7 Ways to Manage Pelvic Fracture in Elderly: Treatment, Prognosis, and Helpful Tips

Last update: September 2023
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What are the different types of pelvic fractures in the elderly?

Pelvic fractures (= fractures of the pelvis)g in the elderly are relatively common, particularly among women over 60 years of age.

Here are the three most common types of pelvic fractures:

1.  pelvic ring fractures (74%),
2. acetabular fractures (20%);
3. and combined pelvic ring/acetabular fractures (6%).

Other types and names of pelvic fractures:

1. Pubic rami fracture, at the level of the pubis.
2. Sacral pelvic fractures. These fractures occur when the sacrum, located at the base of the spine, is damaged. They can cause pain in the lower back, which is the main symptom.
3. Iliac bone fractures. The iliac bone is the upper part of the pelvis. Fractures of the iliac bone are often associated with fractures of the spine (such as compression vertebral fractures).

Sometimes the fracture line affects multiple bones. That’s why you might sometimes read on your X-ray report “sacroiliac fracture,” “ilioischial fracture,” or similar terms.

Other terms used include:

• “Double pelvic fracture” when two bones of the pelvis are fractured, when you break your pelvis in two places.
• “Crack” or “fissure”: The fracture line is more subtle, less severe than in the case of a complete fracture.
• “Spontaneous fracture”: A fracture that occurs without a fall, trauma, or accident. This is often due to osteoporosis in elderly individuals.
• Pelvic fracture icd 10 (WHO classification), openbook pelvic fracture, hairline pelvic fracture, superior pubic ramus fracture, unstable pelvic fracture, ischium fracture, pubic symphysis fracture, lc1 pelvic fracture, pelvic insufficiency fracture, parasymphyseal fracture pelvis.

All of these fractures can be displaced or non-displaced (less severe). The treatment will partly depend on whether the fracture is displaced or not. Displaced means that there is a significant gap between the two ends of the bone fragments where the fracture line is located.

Pubic rami fracture

Fracture of the pubic rami is the most common fracture in elderly individuals. It often occurs as a result of a fall on the side and causes pain in the groin area.

Superior and inferior pubic rami fracture can be broken.

These are parts of the pelvis that connect the pubic bone to the iliac bone.

They are often categorized as simple fractures, as opposed to other complex fractures (Wu 2020).

Obturator ring pelvis fracture

The obturator ring is a small, hole-shaped opening in the pelvic bone, located near the hip joint. Obturator ringfractures occur when there is a fracture of the bone surrounding the opening, usually caused by a fall or direct trauma.

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Fractures of pubic rami are most common in elderly individuals. It is common for the pelvis to be fractured in multiple places, but this does not necessarily mean that the recovery will be longer or more difficult.

Acetabular fractures also exist but are rarer in elderly individuals than in younger individuals (Küper 2019).

What is the treatment for a pelvic fracture in an elderly person?

In an elderly person, it is important to strike a balance between two aspects:

• Ensuring proper bone healing by avoiding excessive stress on the fracture site.
• Preventing complications associated with surgery or loss of physical function due to immobilization.

That’s why, for the same fracture, the approach can vary significantly depending on age, overall health, and functional status prior to the fracture.

What is the fastest way to heal a broken pelvis?

A doctor or surgeon has reviewed and interpreted the results of your X-ray. Based on the X-ray (or a CT scan or MRI), as well as a clinical examination and review of your medical history, the healthcare professional will try to determine:

• The stability of your fracture: Whether the bone fragments are at risk of shifting if you move or walk a lot in the coming weeks. Is surgery necessary (rare in elderly individuals) to stabilize or fix the fracture? Bed rest? A restriction on sitting?
• The risks you may face if you remain bedridden for several weeks after the fracture. Strict bed rest for 10-12 weeks (2 to 3 months) is often recommended for significant pelvic fractures in younger individuals, typically after a major accident. However, this is much less common in older individuals due to the higher risk of deconditioning.

The orthopedic doctor or surgeon will provide recommendations on the course of action, whether you have undergone surgery or not:

• Are you allowed to walk? If yes, are you permitted to bear full weight on the leg based on pain tolerance, or do you need to avoid putting too much weight on it?
• Do you need to remain bedridden in a strict supine position (or with the head elevated up to 30°)? For how long (often several weeks)?
• Should you review or initiate treatment for osteoporosis?

These recommendations are typically provided verbally. They are also documented in your examination or hospitalization report and sent to your primary care physician, often your physiotherapist as well.

If the recommendations seem inappropriate for your situation, you can discuss them with your primary care physician or physiotherapist.

