Pelvic fracture – physiotherapy after surgeryInformation for patientsThis leaflet gives you information about exercises to do after you have had an operation to treat your broken pelvis. If you have any questions or concerns, please do not hesitate to speak to the doctors or nurses caring for you.

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These exercises help you get the best possible result from your operation. This is a guide only and the physiotherapy treatment you need may vary, depending on your circumstances.

You have a very important part to play in your own recovery, so it is very important that you follow the advice we give you.

What is a pelvic fracture?The pelvis is made up of two bones joined to the sacrum (tail bone) at the back, and the pubic symphysis at the front.

The pelvis protects the bladder, bowel, sexual reproductive organs and the blood vessels and nerves that go to your legs. When you walk and sit, your pelvis supports your upper body weight.

The pelvis can break in any area after a traumatic event. This can cause pain and restrict movement.

Will I need to have any tests?You will have x-rays and possibly a CT scan, so that we can assess your injuries and help the surgeon to decide the best treatment for you. Your rehabilitation depends on where your fracture is and the treatment you will have.

How do you treat a pelvic fracture?1. Operation using plates and screws. These are screwed into the bones inside your body to hold your bones together while the fracture heals.

2. Bed rest and gradual movement using crutches. If your injury is not severe and you do not need surgery, we may tell you to rest in bed for a short period, which could be a few days but depends on the injury. Your physiotherapists will then help you to start walking again.

3. Operation using an external fixator. This is a metal frame attached to the front of the pelvis on the outside of the body. It corrects the position of the bones and prevents you moving more while the fracture heals. This is temporary.

ExercisesYour physiotherapists will show you how to do the exercises in this leaflet.

After surgery Your physiotherapists will tell you which exercises you can start immediately after surgery and help you to move until you can manage on your own. We will tell you if there is anything you need to avoid or precautions you need to take.

How much weight you can put on each leg will depend on your fracture and how it is fixed. Your physiotherapists will give you equipment to help you move.

Your physiotherapists or surgeon will talk with you about this.

You should do the following exercises at least four times a day (unless told otherwise) as you are able. You can increase the number as your condition or pain improves.

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.

Lie on the bed (if you have hip movement restrictions) or sit up in bed and bend your hip and knee as far as possible.

Repeat 10 times for each leg.

Move your leg out to the side and then back to the middle.

Repeat both sides 10 times.

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.

Once you can sit in a chair or wheelchair comfortably:

Lie flat 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.

Sit towards the edge of your chair with your feet on the floor. Bend your knee on the injured side as much as possible.

Repeat 10 – 15 times every hour.

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.

Pelvic stabilityThe strength of your pelvis depends on your bones, strong ligaments and muscles.

For this reason, your physiotherapists will show you some exercises to strengthen your stomach (abdominal) muscles as well as the muscles that support your bladder and bowel (the pelvic floor). If you are concerned about any of these functions, please speak to your hospital doctor, GP (home doctor) or physiotherapist.

The following two exercises should be done four times a day.

WalkingOnce you have seen the surgeon after your operation, you will be able to walk or get into a wheelchair but this will depend upon your fracture.

Fracture on one side of your pelvis onlyYou may be allowed to stand and walk using crutches without putting weight on the injured side (non-weight bearing). The surgeon will talk to you about this.

Fractured both sides of your pelvisWe may ask that you don’t to stand on either leg for 12 weeks or more. If this is the case, once you are able to comfortably support yourself sitting over the edge of the bed, your physiotherapists will show you how to get into and out of a wheelchair.

Lie on your back with both knees bent. Imagine you are trying to stop yourself passing wind and at the same time trying to stop the flow of urine midstream. Squeeze and lift the muscles, closing and drawing up the back and front passages.

Hold for 5 – 10 seconds. Rest for four seconds. Repeat 10 times.

Lie on your back with both knees bent. Tighten your lower stomach muscles and gently flatten the small (lower part) of your back into the bed (as if you are drawing your belly button towards your back bone).

Hold for 5 – 10 seconds. Repeat 10 times. Gradually increase the length you can hold the contraction.

Depending on the type of fracture you may then be able to start getting out of bed with the help of your physiotherapists. This depends on whether you have any other injuries.

You may feel dizzy, light-headed or faint the first few times you get up and walk. This is normal, as your body is adjusting to being in an upright position.

You will probably need ongoing physiotherapy to help you recover. Your physiotherapist will refer you to local physiotherapy services.

Who do I contact with queries and concerns?If you have any queries regarding your exercises or your physiotherapy referral please contact Inpatient orthopaedic physiotherapy (Denmark Hill): 020 3299 2368.

Sharing your informationWe have teamed up with Guy’s and St Thomas’ Hospitals in a partnership known as King’s Health Partners Academic Health Sciences Centre. We are working together to give our patients the best possible care, so you might find we invite you for appointments at Guy’s or St Thomas’. To make sure everyone you meet always has the most up-to-date information about your health, we may share information about you between the hospitals.

Care provided by studentsWe provide clinical training where our students get practical experience by treating patients. Please tell your doctor or nurse if you do not want students to be involved in your care. Your treatment will not be affected by your decision.

PALSThe Patient Advice and Liaison Service (PALS) is a service that offers support, information and assistance to patients, relatives and visitors. They can also provide help and advice if you have a concern or complaint that staff have not been able to resolve for you.

PALS at King’s College Hospital, Denmark Hill, London SE5 9RS:Tel: 020 3299 3601 Fax: 020 3299 3626 Email: kch-tr.pals@nhs.net

You can also contact us by using our online form at www.kch.nhs.uk/contact/pals

PALS at Princess Royal University Hospital, Farnborough Common, Orpington, Kent BR6 8NDTel: 01689 863252Email: kch-tr.palskent@nhs.net

If you would like the information in this leaflet in a different language or format, please contact PALS on 020 3299 1844.

www.kch.nhs.uk Corporate Comms: 1122PL702.1 August 2015 Review date August 2018