Rehabilitative management of pelvic fractures: a literature-based update


Submitted: 23 June 2021
Accepted: 15 August 2021
Published: 17 September 2021
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Authors

A comprehensive rehabilitation program is required after Pelvic Fracture (PF). In a PF rehabilitation setting an effective treatment and a proper management of complications is supplied by an appropriate and reliable clinical assessment. In this literature-based update, we search on MEDLINE, EMBASE, and the Cochrane Database of Systematic reviews to find articles, scientific society guidelines and practioners experiences defining the rehabilitative management of clinically PF outcomes. Based on literature evidences and expert opinions, a set of key topics was collated to generate advices and recommendations to put into daily practice. Even if there are no high-quality evidence for rehabilitative interventions after PF in terms of duration and modality of therapy, rehabilitation setting, care pathways, and long-term functional outcomes, it is strongly recommended an early multidisciplinary intervention to improve recovery from PF.


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Rommens PM. Pelvic ring injuries: a challenge for the trauma surgeon. Acta Chir Belg. 1996;96(2):78-84.

Wilker DK, Izbicki JR, Euler E, Schweiberer L. Verletzungen des Beckens und der Retroperitonealorgane [Injuries of the pelvis and retroperitoneal organs]. Urologe A. 1991;30(3):183-188.

Phruetthiphat OA, Willey M, Karam MD, Gao Y, Westerlind BO, Marsh JL. Comparison of Outcomes and Complications of Isolated Acetabular Fractures and Acetabular Fractures With Associated Injuries. J Orthop Trauma. 2017;31(1):31-36. DOI: https://doi.org/10.1097/BOT.0000000000000720

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Raman R, Senior C, Segura P, Giannoudis PV. Management of scrotal swelling after pelvic and acetabular fractures. Br J Nurs. 2004;13(8):458-461. DOI: https://doi.org/10.12968/bjon.2004.13.8.12782

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Čižmář I, Vlček M, Ehler E, Dráč P. Rekonstrukce paréz dolní končetiny po zlomeninách pánve svalovými transfery [Reconstruction of Lower Extremity Palsy after Pelvic Fractures with the Muscle Transfers]. Acta Chir Orthop Traumatol Cech. 2019;86(5):348-352.

Chiodo A. Neurologic injury associated with pelvis fractures: radiology and electrodiagnosis evaluation and their relationships to pain and gait outcome. Arch Phys Med Rehabil. 2007;88(9):1171-1176. DOI: https://doi.org/10.1016/j.apmr.2007.06.004

Cakmak A. Electrical stimulation of denervated muscles. Disabil Rehabil. 2004;26(7):432-433. DOI: https://doi.org/10.1080/09638280410001663157

Jang DH, Byun SH, Jeon JY, Lee SJ. The relationship between lumbosacral plexopathy and pelvic fractures. Am J Phys Med Rehabil. 2011;90(9):707-712. DOI: https://doi.org/10.1097/PHM.0b013e31821f6bd9

Fleiter N, Reimertz C, Lustenberger T, et al. Bedeutung der korrekten Positionierung eines Beckengurts zur temporären Stabilisierung von Beckenringverletzungen [Importance of the correct placement of the pelvic binder for stabilisation of haemodynamically compromised patients]. Z Orthop Unfall. 2012;150(6):627-629. DOI: https://doi.org/10.1055/s-0032-1327796

Hsu SD, Chen CJ, Chou YC, Wang SH, Chan DC. Effect of Early Pelvic Binder Use in the Emergency Management of Suspected Pelvis fractures: A Retrospective Cohort Study. Int J Environ Res Public Health. 2017;14(10):1217. DOI: https://doi.org/10.3390/ijerph14101217

Fu CY, Huang RY, Wang SY, et al. Concomitant external and internal hemorrhage: Challenges to managing patients with open pelvic fracture. Am J Emerg Med. 2018;36(11):1937-1942. DOI: https://doi.org/10.1016/j.ajem.2018.02.014

Yi C, Hak DJ. Traumatic spinopelvic dissociation or U-shaped sacral fracture: a review of the literature. Injury. 2012;43(4):402-408. DOI: https://doi.org/10.1016/j.injury.2010.12.011

Wong LC, Chiu WK, Russ M, Liew S. Review of techniques for monitoring the healing fracture of bones for implementation in an internally fixated pelvis. Med Eng Phys. 2012;34(2):140-152. DOI: https://doi.org/10.1016/j.medengphy.2011.08.011

Ruedi T. AO principles of fracture management. New York: Thieme; 2007.

Khan F, Amatya B, Hoffman K. Systematic review of multidisciplinary rehabilitation in patients with multiple trauma. Br J Surg. 2012;99 Suppl 1:88-96. DOI: https://doi.org/10.1002/bjs.7776

Meys G, Kalmet PHS, Sanduleanu S, et al. A protocol for permissive weight-bearing during allied health therapy in surgically treated fractures of the pelvis and lower extremities. J Rehabil Med. 2019;51(4):290-297. DOI: https://doi.org/10.2340/16501977-2532

Bergstrom N, Bennet MA, Carlson et al.: pressure ulcer treatment clinical practice guideline. Quick reference guide for clinicians, No 15, Rockville, MD, US Department of health and human service. Agency for health care policy and research. AHCPR publication No 95-0653. December 1994.

