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(a)

Isolated fractures of Ilium, pubic rami & sacroiliac subluxation

These are closed, stable injuries (dont need specific physiotherapy) During bed rest, full range ankle toe movements, Isometrics (Quadriceps, Hamstrings, Glutei) Active or Resisted exercise to upper limb Gradual weight bearing (after immobilization period) If pain still persists; heat therapy
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(b) Fracture of pelvis with disruption of pelvic ring Conservative Treatment

During immobilization, it is as same like isolated fractures of ilium ilium, , pubic rami & sacroiliac subluxation During Mobilization, initially, mobility & strengthening Ex to lower limbs Progress to sitting & assisted standing Weight bearing & walking in parallel bars (2(2 -3 day)
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Postural training for functional movements like sitting, getting up, turning to be taught Prolonged prone lying with isolated hip extension (for hip flexor tightness) Patient should attain full function within 88 -10 weeks

During Immobilization

Adequate chest physiotherapy to avoid respiratory complications Check to assure correct positioning of the limb (avoid rotations) Ankle toe movements and resistive Ex to other joints Strong isometrics to Quadriceps, Hamstrings, hip extensors & abductors
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Initiate early knee mobilization Initiate sitting in the bed at earliest Site of skeletal traction pin should often be inspected for infection/lossening infection/lossening

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During Mobilization
Weight transfers & brief periods of full weight bearing on affected leg(when FWB allowed) Periods of prone lying, four point kneeling & knee walking are extremely useful as prepre weight bearing Ex Kneel standing to be progressed to kneel walking PRE Ex to Quadriceps, Hamstrings, Glutei By 88-12 weeks, patient should be functionally independent
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During Immobilization (1(1-10 Days)

Deep breathing & coughing techniques Vigorous ankleankle-toe movements with isometrics to Quadriceps, Hamstrings, Glutei Proper positioning of the limb on bed (knee straight or slightly bent & limb in neutral rotation)

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During Mobilization (after 10 Days)

Relaxed passive movements CPM to initiate gradual hip & knee ROM Progressive active assisted flexion ROM (heel drag) Assisted abduction (Suspension) Assisted SLR Knee swinging (Sitting at the edge of the bed) Full weight bearing is deffered till 12th week
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Conservative & post surgical rehabilitation is same as in Fracture neck of Femur

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During Immobilization Same as in fracture neck of Femur

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During Mobilization

Early knee mobilization & isometrics to Quadriceps & Hamstrings (Skeletal traction; upto 12 weeks)weeks)-with split bed Mobilization of Hip & Knee by 22-3 weeks (IM nailing) Strengthening of Quadriceps to achieve SLR by 2-3 weeks PWB to be initiated within 66-8 weeks & FWB by 12 weeks

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During Immobilization (1 Week)

Thomas splint

Limb elevation, pressure bandage (for swelling), Isometrics for Quadriceps & Hamstrings Strong ankleankle-toe movements

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During Mobilization (after 1 Week)

Gradual, relaxed passive knee mobilizations Thermotherapy or cryotherapy to reduce pain Controlled mobilizations using CPM Self assisted relaxed knee swings (sitting at the edge of the bed & operated leg supported by the good leg) NWB crutch walking Comfortable knee flexion beyond 90 90 (by 44-6 Weeks)
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All programmes made vigorous to gain maximum ROM & strength PWB is initiated after 9 weeks FWB is permitted by 88-12 weeks

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(a)Undisplaced Fractures (Plaster cast for 3-4 Weeks)

Static Quadriceps within the POP with assisted SLR initiated immediately Weight bearing with crutch walking started from 2nd day POP is removed after 44-6 weeks & knee flexion initiated using CPM If pain still persists; heat therapy or cryotherapy Correct weight bearing & gait to avoid limp
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(b)Displaced Fractures (TBW) During Immobilization (1(1-10 Days)

Limb in POP should be elevated with pillows Vigorous ankleankle-toe movements & relaxed passive movements to hip Static Quadriceps to be deferred till 33-4 day Gradual SLR to begin by 33-4 day NWB crutch walking as pain subsides
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During Mobilization (10th Day onwards)

Small range mobilizations with CPM or relaxed passive movements Strong isometrics to Quadriceps Gradual weight bearing after 6 weeks Patient must gain adequate knee ROM & strength by 66-8 weeks Full ROM by 88-12 weeks Extensor lag might be present for about 6 months
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(c)Comminuted Fractures (Patellectomy) 1st Week

Strong ankleankle-toe & foot movements with leg elevated Mild, indirect contractions to Quadriceps using a soft wedge under the knee Electrical stimulation to rere-educate Quadricep action Assisted SLR
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2nd Week
PWB with Walking aid Small arc passive movements Controlled CPM or relaxed passive movements

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3rd Week
Assisted active movements with graduated weight bearing Patients treated with POP; NWB facilitates to get back to work as cast is continued upto 6 weeks Ex programme made vigorous by 6 weeks Hydrotherapy to improve mobility & strength Intensive PRE programme for Quadriceps, Hamstrings, Glutei Proper gait training
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(a)Undisplaced Fractures (Plaster cast for 3-4 Weeks)

Static Quadriceps within the POP with assisted SLR initiated immediately Weight bearing with crutch walking started from 2nd day POP is removed after 44-6 weeks & knee flexion initiated using CPM If pain still persists; heat therapy or cryotherapy Correct weight bearing & gait to avoid limp
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