Often, there is no surgery for a pelvic fracture in an elderly person. The treatment is then referred to as “conservative” and primarily focuses on gradually resuming mobility as quickly as possible.

What is the rehabilitation process for a pelvic fracture?

To my knowledge, most elderly individuals with a pelvic fracture receive a prescription for rehabilitation sessions provided by a physiotherapist.

Often, physiotherapy sessions are conducted at home for people who are unable to travel.

Sometimes, people are admitted to a rehabilitation center or a post-acute care facility.

Here are the most frequently asked questions by my patients or their loved ones regarding this matter, along with my responses!

When should rehabilitation begin?

After a pelvic fracture in an elderly person, I recommend consulting with a physiotherapist as soon as you return home.

Initially, it may not be for immediately starting regular and active sessions. But rather to assess what you can currently do throughout the day:

• How to move safely without excessive pain
• How to get out of bed or a seated position
• How to use the bathroom and maintain personal hygiene
• Is it better to walk or perform occasional exercises?
• And simply, to provide reassurance. Feeling supported and surrounded by care is an important criterion for a successful recovery and overall good health.

Elderly people who already had difficulties before the fall that resulted in the fracture may experience post-fall syndrome. This can involve significant difficulties in standing and walking, with a backward imbalance. Therefore, it is essential to consult a physiotherapist promptly to assess the possibilities.

Begin physical therapy upon returning home after a pelvic fracture.

What does physiotherapy rehabilitation involve?

The goal of physiotherapy is to help you regain your previous lifestyle as quickly as possible (to the extent possible). Together with your physiotherapist, you will identify your priority goals and work on strategies to achieve them, either independently or with their assistance:

Relieving pain Walking a few steps Climbing and descending stairs Going outside Reducing reliance on walking frames, walkers, or crutches In some cases, maintaining mobility, strength, and flexibility during the immobilization period (which can last several weeks)

Physiotherapists assist you in setting realistic goals and timelines. By encouraging early mobilization, they help minimize the risk of complications associated with immobility (such as pressure ulcers, muscle atrophy, and blood clots).

Physiotherapists, along with nurses and primary care physicians, are experienced in providing daily care to individuals in your situation. These professionals can address your questions and provide reassurance. Offering reassurance is a significant part of their role as healthcare providers!

There is no standardized protocol or specific muscle strengthening or balance exercises that must be performed. The essence of the treatment lies in gradually resuming your activities.

Step by step, the idea is to increase your daily physical activity until you regain your previous level of functioning!

I can’t find a physiotherapist… Is it serious?

Depending on where you live, you may encounter difficulties in finding a physiotherapist in a clinic or for home visits.

Are you certain that you have explored all avenues to find a physiotherapist, yet you still don’t have an appointment or can only secure one several weeks later?

Please read this article carefully; it should provide you with numerous options for self-rehabilitation. If you have any concerns, reach out to your nurse or primary care physician.

Many people do not undergo physiotherapy sessions after a pelvic fracture (either due to lack of prescription or their ownh choice) and do not necessarily experience a slower or less complete recovery.

Therefore, please be reassured; if you are reading this article, even if you haven’t been able to find a physiotherapist, you likely have all the resources to manage on your own 💪!

Is it normal to experience pain after a pelvic fracture?

Even a “small” crack or fracture in the pelvis is generally quite painful (unless you’re one of the exceptions!). Good news: the intensity of the pain is not necessarily linked to the time it will take for you to recover.

The pain usually decreases over the course of days, sometimes weeks, and rarely months.

Several things can be implemented to limit, prevent, or relieve the pain:

• Proper positioning in bed and in the chair. Don’t hesitate to use a lot of pillows for support.
• Regular movement.
• Using a walker, crutches, or a walking frame to relieve pressure. Also, using armrests and handles for sitting and getting up.
• Applying cold packs to the painful area.
• Taking pain medication.

Pain is common after a pelvic fracture and is not necessarily a sign of complications or concern. It usually diminishes within the first few days or first month.

When can one start walking again after a pelvic fracture?

When you have been diagnosed with a pelvic fracture, you are typically informed whether you are allowed to walk immediately or not. If you have been instructed not to walk, you were likely given a specific duration for this restriction (often at least one month, and sometimes 2 or 3 months).

Alternatively, you may be instructed to wait for a scheduled follow-up X-ray to assess the progress of healing and determine if weight-bearing is possible.

Once you are given permission to walk, you can gradually resume walking to recondition your lower limb and muscles. Initially, you may rely on crutches or a walker for support.

The return to walking “as before” generally takes at least one month, sometimes 2 or 3 months.

