How is a pelvic fracture treated, what therapy does a pelvic fracture require?
The patient, who is admitted to hospital as an emergency with suspected pelvic fracture, must be treated by a whole series of doctors because of the complexity of the event: there is a risk of shock due to blood loss, and injuries to the abdomen, pelvic area or vascular structures are also possible.The muscle-bone area of this accident falls within the competence of the orthopedist.
There are two treatment options, conservative and surgery. Conservative treatment is used for stable fractures, especially in the elderly, and varies depending on the age of the patient, prospects of recovery, general health, etc.
It is quite possible that the patient will be immobilized in bed for at least a month to promote the formation of the bone callus.
Effective pain management after the procedure is very important to improve the mobility of the patient. Epidurally injected anesthetics bring enormous relief in the acute phase. However, it must be taken into account that there is a potential risk of bleeding due to the anticoagulant effect of these agents.
Orally taken anesthetics with long-term effects can be used supportively so that the patient can continue to control pain. When the intravenously administered narcotic therapy is finished, oral anesthetics with or without long-term effect are used against the postoperative pain.
Important after the surgical procedure is the aggressive prophylaxis of deep vein thrombosis (DVT). Medical aids, such as compression stockings, counteract stasis (stagnation of blood in the vessel) and thus reduce the risk of thrombus formation. Sequential compression devices (compression therapy) are used to reduce venous stasis and can play a role in stimulating the fibrinolysis system and releasing the anticoagulant (inhibitor) of coagulation factor X.
Antibiotics should be given if there is a suspicion of an intestinal, vagina, or urinary tract problem. Since bleeding is one of the most dangerous complications of pelvic fracture, anti-inflammatory drugs should be avoided during initial treatment. They may be used later if the inflammation causes great pain.
In the acute phase, mainly anesthetics are administered. Pain control is fundamental to the patient’s quality of life. These drugs guarantee the patient’s well-being, stimulate pulmonary hygiene and allow physiotherapy to be carried out. Many analgesics have sedative (sedative) properties and have a very positive effect in patients with pelvic fracture.
Efficient pain therapy keeps the patient calm and prevents pelvic movements. This group of medicinal products may cause side effects, even serious ones; therefore they are prescription only and the recommended dosage must be adhered to.
Morphine sulfate (Severdol, Mst)
This anesthetic is an excellent painkiller because of its reliable and predictable action, safety and reversibility with naloxone. It is extremely helpful in traumatized patients to avoid sedation or hypotension. In patients with low blood pressure, it should be administered with caution, because hypotension may increase due to the release of histamine. In this case, fentanyl is recommended.
An excellent painkiller for patients with low blood pressure or unstable circulation. It does not release histamine. The effect is short-lived, but it can be taken several times a day, thus prolonging the effect.
Paracetamol (Ben-u-ron) This is the painkiller of choice in patients who are hypersensitive (allergic)
to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), in patients at high risk of bleeding and in those taking oral anticoagulants (anticoagulants). It relieves pain, but has no effect on inflammation.
Oxycodone (Oxygesic, Oxycodone Ratiopharm) and Paracetamol
Combined for severe pain for patients who are allergic to aspirin.
If the orthopedist decides to undergo surgery, the bone fragments are fixed by osteosynthesis; If the pelvis is completely unstable, osteosynthesis takes place at the front and back of the bone. During surgery, the hernia is first set up (repositioned), i.e. the fragments are brought back into the exact, anatomically appropriate position; then osteosynthesis takes place, in which the femur is pulled longitudinally. Fractures of the sacral-iliac joint and the iliac shovel are fixed by two tension screws.
If the seat bone and pubic bone are injured, the muscle attachment of the straight abdominal muscles must be detached from the pubic bone; later it is fixed with one or two plates; the spermatic cord must not be damaged in men and the round uterine ligament in women.
In the treatment of acetabular fractures, the head of the femur is kept as far as possible from the bottom of the pan until the fracture heals; a plaster cast is applied, which encloses the entire lower limb from the pelvis to the foot and is attached to the femoral head with a steel wire. If surgical care is necessary, you should entrust yourself to an orthopedist who has a lot of experience in this field, because these operations are not very common and experienced doctors achieve better results.
What complications can occur with osteosynthesis of the pelvis?
Possible complications of surgical intervention include:
- damage to the sciatic nerve, especially if access to the pelvis is from behind;
- abnormal bone formation;
- infections inside or outside the joints;
- premature osteoarthritis;
How long are the recovery times after a pelvic fracture?
Before everyday activities can be resumed without running the risk of pseudo-arthrosis or failure to consolidate the fracture, a certain amount of time must pass; How long the recovery takes depends on the location, size and typology of the fracture (displaced, open, debris fracture), as well as the age of the patient and any osteoporosis present.
After an operation without complications, immobilization takes place for about a month and then everyday activities can be gradually resumed. In the case of a stable, non-operated fracture, orthopedists prescribe 1-2 months of bed rest so that the bone fragments can heal. After that, rehabilitation takes place in the water and in the gym to rebuild muscle strength and joint functions. Possible effects:
- injuries of the abdominal organs, especially intestines and colon;
- damage to the bloodstream (rarely), accompanied by bleeding (hemorrhage), especially to the iliac artery;
- in acetabular fractures, hip arthrosis and femoral head necrosis can occur as long-term consequences due to the lack of blood supply.
What rehabilitation is performed after a pelvic fracture?
The only therapy that accelerates bone consolidation is magnetic therapy; if it starts early, everyday and sporting activities can be resumed more quickly.
Rehabilitation must begin as soon as possible; as soon as the orthopedist prescribes physiokinesitherapy, the patient must begin to move, strain the lower limbs and walk.
In the first phase, hydrokinesitherapy (movement therapy in water) helps to strengthen the muscles and regain the normal range of motion, even if a full load on the leg is not yet possible. In the second stage, rehabilitation begins in the gym with an ergometer, special exercises for the hip joint, lumbar and back region; Initially, the programme consists mainly of passive and assisted active mobilisation.
After a month of bed rest, muscle tone has dropped significantly, especially of the quadriceps. At first, with physiotherapy, only one limb is loaded, so the sick leg must be strengthened from the hip to the foot.
The first exercises are isometric in nature, that is, tensing the muscles without movement; later concentric exercises take place, here the tension takes place during movement. If pain occurs, physical therapies can help, such as laser therapy or Tecartherapy®, which relieve the inflammation.