible pain free allowing your knee to bend
(figure 2).Then return to the starting
position. Repeat 10 - 20 times provided there
is no increase in symptoms.Then repeat on
leg
59. Begin with your knee bent and foot flat on
the floor.Take your knee to the side as far as
possible pain-free (figure 3). Repeat 10 - 20
times provided there is no increase in
symptoms.Then repeat on the other leg