Pelvic Fractures:Low Impact

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Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton, Mahbubur Rahman and Kim Jackson  

Introduction[edit | edit source]

Due to the increasing life expectancy we are seeing more fragility fractures of the pelvis (FFPs). Studies have shown a significant increase in low-energy pelvic ring injuries in ages 60 and older[1]. These kinds of fractures are the result of a low-energy impact or they may even occur spontaneously in patients with severe osteoporosis.

  • Due to some distinct differences, the established classifications for pelvic ring lesions in younger adults do not fully reflect the clinical and morphological criteria of FFPs. Most FFPs are minimally displaced and do not require surgical therapy.
  • Low-energy fractures of the elderly population sustained from a ground level fall frequently result in pelvic fractures that do not damage the true integrity of the ring structure and are often treated non-operatively. These fractures include superior and inferior pubic rami fractures as well as non-displaced sacral alar fractures[1].
  • In some patients, an insidious progress of bone damage leads to increasing displacement, nonunion and persisting instability. New concepts for surgical treatment have to be developed to address the functional needs of the elderly patients.[2]

Etiology[edit | edit source]

Low impact injuries are seen more frequently in adolescents and the elderly.

  • In adolescents, typically as a result of athletic injuries (e.g. avulsion fractures of superior or inferior iliac spines or apophyseal avulsion fracture of the iliac wing or ischial tuberosity)
  • In the elderly as a result of falls. (e.g. stable fractures of the pelvic ring or insufficiency fractures of sacrum and anterior pelvic ring)
  • Falls can be caused by:balance problems; vision problems; medication side effects; general frailty; by encountering unintended obstacles such as pets underfoot, slippery floors, or unanchored throw rugs[3][4]

Expected Outcomes/Mortality Rates[edit | edit source]

  • Low-energy pelvic injuries do not appear to increase rate of mortality (compared to the US population).
  • Fracture pattern, race, sex, discharge disposition and length of stay do not seem to have an effect on mortality.
  • Elderly patients with an average age of 84.5 years and more than two comorbidities had higher rates of mortality; however, these patients were likely to sustain earlier mortality regardless of low-energy pelvic fracture[1].

Physiotherapy[edit | edit source]

In pelvic fractures in the elderly population, the rehabilitation process will be focused on optimising their quality of life.

  • Rapid mobilisation and sufficient pain relief are the main objectives of treatment[5] 
  • Appointment of the home to assess the need for eg rails, ramps, increased lighting, removal of loose mats.
  • Appropriate walking aids should be supplied.
  • A falls prevention outpatient program could be of benefit.
  • A home rehabilitation program should be implemented. [6] 

Low-impact pelvic fractures often are considered as mild fractures; they may heal with several weeks of rest. Ways by which physiotherapists help individuals with low-impact pelvic fractures

  • Restore their strength
  • Restore their range of motion (hip, spine, and leg motion)
  • Restore their balance[4]
  • Reduce their pain level
  • Aid speed of healing
  • Speed up clients return to activity and sport

Sub Heading 3[edit | edit source]

Resources[edit | edit source]

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References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 Ghassibi M, Boyalakuntla DS, Gentile J. Low-Energy Pelvic Ring Fractures in the Elderly Population: Expected Outcomes and Associated Mortality Rates. Journal of Clinical Medicine Research. 2019 Nov;11(11):725.Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6879025/(last accessed 11.10.2020)
  2. ↑ Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment. Injury. 2013 Dec 1;44(12):1733-44.Available from:https://pubmed.ncbi.nlm.nih.gov/23871193/ (last accessed 11.10.2020)
  3. ↑ Davis DD, Foris LA, Kane SM, Waseem M. Pelvic Fracture. StatPearls [Internet]. 2020 Jan.Available from:https://www.ncbi.nlm.nih.gov/books/NBK430734/ (last accessed 11.10.2020)
  4. ↑ 4.0 4.1 Phoenix rehab Pelvic Fractures Available from:https://www.phoenixrehabgroup.com/pelvic-fracture-physiotherapy.html(last accessed 11.10.2020)
  5. ↑ Oberkircher L, Ruchholtz S, Rommens PM, Hofmann A, Bücking B, Krüger A. Osteoporotic pelvic fractures. Deutsches Ärzteblatt International. 2018 Feb;115(5):70. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5817189/ (last accessed 3.4.2019)
  6. ↑ Zidén, Lena, Margareta Kreuter, and Kerstin Frändin. "Long-term effects of home rehabilitation after hip fracture–1-year follow-up of functioning, balance confidence, and health-related quality of life in elderly people." Disability and rehabilitation 32.1 (2010): 18-32
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