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SacroLoc for pubic rami fractures “Regain mobility after just a few days“

Issue 02/2017

At first glance, using SacroLoc to treat pubic rami fractures may seem rather unorthodox. However, Prof. Dr. med. Rolf Haaker, Chief Physician in Orthopedics at St. Vincenz Hospital in Brakel , Germany, has achieved remarkable success by following this very approach.

According to Chief Physician Prof. Dr. med. Rolf Haaker, pain relief is a crucial part of getting patients back on their feet after pelvic fractures.
According to Chief Physician Prof. Dr. med. Rolf Haaker, pain relief is a crucial part of getting patients back on their feet after pelvic fractures.

Bauerfeind life: Pubic rami fractures are difficult to diagnose. Why is this?
Prof. Haaker: Firstly, since they are one of the rarest types of pelvic fracture, physicians treat very few cases in everyday practice. On top of this, the complex anatomical and biomechanical relationships in the pelvis mean that the cause of pain is often not immediately discernible. Affected patients generally complain of non-specific, unexplainable lower back pain. This type of back pain is very common, making it easy to incorrectly diagnose. This may lead to spinal canal stenosis or inflamed intervertebral disks being hastily suspected and the wrong kind of treatment being prescribed as a result. I’ve come across cases where patients have even been fruitlessly operated on due to these misdiagnoses and the pain was still there afterwards.

How can pubic rami fractures be reliably diagnosed?
Prof. Haaker: Even to the well-trained eye, this type of fracture is frequently very difficult to detect from traditional X-ray images and is often easily overlooked. Computed tomography, on the other hand, is a reliable diagnosis method.

Are pubic rami fractures very painful?
Prof. Haaker: The pain can be extreme – and persistent. This is due in part to the structure of the pelvis, as the high number of muscles running through this part of the body pull on the bones. These pelvic muscles move almost constantly, causing incessant pain. Walking, sitting, going to the toilet , and even the seemingly motionless act of lying in bed may leave patients in agony. To compound matters, in patients with a fracture, the nutation of the pelvis means that even a small movement is enough to trigger agonizing pain.

How do you treat pubic rami fractures?
Prof. Haaker: We distinguish between an incomplete and complete pelvic ring fracture. If it is incomplete, i.e. if only the superior or inferior pubic ramus is broken, the fracture generally heals by itself within three months. In patients with a complete pelvic ring fracture, i.e. in cases where both the superior and inferior pubic rami or other parts of the pelvic structure, such as the sacral bone, are affected as well , surgery is the only option. Patients diagnosed with an isolated pubic ramus fracture immediately after a fall or accident must stay in bed for the first few days. Although the most important course of action at this stage is to significantly reduce the pain, we also take measures to stabilize the pelvis. After this, it is a matter of early mobilization. Risks such as embolisms and the loss of muscle strength and mobility are well researched and are all too familiar in elderly patients. This is why, depending on the patient’s overall state of health, it is vital to get them on their feet again as quickly as possible.

A better quality of life: SacroLoc gets patients moving again.
A better quality of life: SacroLoc gets patients moving again.

How exactly do you stabilize the pelvis and get patients moving again?
Prof. Haaker: We use SacroLoc on patients while they are still in bed and many of them tell us that it eases the pain right away. We aim to get our patients out of bed and moving again with guidance from a physiotherapist after five or six days at the latest. Depending on the patient’s general state of health, this involves the use of crutches or a rollator.

Why is SacroLoc so good at treating this condition?
Prof. Haaker: Among other things, this orthosis is used to immobilize hypermobile sacroiliac joints, which are often the cause of severe pain. It does this by helping to reduce the nutation movement of the pelvis. The structure of the orthosis also applies gentle compression to the pelvic region.

What do you pay attention to when putting on the orthosis?
Prof. Haaker: It is important that the front of the orthosis sits underneath the anterior superior iliac spine and fits well. This ensures that sufficient compression is applied to the pelvic region in order to restrict nutation and to tilt the pelvis slightly forwards. The compressive effect considerably reduces the pain and, in some cases, causes it to disappear completely. The obvious benefits include a reduced reliance on painkillers, the ability to get patients back on their feet more quickly and confidently, and an improved quality of life. Patients who have been suffering from seemingly untreatable pain caused by a previously undiagnosed fracture feel better from one day to the next thanks to the orthosis. In fact , they often say that they suddenly see light at the end of the tunnel.

How do patients respond to SacroLoc?
Prof. Haaker: Patients generally report a significant reduction in pain after putting the orthosis on for the first time. Moreover, thanks to its stabilizing effect on the pelvic region, we notice a considerable improvement in our patients’ mobility, as they are able to walk for longer distances and increase their stride length at will.
For an orthosis of its kind, SacroLoc is very small and practical. It is easy to handle and adjust , and can even be fitted quickly and effectively on patients who are still confined to bed. What’s more, after receiving brief instructions from a physiotherapist , patients are able to put on the orthosis by themselves without any assistance.

How long should SacroLoc be worn for?
Prof. Haaker: Until the fracture is fully healed. In other words, it has to be worn daily, from morning to evening, for around twelve weeks.

Skeptics fear that the use of orthoses reduces muscle strength. Is this the case with SacroLoc?
Prof. Haaker: SacroLoc often enables patients to walk for longer distances without feeling any pain for the first time since they began noticing symptoms. Walking and standing activate the back extensor muscles and build muscle strength.

Images: Stefan Durstewitz, Bauerfeind


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