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Post
surgical treatment, physical therapy intervention started after 3 days, which
included –

Bed mobility – log rolling, supine to
sit form side lying position without rotation at the hip joint and trunk, edge
of bed sitting within pain limits.

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Strengthening – AROM exercises of BLE and
BUE and strength exercises of knee and ankle joints in all the planes in long
sitting in bed and high sitting at the edge of bed.

Transfers – bed to bedside
commode/wheel chair transfers with sliding board.

Pain management – ice and hot packs
alternatively to decrease pain and inflammation and to increase blood
circulation. Medications scheduled around physical therapy treatment to
minimize pain during session.

Positioning – to prevent pressure ulcers

Pelvic floor exercises – to strengthen pelvic floor
musculature to prevent visceral herniation.

Pelvic Binder – reduces pubic diastases and
to restore the alignment of the pelvis.

3 weeks post physical therapy treatment patient
started complaining of sharp pain and poking sensation in the pelvic area and
inability to perform bed mobility in all positions and increased assistance for
transfers. Upon further evaluation by Dr and with help of the plain film
radiographs it was identified that screws and plate have dislodged on the Right
side and are moving freely in pelvic viscera causing sharp pain and poke on the
bladder every time patient perform any movement. The patient had to undergo
corrective surgery to remove the hardware and to heal pelvis conservatively. Post
surgical and during conservative treatment, patient was advised bed rest for 8
weeks and NWB on BLE to complete healing process. During conservative
management patients Left SI joint presents with crepitus and LLE remains in
external rotation during movement and weight bearing because of loss of
ligament and muscle strength, while the right side pelvis and LE return to
normal alignment with recovery. Physical
therapy intervention during 8 weeks
included – Isometric exercises – isometric contractions of gluteus,
hip, knee and ankle to strengthen muscles.AROM exercises – AROM of all joints at the ankle
and knee to prevent muscle tightness and contractures.Bed mobility – log rolling, edge of bed
sittingPositioning – to prevent pressure soresPost 8 weeks –  Strengthening exercises – Aggressive strengthening
exercises of ankle, knee and hip in all planesBed mobility – supine to sit, edge of bed
sitting to decrease orthostatic hypotensionGait training – Patient ambulates with a
limping gait due to the pelvic instability, loss of alignment and weight
distribution. The patient started ambulating with a standard walker, followed
by rollator walker and then finally with a standard cane with a waddling gait.Other
exercises that may benefit are Hydrotherapy
for ROM and strengtheningAerobic
exercises for endurance and activity tolerance Stabilization
exercises to increase pelvic and surrounding joint stabilityDynamic
standing and proprioception exercises to increase balance

Functional
exercises to return to the vocational activities.

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