Pelvic fractures

A pt presented to the ED after a fall and subsequent DKA (diabetic ketone acidosis) from lying on the floor for several days, and unable to get to medication. X-rays were performed on the femurs and lumber spine and were cleared for fractures. The pt was medicated and there were no contraindications to physiotherapy, so exercises to improve strength, endurance and balance were commenced.

After implementing bed exercises on day 1, amb began day 2 with other strength and balance exercises. The pt was complaining of inguinal pain on the (L) that came on intermittantly with WBing. Pain radiating down the thigh was also reported with knee pain. The pt was very weak in th LL's with a glut med gait on the (L) from a gradual decrease in exercise and the recent episode of fall and DKA. The pain was thought to be related to this weakness and deconditioning, so the exercises were continued to be progressed. The pt was tolerating exercise well and their spirits were up, so a fracture in the hip seemed unlikely.

Mid-week, the consultant suspected a fracture as knee pain is often associated with a hip/acetabular fracture, and on bone scan and follow up X-ray of the pelvis a acetabular, sacrum and sup/inf pubic rami fractures were found. The pt was given RIB orders, with non-Wbing (L) LL for transfer to commode. Otherwise the exercises he had been performing and progressing with were contraindicated.

From this experience having a greater knowledge of the signs and symptoms of an acetabular fracture, it may have been spotted earlier and a potentailly harmful programme would not have been implemented. Also, so muscular pain can be excluded, more investigation should have been undertaken to realise the pt's atrophy was not the cause of the pain and the cause of the decrease WBing on the (L) LL.