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Had multiple fracture on pelvic bone, not progressing with the pain. Advise?

Apr 2013
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General Surgeon
Practicing since : 2008
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My wife has been in the hospital now for 3.5 weeks with a multiple fractures of her pelvic bones. She is in a small rural hospital and I'm concerned that she does not seem to be progressing as they think she should especially with the pain. Should I have her moved to a larger more specialized facility?
Posted Thu, 4 Jul 2013 in Bones, Muscles and Joints
Answered by Dr. Ivan R. Rommstein 37 minutes later
Hi and welcome to XXXXXXX

Thank you for your query.

The only reason why she should go to more specialized facility is necessity of complex surgical procedure. If she wasn't managed surgically and there wasn't serious XXXXXXX pelvic bleeding then recovery would be the same in every hospital in country. Pain control is very simple and there are several categories of painkillers which can be used depending on intensity of pain. Every hospital has all these painkillers on disposition and I am sure that doctors can recognize is there need for nonsteroidal painkillers, narcotics, mild opiates or for strong opiates.

Pelvic fractures heal slowly and more than 12 weeks must pass till 50% of bone strength is recovered. But pain subsides much faster and after 6 weeks it shouldn't be felt in rest anymore.

I don't know the type of fracture but in most of it,strict rest is necessary. She should be able to stand only after the pain subside. It is only important to prevent bedsores and clotting incidents. Healing cant be facilitated or speeded up unfortunately, so you just need patience and optimism.

Wish you good luck. If you have any questions I ll be glad to help.

Above answer was peer-reviewed by
Follow-up: Had multiple fracture on pelvic bone, not progressing with the pain. Advise? 2 hours later
Thank you doctor! Your review of the case of course is limited by no x-rays or CT scans. It seems that even though there are fractures they seem to be in place according the CT scan. No one has even told us what to expect in terms of healing (the Dr. and nurses all say everyone is different) and you have given us some ball park figures to consider. We are in Winner, SD over 800 miles from home and are considering transporting her to Salt Lake City when she will be able to tolerate travel by automobile. When in your opinion would it be tolerable for her to travel given a reasonable tolerance to pain?
Answered by Dr. Ivan R. Rommstein 3 hours later

Thanks for writing back.

Definitely not before 6-7 week. Pelvic fractures are complex ones and pain is just one problem . Other one are movements during transport which may have bad effect on fracture fragments especially since she has osteoporosis. So it is better to be bit more patient, repeat xray every 3 weeks and see is there improvement. Some signs of healing should already be seen, but it is still to early to talk about prognosis.
Do you know the name of fracture? is it pubic bone, ilium, ischium or acetabulum or this is sacral bone and coccigeus fracture?
And what was the mechanism of injury?

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Follow-up: Had multiple fracture on pelvic bone, not progressing with the pain. Advise? 32 minutes later
I do not know the name of bones affected but I was told that two of the fractures involve the superior ramus which seems to be long fracture and the inferior ramus which seems to be direct break. She fell directly on the left hip first and then the rest of the body followed. She has poor balance and fell as a result of trying to help a toddler. She landed on the concrete. She was assessed by a RN almost as soon as she fell. We were on an Indian Reservation which could not help by law except to stabilize and transport. She was placed in our car and I drove 50 + miles to the hospital in Winner, SD. That may have been foolish but the RN seemed to think that it was the best alternative (at that time there was no mention of a possible pelvic problem just the hip). I've been told by our Dr. in Salt Lake City that there are multiple fractures not just the two mentioned. For several days the hospital and staff were treating her as if she had only one fracture and that involved standing for up to 15 minutes at a time but when our Dr. in Salt Lake City saw the results of the initial x-ray which I had sent by DVD he told me that he had seen multiple fractures. The hospital staff ordered a CT scan when I reported that there were multiple fractures and concurred with the Dr. in Salt Lake City and the aggressive physical therapy was stopped. The problem is that they have not been able to get the pain under control.
Answered by Dr. Ivan R. Rommstein 52 minutes later

Thanks for writing back.

Yes, this is probably ramus pubicum.

If possible please do attach xray report here?

Even if there is no acetabular or femur fracture it shouldn't be managed by physical therapy. Even some single fractures are treated strictly by rest if there is danger of fracture movements.

If she is hemodynamically stable, I am sure she will recover soon. It doesn't seems to be like very serious fracture if they couldn't notice fracture on xray exam ( or they aren't educated enough). Pain in pelvic fractures is to be expected and intensive unfortunately since it is impossible to keep pelvis immobilized as it can be done with legs and arms. So there is strong pain during defecation,coughing or sneezing and it can be refractory to standard therapy.

It is advisable to use tamadol first and increase dosage if necessary. Some stronger opiates should be avoided if possible since it has much more side effects. Your doctors in Winner can always consult pain specialists from other institutions and change treatment regime.

There is no need to change hospital just because of it if you ask me.

Above answer was peer-reviewed by
Follow-up: Had multiple fracture on pelvic bone, not progressing with the pain. Advise? 1 hour later
Dr. Romic,

It is nice to be able to discuss this issue with someone who is not involved in the day to day treatment and may feel a need to defend themselves. I will follow your advice as it is very consistent with the Dr. in Salt Lake City, and amongst the Dr.s here in Winner, SD. Thanks so much for the time and your concern. I don't think that I have any more questions for you tonight but there may be some tomorrow or later.

But again thanks so much for the information and time.

Answered by Dr. Ivan R. Rommstein 12 hours later

You are welcome. If you have any questions, I'lll be glad to help. It is always good to look for other opinions.

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