PELVIC INJURIES AND MANAGEMENT

By – Dr.Ushma saini

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.

Ligaments Posterior sacroilial ligament

anterior sacroiliac ligament

interosseous ligament

sacrospinous ligament

scrotuberous ligament

Muscles

Arteries

Nerves

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%

INJURY CLASSIFICATION

1-Young and Burgess Classification

2-Tile Classification

3-Apley ‘s Classification

Young CLASSIFICATION

Lateral Compression

(LC)

AnteroposteriorCompression

(APC)

Vertical Shear (VS)

TILES CLASSIFICATION

Type A : Stable

Type B : Rotationally

unstable / Vertically stable

Type C : Rotationally and vertically

unstable

APLEY’S classification

Sacral / coccygeal fractures

Avulsions-Due to violent

muscle action

Ring fractures-stable and unstable.

Acetabularfractures

Initial

Assesement

Primary survey

Airway Maintenance with c-spine protection

Breathing and ventilation

Circulation with hemorrhage control

Disability :neurologic status

Exposure –undress patient but prevent

hypothermia.

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.

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

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

After patient is resuscitated:

Inlet view (X-Ray beam tilted 40o

caudal) : shows

anteroposterior displacement, rotational deformity,

and crescent fractures

Outlet view (X-Ray beam tilted 40o

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

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

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.

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.

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.

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.

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.

Improve Balance

The hip area contains many muscles that are vital for balance and steadiness when walking.

Speed Recovery Time

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.

Return to Activities

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.

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.

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.

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

Hip External Rotation

Bridging

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

Balance Exercises

Single Leg Balance on Pillow (right side)

Walking Heel Toe

Intermediate Balance Exercises

Ball Under Leg

Core Exercises – Basic

Transversus Abdominis Activation

Bridging

Abdominal Crunch

Prone Hold

Four Point Kneeling Opposite Arm & Leg Raises

Side Holds

Roll Outs

Thanks youby

ushma saini