ASK THE EXPERT: PELVIC FRACTURES

by Dr. Allan Inglis Jr.

Dr. Allan Inglis Jr., orthopedic surgeon, answers readers’ questions on fractures of the pelvic bone, one of the most serious injuries in his field.

Q1. My friend broke her pelvis but wasn’t operated on – just told to rest. What determines if a patient should have surgery or not?

Many pelvic fractures are treated without surgery. Some patients don’t need surgery because the type of fracture (where it is located in the pelvis) is not dangerous, and the fracture is likely to heal of its own accord. There are also fractures that are not severe in that the broken bones are very close together and again are likely to heal on their own. In contrast, a patient may have fractures that are very severe or there may be other severe injuries that require surgery.

Also to consider is that the patient’s health may be too precarious to permit safe completion of an operation. Frequently a patient may not be healthy enough to undergo surgery even though it might be recommended.

Q2. How long is recovery after sustaining a pelvic fracture?

Pelvic fractures usually start to heal about four weeks after the fracture. Some patients may notice less pain as soon as a few days after a fracture, depending on the severity of the fracture, but most patients take pain medication for four to six weeks after the injury.

In terms of activity, patients can be bedbound for days or up to a week. Most patients, however, start transferring to a chair in a couple of days and start getting around the bedside with a walker in another couple of days.

Final resolution of pain and restoration of function can take six to 12 weeks.

Q3. Why do some pelvic fracture patients need more than one surgery?

There are a variety of reasons for multiple surgeries:

• There may be several different fractures in different areas of the pelvis requiring separate surgical procedures either under one anesthetic or under several anesthetics.
• The patient may have suffered many injuries and is only able to withstand one operation at a time.
• Some patients are stabilized after a severe trauma with a smaller operation to save their life and allow comfortable further non-orthopedic life-saving care. When they are sufficiently stabilized they can then return to the operating room for the definitive surgery.
• Some patients have implants inserted, which are removed at a separate operation after healing because the implants may cause or are causing pain or other problems.

Q4. What is the most common cause of pelvic fractures?

The most common pelvic fracture is towards the front (the pubic bones), which occurs in older patients. These fractures are usually due to some thinning of the bones from osteoporosis. A common scenario is a patient loses his or her balance, lands awkwardly and breaks his or her pelvis. It is also possible for patients to lose their balance and cause their muscles to pull so hard against each other that they can pull the pelvis apart.

Most of these fractures will heal themselves with time.

Q5. How do pelvic fractures heal? Do you use a cast or brace?

Most pelvic fractures heal on their own. The local tissues in the area of the fracture frequently keep the fracture pieces in order and the bones heal with a little rest and good nutrition. This tends to occur a little more slowly in older people, but the same cells that heal fractures when you are young do the same when you are older.

We rarely use an orthosis around the pelvis. The good news is that most patients don’t need any bracing or casting for a full recovery.

Allan E. Inglis Jr., M.D.’s practice is dedicated to the surgical treatment of arthritic conditions in adults. He holds a special interest in total joint replacement of the hip, knee, and elbow, and is intimately involved in the custom design of joint replacements in the most difficult cases. He also has extensive experience and expertise in the surgical treatment of fractures of the pelvis and acetabulum, hip, femur (thigh bone), knee and tibia (shin bone).