How To Manage Pelvic Ring Fractures In The Elderly

The pelvic area plays an important role in your body by supporting your head and torso. However, as you grow and age, your body becomes more fragile, more vulnerable to various illnesses, and more prone to accidents. 

Meanwhile, accidents in the pelvic area may cause fractures, which can lead to long-term health issues. Although the primary goal is to provide appropriate first aid to victims during accidents, it takes a few minutes for emergency response teams (EMTs) to arrive at the scene.

To avoid further injury, you can use a pelvic belt to effectively stabilize and reduce open-book pelvic ring fracture. It’s one of the helpful inventions that uses optimal force stabilization.

What Are Pelvic Ring Fractures?

The pelvic ring is used to describe the orientation of the three innominate bones of the hip, namely the ilium, ischium, and pubis. They serve as a broad area for muscular attachments. 

In addition, they act as support for the upper part of the body and as an axis for the rotational movements. A coordinated rhythmic pelvic swing is responsible for the smooth translation of the trunk and lower extremities. 

On the other hand, trips, falls, or motor vehicular accidents (MVA) are the primary causes of pelvic ring fractures. Unlike your limbs, the pelvic region houses many vital organs like the stomach, liver, and intestines. It’s also connected to the backbone, which contains the spinal cord. Thus, these types of fractures must be given immediate medical attention.

Management Of Pelvic Ring Fractures For The Elderly

Older people have delicate bones and tissues due to cellular aging or in the presence of an underlying condition. Their immune systems may also be compromised. Therefore, this can lead to a weak defense system against bacteria or inflammation, and a delayed healing process. 

Proper medical management is vital to prevent the worsening of injuries and preserve life. Here are the following treatments:

1. First Aid 

First aid is the initial management of pelvic ring fractures. It’s one of the crucial stages because the EMTs need proper knowledge to find the source of bleeding in an open wound. 

In addition, they need to determine if there’s a potential for a hip fracture. Furthermore, they should be able to provide the necessary tools to immobilize the patient and stabilize their condition before reaching the hospital. 

2. Thorough Medical Assessment

senior doctor xray results scaled
Doctor checking a senior female patient’s x-ray image during a visit at the hospital, injury and osteoporosis concept

A thorough medical assessment includes an interview with the patient if conscious, a physical examination, and diagnostic imaging results. They’re required to determine the type, direction, degree of instability, and severity of the fracture. Attaining the proper diagnosis is essential to start planning the treatment procedure. 

On the other hand, pelvic ring fractures are diagnosed through medical imaging such as X-rays and computerized tomography (CT) scans. An orthopedic surgeon will examine the initial findings, assess the patient, and determine an accurate diagnosis. 

The fractures are classified according to type, direction, degree of instability, and severity. Here are the following: 

  • Anteroposterior Compression (APC)
  • APC I: A stable fracture with less than 2.5cm pubic diastasis
  • APC II: Vertically stable but rotationally unstable; pubic diastasis is greater than 2.5cm
  • APC III: Unstable; the presence of a total hemipelvis separation but without a vertical displacement; pubic diastasis is more than 2.5cm
  • Lateral Compression (LC) 

Occurs when the pubic rami have a transverse fracture or if they’re broken perpendicular to their length. It’s the most common type of pelvic ring fracture.

  • LC I: A stable fracture; the presence of an oblique fracture in the pubic rami
  • LC II: Vertically stable but rotationally unstable; ipsilateral iliac wing fracture
  • LC III: The combination of LC II and contralateral APC
  • Vertical Shear (VS) 

Occurs when displaced fractures occur in the anterior and posterior areas. It includes a joint dislocation and is, therefore, considered completely unstable.

  • Combined Mechanism (CM) Fracture

Combination of APC, LC, and/or VC. It’s completely unstable and may include internal organ damage. 

3. Conventional And Non-Surgical Treatment

Bones can heal on their own. However, the natural healing process may be compromised due to old age and comorbidities such as diabetes, hypertension, heart problems, and other systemic diseases. 

The patient needs to be admitted and be under close monitoring for minor fractures until the overall condition is stabilized. Non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics are given to treat inflammation and alleviate pain. The recovery period may last for six to twelve weeks. 

The diagnostic tests need to be repeated to document the progression or regression. Physical therapy is highly recommended to teach the elderly how to use assistive devices like crutches or walkers. This is to prevent falls and teach compensatory movements to avoid putting stress on the fracture site.

4. Invasive Or Surgical Treatment

Invasive or surgical treatment is needed for moderate-to-severe cases. The decision and type of surgical treatment depend on the surgeon’s discretion. For older people, high-strength and advanced metal devices, compression screws, and side plates are preferred to replace shattered bones. 

Physical therapy must begin after a few days, when the inflammation and pain in the surgical site have reduced. Early mobilization is needed to promote blood circulation and prevent overall body deconditioning. 

Takeaway

The safety and security of older people must always be prioritized. Assistive devices may be provided, and a trustworthy person accompanies or drives them to their appointments. When a pelvic ring fracture is acquired, adhere to the treatment regimen given by the doctor to ensure a safe and fast recovery.

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Rasha

When I'm not volunteering my time at a local nonprofit, I write about family. Running a household isn't easy, but I'll do my best to share my insights!

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