1) Pelvic fractures usually result from high-velocity trauma like car accidents or falls and involve bones in the pelvis joining at the pubis, ischium, and ilium. 2) Initial assessment focuses on stabilizing the patient's airway, breathing, and circulation before examining for signs of pelvic fracture like pelvic hematomas. 3) Imaging like x-rays and CT scans are used to classify the fracture using systems like Young's, Tile's or Apley's to guide treatment. 4) Physical therapy plays an important role in pelvic fracture recovery by reducing pain, improving hip and leg movement, strength, and balance through a personalized home exercise program to help return to normal activities

1. PELVIC INJURIESAND
MANAGEMENT
By – Dr.Ushma saini

2. 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.

4.  Ligaments
 Posterior sacroilial ligament
 anterior sacroiliac ligament
 interosseous ligament
 sacrospinous ligament
 scrotuberous ligament

6.  Muscles

7.  Arteries

8. Nerves

9. 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%

10. INJURY CLASSIFICATION
1-Young and Burgess Classification
2-Tile Classification
3-Apley ‘s Classification

11. Young
CLASSIFICATION
Lateral
Compression
(LC)
Anteroposterior
Compression
(APC)
Vertical Shear
(VS)

12. TILES
CLASSIFICATION
Type A : Stable
Type B
: Rotationally
unstable /
Vertically stable
Type C
: Rotationally
and vertically
unstable

13. APLEY’S
classification
Sacral /
coccygeal
fractures
Avulsions-Due
to violent
muscle action
Ring
fractures-
stable and
unstable.
Acetabular
fractures

15. Initial
Assesement

16. Primary survey
 Airway Maintenance with c-spine protection
 Breathing and ventilation
 Circulation with hemorrhage control
 Disability :neurologic status
 Exposure –undress patient but prevent
hypothermia.

17. 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.

18. 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

20.  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

21.  After patient is resuscitated:
 Inlet view (X-Ray beam tilted 40
o
caudal) : shows
anteroposterior displacement, rotational deformity,
and crescent fractures
 Outlet view (X-Ray beam tilted 40
o
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

45. 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

46.  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.

47.  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.

48.  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.

49.  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.

50. 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.

51. Improve Balance
 The hip area contains many muscles that are
vital for balance and steadiness when walking.
Speed RecoveryTime
 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.

52. Return toActivities
 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.

53. 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.

54. 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.

56. 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

57. Hip External Rotation

58. Bridging

59.  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

60. Balance Exercises

61. Single Leg Balance on Pillow (right side)

62. Walking Heel Toe

63. Intermediate Balance Exercises

64. Ball Under Leg

65. Core Exercises – Basic
 Transversus Abdominis Activation

66. Bridging

67. Abdominal Crunch

68. Prone Hold

69. Four Point Kneeling Opposite Arm &
Leg Raises

70. Side Holds

71. Roll Outs

75. Thanks you
by
ushma saini