If you were not given any specific instructions regarding walking, it means that walking is possible once you are back home, depending on the level of pain. You may still need crutches or a walker for a few days (sometimes weeks) to alleviate pain.

100% of elderly individuals hospitalized after a pelvic fracture require crutches or a walker, and over half of them also need additional human assistance to be able to walk (Morris 2000). 84% of them require external assistance once they are at home.

Broken pelvis recovery: Can elderly recover from a pelvic fracture?

The prognosis for the quality and speed of recovery does not depend so much on the location of the fracture or the anatomical structure of the pelvis affected but rather on the presence or absence of associated vascular damage. This refers to a significant hematoma (Wu 2020).

	Typical Timeframe
Bone healing	6-12 weeks
Reduction in pain	Few days to a few weeks
Resumption of walking with crutches or walker	Immediately – Sometimes as early as 2 months
Length of hospital stay	Few days (although a study conducted in the United Kingdom indicates that the average hospital stay after a pelvic fracture in elderly individuals was 18 days, but this data is from the 1990s! (Source: Morris 2000). A study published in 2020 provides shorter average durations of 10 to 13 days depending on the severity of the fracture (Source: Wu 2020).
Full functional and muscular recovery	2 months – 1 year

The recovery time for a pelvic fracture in elderly ranges from a few weeks to a few months.

What are the complications after a pelvic fracture in the elderly?

The most common complications following a pelvic fracture in an elderly person are not so much due to the fracture itself but rather to the consequences of immobilization and loss of mobility.

However, these complications are more of an exception than the rule. Here are the most frequent ones:

1. Osteopenia: the bones lose density and become more fragile.
2. Pulmonary infection.
3. Deep vein thrombosis and the risk of blood clots. (Küper 2019)

The primary action to prevent these complications? Move as much as possible, considering any contraindications and your abilities.

If there are no contraindications, compression stockings may also be recommended to prevent the risk of thrombosis.

Some elderly people may need to live in institutional settings (nursing homes, assisted living facilities, housing facilities) following the pelvis fracture due to loss of autonomy. Approximately 10% according to older data from the United Kingdom based on a small sample (Morris 2000).

What should be avoided during pelvis fractures?

Some people with a pelvic fracture must strictly remain bedridden. Therefore, they cannot get up to take a shower. In such cases, here are some tips for still maintaining personal hygiene:

• If you are in the hospital or a rehabilitation center, there are sometimes bathrooms and stretchers adapted to allow for occasional proper showers.
• At home, a sponge bath is often necessary, using a washcloth. You can usually roll onto your side as a whole unit. Your physiotherapist, nurse, or caregiver can show you how to turn. You will likely need the assistance of another person to clean yourself everywhere, at least initially.

For elderly individuals who theoretically have the ability to stand but are not stable enough, there are shower chairs that can be adapted even in small spaces, or seats that can be adjusted for bathtubs.

These devices can be purchased online, but you can also obtain them for purchase (and sometimes for rent) from medical supply stores. They are also available, albeit less commonly, at pharmacies.

What is the life expectancy after a pelvic fracture?

Hundreds of people in United-States alone wonder each month about the life expectancy of someone who has broken their pelvis.

Different studies follow individuals diagnosed with a pelvic fracture and examine how many of them pass away in the days, weeks, or months that follow. This is the mortality rate.

Ideally, this data should be compared to the number of deaths in people of the same age who have not experienced a pelvic fracture because people also pass away in these populations.

Here are some figures from this type of study:

🇦🇹 Austria – Data from the 2010s (Behanova 2022): The mortality rate one year after the fracture was higher in men than in women (13.0% and 11.1%, respectively). Patients with pelvic fractures aged ≥65 years had a high risk of mortality compared to controls.

🇺🇸 United States – Data from the 2010s (Siada 2017): The mortality rate at 3 months for open pelvic fractures decreased between the 2000s and 2010s, from 44% to 16%.

🇰🇷 South Korea – Data from the 1990s (Chong 1997): The overall mortality of patients with pelvic fractures was 10.5%, which is 1.4 times higher than that of other trauma patients during the same period without pelvic fractures. Mortality was significantly higher in patients over 60 years old (37% mortality vs. 8%).

🇫🇮 Finland – Data from the 2010s (Reito 2019): Compared to the general population, a pelvic fracture was associated with a 8.5- and 11.0-fold increased risk of mortality at 90 days for women and men, respectively (95% CI: 5.4-22.3). The risk of mortality at 90 days is the same for patients with a femoral neck fracture and those with a pelvic fracture.