A pelvic fracture is a break in 1 or more bones in the pelvis. It is sometimes referred to as a "hip fracture" or "broken hip" because it occurs in the bones that make up the hip area. A pelvic fracture causes difficulty walking or standing. It can also cause abdominal pain, bleeding from pelvic cavities, and difficulty urinating. Pelvic fractures in the United States are relatively rare, making up 0.3% to 6% of all fractures. Pelvic fractures are most common in people 15-28 years of age. In people younger than 35, males suffer a higher incidence of pelvic fractures than females. In people older than 35, females suffer pelvic fractures more often than males.
Fractures of the neck of the femur are most common in postmenopausal women, as their estrogen levels decrease and the body naturally becomes less efficient at absorbing vitamins and minerals, such as calcium, vitamin D, and phosphates - and will increase the risk of osteoporosis and risk of future fractures.
Spontaneous and mild-trauma (falling from standing height or less) fractures of the femur are clinical signs of osteoporosis.
What is a Pelvic Fracture (Hip Fracture)?
A pelvic fracture is a crack or break in one or more of the pelvic bones, which are located at the base of the spine. The pelvis is often referred to as part of the hip. (When you "put your hands on your hips," your hands are actually resting on your pelvic bones.)
A pelvic fracture can result from a low-impact or high-impact event.
Low-impact pelvic fractures most commonly occur in 2 age groups: adolescents and the elderly. Adolescents typically experience fractures of the tips of 1 of the pelvic bones, resulting from an athletic injury (football, hockey, skiing) or an activity such as jogging. Pelvic fractures also can occur after minor falls in people with osteoporosis or even occur spontaneously when bones are weak. The elderly frequently suffer fractures of the thicker part of the pelvic bones. These "pelvic ring fractures" result from falling onto the side of the hip. These falls can be caused by balance problems, vision problems, medication side effects, general frailty, or unintended obstacles such as pets underfoot, slippery floors, or rumpled rugs. Low-impact pelvic fractures often are mild fractures, and they may heal with several weeks of rest. Physical therapy is very helpful in restoring strength and balance in these cases.
High-impact pelvic fractures most commonly result from major incidents such as a motor vehicle accidents, a pedestrian being struck by a vehicle, or a fall from a high place. These pelvic fractures can be life-threatening, require emergency room care, surgery, and extensive physical therapy rehabilitation.
How Can a Physical Therapist Help?
Pelvic fracture recovery often involves surgery or long periods of bed rest. In the case of athletes, avoidance of sport activities is recommended until pain has resolved. During these periods of rest, which are usually weeks to months, a person often loses strength, flexibility, endurance, and balance abilities.
Physical therapists can help you recover from a pelvic fracture by improving your:
- Pain level
- Hip, spine, and leg motion
- Strength
- Flexibility
- Speed of healing
- Speed of return to activity and sport
When you are cleared by your physician to begin physical therapy, your physical therapist will design a specific treatment program to speed your recovery, including exercises and treatments you should do at home. This program will help you return to your normal life and activities and reach your recovery goals.
The First 24-48 Hours
Your physical therapist may help you learn to use crutches so you can move around your 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.
Reduce Pain
Your physical therapist can use different types of treatments and technologies to control and reduce your pain, including ice, heat, ultrasound, electrical stimulation, taping, exercises, and special hands-on techniques called manual therapy that gently move your muscles and joints.
Your 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 your leg and hip joint, and progress to active exercises and stretches that you perform yourself. 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.
Improve Strength
Certain exercises will benefit your healing at each stage of recovery, and your 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.
Improve Balance
The hip area contains many muscles that are vital for balance and steadiness when walking or performing any activity. Your physical therapist will teach you effective exercises to restore strength and endurance to these muscles so that you can regain your balance.
Speed Recovery Time
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.
Return to Activities
Your 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.
Prevent Future Problems
Your 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.
If Surgery Is Necessary
If surgery is required, your physical therapist will help you minimize pain, restore motion and strength, and return to normal activities in the speediest manner possible after surgery.
Can this Injury or Condition be Prevented?
Pelvic fracture can be prevented by:
- Warming up before starting any sport or heavy physical activity. Your warm-up should include stretches taught to you by your physical therapist, including stretches for the muscles on the front, side, and back of the hip.
- Increasing the intensity of an activity or sport gradually, not suddenly. Avoid pushing yourself too hard, too fast, too soon.
- Following a reasonable and safe nutritional plan. Nutritional factors can contribute to osteoporosis, which can put you at higher risk of pelvic fracture.
- Maintaining good balance skills. Balance problems can increase the risk of falling and thus increase the risk of incurring a pelvic fracture. Physical therapy can help maintain and improve balance ability, which can help prevent falls.
- Driving safely to avoid motor vehicle accidents.
- Clearing your house of obstacles that you could trip over, and eliminating slippery walking surfaces.