How are unstable and major pelvic fractures treated?
If you have an unstable pelvic fracture the treatment will depend on the location of the fractures, and on any other injuries you might also have. The main aims of treatment of an unstable pelvic fracture are first to stabilise the pelvis and prevent further blood loss, then to keep the bones still to allow healing.
First aid in pelvic fracture
Until help arrives a person with a suspected pelvic fracture should be covered with a blanket or jacket and should not be moved by non-trained personnel, especially if there is severe pain.
If you are at a serious road accident and a person is walking around, get them to sit still. Ask if there is any pain anywhere, particularly in their chest, tummy (abdomen) or hips. If there is pain anywhere near the pelvis they could have a major pelvic fracture, and you should assume they are seriously injured and keep them still and warm until emergency services arrive. It is well known that sometimes people walk around with severe pelvic fractures immediately after road accidents, as shock can prevent them from initially feeling much pain.
Treatment of blood loss
Reduction in bleeding from the pelvis is initially helped by keeping the pelvis as stable as possible. Initially this is done by binders and sheets, followed by stabilisation using external fixation (see below).
External pelvic fixation
This involves long screws inserted into the bones from the sides and a large external frame. It is done in the operating theatre, under anaesthetic. It helps prevent further blood loss by holding the bones together. The metal pins or screws are inserted into the bones through small incisions into the skin and muscle. They project out of the skin on both sides of the pelvis where they are attached to carbon fibre bars. The external fixator acts as a stabilising frame to hold the bones in proper position.
This involves a pulley system of external pins in the bones, with weights and counterweights. It helps line up the pieces of bone. Skeletal traction is sometimes used as a temporary treatment, and it often provides some pain relief. Occasionally, pelvic fractures are treated with skeletal traction alone but this is unusual.
Internal pelvic fixation
A few patients require internal fixation to keep the bones in place. This is open surgery, performed under anaesthetic. The bone fragments are repositioned, then held together with screws or metal plates which are left permanently in place. Getting the pelvis fixed and stable is very important both for pain control and for the long-term results of your treatment. It is more likely to be necessary if there are multiple fractures.
Management of pain
Pain is managed using painkillers and by stabilising an unstable pelvis. Strong painkillers and local anaesthetics may initially be needed. You may at first have an epidural anaesthetic to help manage the initial pain.
Doctors usually prescribe 'blood thinners' (anticoagulants) to reduce the risk of blood clots forming in the veins of your legs and pelvis. Pelvic fractures are known to increase the risk of blood clots.
Initial treatment is with pain relief and bed rest, followed by mobilisation. Doctors will want to get you moving as soon as possible, as this is better for your long-term recovery, and also reduces the risk of blood clots forming (deep vein thrombosis). However, you are likely to need to use crutches or a walker for around three months, or until your bones are fully healed. If you have injuries above both legs, you may need to use a wheelchair for a period of time so that you can avoid putting any weight on either leg.
You will be seen regularly by physiotherapists who will try to help you keep muscle strength and joint mobility whilst you are not able to weight bear.
Once you start to weight bear, physiotherapy will still be needed to strengthen your muscles and help you regain your balance, as you may find this is much less good when you first start walking again.
How are stable pelvic fractures treated?
With a stable fracture, the most common treatment is bed rest and prescribed painkillers.
Surgical treatment is not usually needed for stable fractures. Crutches and walking aids are likely to be used as part of your recovery, and physiotherapy will be an essential part of your treatment.
How are pelvic avulsion fractures treated?
Treatment of pelvic avulsion fractures is with rest. These fractures usually heal by themselves over 4-6 weeks. Initially, applying ice can help pain and inflammation.
Occasionally, surgery is needed to re-attach the bone and tendon to the pelvis; however, this is mainly reserved for unusually large avulsion fractures.
Following the rest period, a gradual rehabilitation programme can be commenced which aims to regain full strength and movement at the hip.
How are pelvic stress fractures treated?
Pelvic stress fractures can cause lingering, worsening pain and may become full-thickness fractures, so rest from the activity which caused them is very important. A gradual reintroduction to running can begin after a few weeks, once the athlete is pain-free.
Some specialists now suggest treatment with an infusion of pamidronate, a drug more commonly used to treat 'thinning' of the bones (osteoporosis). This treatment appears to be fairly effective in speeding the healing of stress fractures, even in patients without osteoporosis.
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