Pelvic fracture the plague of the elderly

THE most common cause of pelvic fractures in elderly people is falling, but the most significant fractures involve high-impact events such as motor vehicle or cycling accidents, or a fall from significant heights.

However, Yvonne was involved in a car accident two years ago, and said her pelvic bone broke in three places. For three months, she was confined to bed.

“Of those three months, I had to lay still on my back for six weeks, and had a back belt to support my back. While I was bedridden, I underwent physiotherapy on the upper part of my body, although my left foot had a dead feeling due to pain, and I could not even lift that foot.

According to Dr Awadhesh Kumar Pandey, an orthopaedic surgeon based at Oshakati, the management and long-term recovery of pelvic injuries can be complicated. Because of the location of the pelvis, injuries to other structures, such as major blood vessels, the bladder and the uterus (for women) may occur.

The pelvic skeleton is like a ring, with three main joints (a symphysis pubis at the front and two sacroiliac joints at the back), which are held together by strong ligaments. If the ring is ‘disrupted’ due to trauma, the integrity of the pelvis may be altered.

This may require an operation, or several operations, to bring the pelvis back to its pre-injury state.

Yvonne said her pelvic ring suffered a fracture close to the uterus. “It was very painful, and I had to put on that belt. Although I did not go through surgery, my doctor told me that it was serious. I also had to learn how to walk anew after the six weeks I was bedridden,” Yvonne explained.

Pandey says there are different types of pelvic fractures, and they are classified as the ABC fractures.

“A is for stable injuries, and it is basically the small fractures which occur at the anterior part, and do not affect any bone. A patient doesn’t need surgery on these types of fractures, just bed rest,” he said.

Pandey added that the B and C fractures are the unstable types, and both need surgery. However, the B fracture may need no surgery as the bones grow together sometimes.

“This fracture is also known as the ‘open book fracture’ that causes separation of the bones, and needs surgery to close and stabilise the pelvic. And the C fracture is completely disrupted or shifts at more places than two,” Pandey said.

He further explained that in this fracture, there is massive blood loss, and the vital organs which are supposed to be protected by the pelvis get injured.

“Surgery is needed to add metal pins, plates and/or screws to fix the bone that is disrupted or displaced.”

Yvonne stated that she has not fully recovered, and still goes for physiotherapy now and then. She also said she feels very tired when she stands for a long time or walks long distances.

Pandey said healing differs from person to person, but pelvic fractures usually heal completely.

Pain and tenderness in your pelvic bone area, bruising and swelling over your pelvic bones, numbness or tingling in your genital area or in your upper thighs, discomfort or pain when you sit, stand, walk, or have a bowel movement.

Treatment depends on the kind of fracture. You may need prescription pain medicine.

Ask your healthcare provider how to take this medicine safely. Bed rest will be needed while your fracture heals. Apply ice on your hip for 15 to 20 minutes every hour, or as directed. It is advisable to use an ice pack, or put crushed ice in a plastic bag.

Cover it with a towel. Ice helps prevent tissue damage, and decreases swelling and pain. Crutches or a walker may be needed to keep weight off your hip bone until it heals. An external fixation device may also be put on your hips to hold the broken bones together while they heal.

Screws or a clamp is used to hold the device to your pelvic bones. Surgery may be needed for a severe pelvic fracture. Metal pins, screws, or plates may be used to hold your pelvic bone together.

– Additional information from www.drugs.com

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