Complex Pelvic Fractures and Their Treatment Options

Pelvic crush fracture with right acetabular fracture?

Dear Doctor,
My husband is the patient who was involved in a car accident on January 28, 2022.
The medical summary indicates that he sustained a comminuted fracture of the right acetabulum with mild displacement, as well as contusions and lacerations to the forehead, and a concussion resulting in head injury.
The orthopedic surgeon mentioned that the bone injuries are fractures, and although there is slight displacement near the pelvic ring, it remains symmetrical.
The risks associated with surgery are quite high, and it was decided that he could either undergo surgery or not.
Consequently, my husband chose to follow the doctor's advice and not have surgery.
He was hospitalized for 13 days, during which he received IV fluids and medication for the first five days, along with daily rounds and consultations.
Upon discharge, he was prescribed medication and advised to have someone assist him with daily care, to rest for three months, and to avoid prolonged standing or labor-intensive work, with follow-up outpatient treatment recommended.
However, no fixation or support devices were applied to the injury site, which leaves me, as the caregiver, confused.
Does this increase the risk of a secondary fracture?
At this moment, I feel lost in navigating the medical care, fearing that I might lead him down a difficult path.
I am overwhelmed by ignorance and fear.
Therefore, I would like to ask you, is this the standard approach to treatment? He has a follow-up appointment on March 1, and due to difficulties with urination, he was also referred to urology.
It was then revealed that his bladder was displaced due to significant bleeding.
No wonder his blood pressure was low during the first few days in the hospital; it was likely due to ongoing bleeding.
I would like to inquire if the bladder can return to its normal position and whether there will be any long-term consequences.
I kindly ask for your guidance.
Thank you.

Lin, 50~59 year old female. Ask Date: 2022/03/02

Dr. Wang Jiacheng reply Orthopedics

After a hip joint fracture, there is a possibility of developing arthritis many years later, which requires ongoing monitoring.
As for bladder issues, it may be necessary to consult a urologist.

Reply Date: 2022/03/02

More Info

Complex pelvic fractures, such as the one your husband has sustained, can be quite challenging to manage due to the intricate anatomy of the pelvis and the potential for associated injuries. In your husband's case, he has a comminuted fracture of the right acetabulum with slight displacement, which can complicate the healing process and functional recovery.

Understanding the Injury
The pelvis is a ring-like structure that supports the weight of the upper body when sitting and standing and protects the pelvic organs. A comminuted fracture means that the bone is broken into several pieces, which can lead to instability in the pelvic ring. The slight displacement noted in the fracture can also affect the alignment of the pelvis, potentially leading to complications such as chronic pain, difficulty walking, or even issues with bladder function, as you've mentioned.

Treatment Options
The decision to operate on a pelvic fracture often depends on several factors, including the degree of displacement, the patient's overall health, and the presence of other injuries. In cases where the fracture is stable and the risk of surgery outweighs the benefits, conservative management is often recommended. This typically includes:
1. Rest and Activity Modification: Your husband has been advised to avoid standing for long periods and to refrain from heavy labor. This is crucial to allow the fracture to heal properly.

2. Pain Management: Medications are often prescribed to manage pain and inflammation. It's important to follow the doctor's instructions regarding medication use.

3. Physical Therapy: Once the initial healing has occurred, physical therapy may be introduced to help regain strength and mobility. This should be done under the guidance of a healthcare professional.

4. Monitoring: Regular follow-up appointments are essential to monitor the healing process and to make adjustments to the treatment plan as necessary.

Concerns About Non-Surgical Management
Your concern about the lack of immobilization or protective devices is understandable. In some cases, especially with stable fractures, doctors may opt not to use braces or casts, as they can sometimes hinder circulation and healing. However, it is crucial to ensure that your husband is following the doctor's advice regarding activity levels and is not putting undue stress on the injury.

Bladder Concerns
Regarding the bladder issue you mentioned, it is not uncommon for pelvic fractures to affect surrounding structures, including the bladder. The displacement of the bladder due to bleeding can lead to urinary retention or difficulty urinating. The good news is that with appropriate care, the bladder can often return to its normal position and function. However, this may take time, and ongoing monitoring by a urologist is advisable to assess any potential long-term effects.

Conclusion
In summary, while the conservative approach may seem daunting, it is often the best course of action for certain types of pelvic fractures. It is essential to maintain open communication with your husband's healthcare team, ask questions, and express any concerns you may have. If you feel uncertain about the treatment plan or if your husband's condition changes, seeking a second opinion from another orthopedic specialist may provide additional reassurance and guidance.

Your husband's recovery will take time, and patience will be key. With proper care and rehabilitation, many patients can regain their function and return to their normal activities.

Similar Q&A

Can Pelvic Fractures Be Repaired? A Case Study of Recovery Options

My sister was in a car accident, and her pelvis was run over by a garbage truck. The doctor diagnosed her with a shattered pelvis, and the section near the femur is almost completely broken. There is significant bleeding from the nerves, and she has already undergone surgery to c...

Dr. Zhou Lizhi reply Orthopedics
Pelvic fractures are a serious major trauma, and their impact extends beyond the pelvic bones themselves to include issues related to nerves, blood vessels, the reproductive system, and the presence of open wounds. Therefore, each patient's condition is different. If there i...

Understanding Pubic Bone Fractures: Treatment Options and Recovery

Hello, doctor. I would like to ask for your opinion because my family member was in a car accident. An X-ray revealed a displaced fracture of the left pubis, a fracture above the right pubis, an open fracture of the left femur, a fractured left patella, and intracranial hemorrhag...

Dr. Shi Guozheng reply Orthopedics
The pubis is a bone that surrounds the pelvis, which functions like a ring, with ligaments and muscles attached to the surrounding bones. If there is a fracture on only one side of the pubis, it is considered a stable fracture, and surgical intervention may not be necessary. Howe...

Effective Treatment Options for Cartilage Compression Injuries

A 27-year-old female friend woke up in the morning with sudden pelvic pain. After visiting an orthopedic clinic, the doctor diagnosed her with cartilage compression and bone contusion. What treatment options or recommendations are available?

Dr. Li Yongheng reply Orthopedics
Hello, generally speaking, pelvic pain should be evaluated to rule out pelvic infections. If there is no infection, attention should be paid to posture, avoiding bending and lifting heavy objects, and training the core muscle groups, which should significantly improve pelvic pain...

Managing Severe Nerve Pain After Complex Pelvic and Foot Injuries

Hello, Doctor. Last August, I had an accidental fall from a height resulting in a complex pelvic fracture and crush fractures in both feet. The sensation in my left foot is abnormal; it feels like there are two wires underneath my shoe, and the nerve pain is unbearable. My attend...

Dr. Zhang Junwei reply Neurosurgery
Due to the lack of detailed medical history and examination records, I am unable to provide an answer. It is recommended to consult a physician in an outpatient setting with the medical records in hand.