Name of the Procedure:

Closed treatment of pelvic ring fracture, dislocation, diastasis, or subluxation; with manipulation, requiring more than local anesthesia

Summary

This procedure involves realigning and stabilizing a fractured or dislocated pelvic ring without making large incisions. It requires more than local anesthesia, often involving regional or general anesthesia, to ensure patient comfort and immobilization during the manipulation.

Purpose

The procedure is performed to correct fractures, dislocations, or separations (diastasis or subluxation) of the pelvic ring. The goal is to restore normal anatomy, alleviate pain, promote healing, and allow for proper function and mobility of the hip and pelvic region.

Indications

• Severe pain in the pelvis area after trauma
• Inability to bear weight on the hips or legs
• Abnormal movement or instability in the pelvic region
• Evidence of pelvic ring fracture or dislocation on imaging studies (e.g., X-rays, CT scans)

Preparation

• Fasting for at least 8 hours before the procedure if general anesthesia is used.
• Review and adjustment of current medications, particularly blood thinners.
• Pre-procedure imaging studies to assess the extent of the injury.
• Complete a pre-anesthetic evaluation.

Procedure Description

1. Administration of anesthesia (regional or general) to ensure the patient is pain-free and immobile.
2. Closed manipulation of the pelvis by the orthopedic surgeon to reposition the bones into their correct anatomical position.
3. Use of imaging guidance (e.g., fluoroscopy) to verify the alignment.
4. Application of external fixation devices or braces if needed to maintain stability.
5. Post-manipulation imaging to confirm successful realignment.

Duration

The procedure typically takes about 1-2 hours, depending on the complexity of the fracture and the method of manipulation.

Setting

The procedure is performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Radiology technician (for imaging guidance)

Risks and Complications

• Infection
• Bleeding
• Blood clots
• Nerve or vascular injury
• Incomplete healing or misalignment
• Anesthesia-related complications

Benefits

Successful realignment of the pelvic bones promotes faster healing, reduces pain, and helps restore normal function and mobility. Benefits are typically noticed within weeks, with gradual improvement over months.

Recovery

• Pain management with prescribed medications.
• Limited movement and weight-bearing activities as directed.
• Physical therapy starting a few days post-procedure to regain strength and mobility.
• Follow-up appointments for imaging and assessment of healing.
• Recovery time varies but usually spans several weeks to a few months.

Alternatives

• Open surgical treatment if closed manipulation is not successful or feasible.
• Non-operative management with prolonged bed rest and traction (rarely recommended due to long recovery and complications).
• Each alternative has varying recovery times, risks, and success rates compared to closed treatment.

Patient Experience

Patients will initially experience grogginess from anesthesia and discomfort managed with pain medications. They may feel stiffness and limited mobility, which improves with physical therapy. Hospital stay may range from a few days to a week, depending on the severity of the injury.