Szulc P. Impact of Bone Fracture on Muscle Strength and Physical Performance-Narrative Review. Curr Osteoporos Rep. 2020;18(6):633-645. DOI: https://doi.org/10.1007/s11914-020-00623-1

Rice LA, Ousley C, Sosnoff JJ. A systematic review of risk factors associated with accidental falls, outcome measures and interventions to manage fall risk in non-ambulatory adults. Disabil Rehabil. 2015;37(19):1697-705. DOI: https://doi.org/10.3109/09638288.2014.976718

Milner-Brown HS, Miller RG. Muscle strengthening through high-resistance weight training in patients with neuromuscular disorders. Arch Phys Med Rehabil. 1988;69(1):14-19.

Cup EH, Pieterse AJ, Ten Broek-Pastoor JM, et al. Exercise therapy and other types of physical therapy for patients with neuromuscular diseases: a systematic review Arch Phys Med Rehabil 2007;88:1452-64 DOI: https://doi.org/10.1016/j.apmr.2007.07.024

AO Foundation. 2014. Available from: www.aofoundation.org

Schmal H, Hauschild O, Culemann U, et al. Identification of risk factors for neurological deficits in patients with pelvic fractures. Orthopedics. 2010;33(8):10.3928/01477447-20100625-13. DOI: https://doi.org/10.3928/01477447-20100625-13

Kaiser R. Chirurgická léčba poranění nervů dolních končetin [Surgical treatment of lower extremity peripheral nerve injuries]. Cas Lek Cesk. 2016;155(3):16-20.

Kim JW, Shon HC, Park JH. Injury of the obturator nerve in the modified Stoppa approach for acetabular fractures. Orthop Traumatol Surg Res. 2017;103(5):639-644. DOI: https://doi.org/10.1016/j.otsr.2017.03.005

Conway RR, Hubbell SL. Electromyographic abnormalities in neurologic injury associated with pelvic fracture: case reports and literature review. Arch Phys Med Rehabil. 1988;69(7):539-541

Studer P, Kosuge D, Rickman M, Solomon LB. Versatility of an Extended Posterior Approach for the Treatment of Acetabular Fractures With Reference to the Superior Gluteal Neurovascular Bundle. J Orthop Trauma. 2016;30(8):e289-e293. DOI: https://doi.org/10.1097/BOT.0000000000000545

Bogdan Y, Tornetta P 3rd, Jones C, et al. Neurologic Injury in Operatively Treated Acetabular Fractures. J Orthop Trauma. 2015;29(10):475-478. DOI: https://doi.org/10.1097/BOT.0000000000000362

Beaulé PE, Antoniades J, Matta JM. Trans-sacral fixation for failed posterior fixation of the pelvic ring. Arch Orthop Trauma Surg. 2006;126(1):49-52. DOI: https://doi.org/10.1007/s00402-005-0069-2

Lehmann W, Hoffmann M, Fensky F, et al. What is the frequency of nerve injuries associated with acetabular fractures?. Clin Orthop Relat Res. 2014;472(11):3395-3403. DOI: https://doi.org/10.1007/s11999-014-3838-9

Lao A, Putman S, Soenen M, Migaud H. The ilio-inguinal approach for recent acetabular fractures: ultrasound evaluation of the ilio-psoas muscle and complications in 24 consecutive patients. Orthop Traumatol Surg Res. 2014;100(4):375-378. doi:10.1016/j.otsr.2014.02.006 DOI: https://doi.org/10.1016/j.otsr.2014.02.006

Mirovsky Y, Neuwirth M. Injuries to the lateral femoral cutaneous nerve during spine surgery. Spine (Phila Pa 1976). 2000;25(10):1266-1269. DOI: https://doi.org/10.1097/00007632-200005150-00011

Quan RF, Yang DS, Wang YJ. Study of the morphology and biomechanics of sacral fracture. Chin J Traumatol. 2006;9(5):259-265.

Kimura J. Electrodiagnosis in diseases of nerve and muscles: principles and practice. Oxoford University Press. 2001.

Kim DH, Murovic JA, Tiel RL, Kline DG. Intrapelvic and thigh-level femoral nerve lesions: management and outcomes in 119 surgically treated cases. J Neurosurg. 2004;100(6):989-996. DOI: https://doi.org/10.3171/jns.2004.100.6.0989

Parizotto NA. Is electrical stimulation a consolidated treatment for denervated muscles and functional recovery after nerve injuries?. Muscle Nerve. 2011;43(2):299-300. DOI: https://doi.org/10.1002/mus.21833

Kern H, Salmons S, Mayr W, Rossini K, Carraro U. Recovery of long-term denervated human muscles induced by electrical stimulation. Muscle Nerve. 2005;31(1):98–101. DOI: https://doi.org/10.1002/mus.20149

Pieber K, Herceg M, Paternostro-Sluga T, Schuhfried O. Optimizing stimulation parameters in functional electrical stimulation of denervated muscles: a cross-sectional study. J Neuroeng Rehabil. 2015;12:51. DOI: https://doi.org/10.1186/s12984-015-0046-0

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