A very fit and healthy 57-year-old Kitchener man was struck by a car while he was biking to work. The accident caused a broken pelvis and other injuries for the cyclist; and he required surgery and hospitalization and was confined to a bed for almost four months. After being released from hospital, the accident victim underwent rehabilitation and slowly regained his ability to walk independently. The injuries prevented him from returning to his job as a meat-manager for a local supermarket until 13 months after the accident occurred, but his physician gave the opinion that he would not have healed as quickly without a high level of fitness prior to the accident.
Fractured bones typically result from traumatic events such as car accidents, falls and sports accidents; however, car accidents and motorcycle accidents are by far the most common causes of fractures to the tibia and femur. And, for many people who sustain these types of injuries in motor vehicle accidents, their bones are broken in several places.
Certainly, any fracture can be debilitating at least over the short term, but serious fractures, such as fractures to the pelvis, tibia or femur, can take a significant time to fully heal. Sometimes, the injured bones never regain the strength and flexibility they had before the accident. To make matters worse, the location of the damaged bone can be susceptible to chronic pain and/or arthritis, which doctors suggested was a likely complication for the injured Kitchener cyclist.
Fractures to the pelvis, tibia and femur are a common cause of disability for Canadians. Healing and recovery time for such serious fractures is dependant on several factors, such as the nature and severity of the fracture, and the health and age of the patient. The disability period and length of time before someone can return to work will also vary depending on the individual’s type of employment. For example, a job that is quite strenuous, requires standing for long periods or lifting heavy objects, would clearly require a high level of recovery for a worker who suffered a fractured pelvis, tibia or femur. On the other hand, a person who sustained a fractured tibia or femur and whose work involves sitting at a desk all day may be able to return to work sooner. However, a fractured pelvis would impact the disability period for almost any type of employment since our pelvic bones support our weight both when we’re sitting and standing.
Fractures to the Tibia
The tibia (or shinbone) is the most commonly fractured long bone. It is the larger of the two long bones in your lower leg and connects your knee joint to your ankle. Since it takes a substantial amount of force to break a tibia, a fracture to the tibia is usually accompanied by a fracture to the other, and smaller, long bone in your lower leg: the fibula. A fracture of the tibial shaft typically results in immediate and severe pain as well as the inability to walk or stand up; leg instability; tenting or protrusion of the bone at the location of the break; and sometimes, a loss of feeling in the foot.
Treatment for a fractured tibia often involves surgery wherein rods and nails are implanted to hold the bone in place while it heals. In the case of a closed fracture, instead of surgery, your doctor may apply a splint or brace for support and protection during healing. Patients generally require crutches or a walker until their leg can fully support their weight as well as rehabilitation therapy to help restore muscle strength. As with any other injury, each patient will heal at a different rate, but the following complications can also delay recovery for anyone who suffered a fractured tibia: blood clots, infection, malalignment of the broken leg fragments, inability of the fracture to fuse, and/or injury to blood vessels or nerves.
Femoral Fractures
The femur or thigh bone is the second most commonly fractured long bone. It is also the longest and, by many accounts, the strongest bone in the human body. The femur connects your hip joint and pelvic bone with your knee joint and tibia. Surgery is usually required to fix a fractured femur and this involves the insertion of a rod or nail into the center of the bone. Less commonly, a plate may be attached by screws to the side of the bone, along with an external fixator to immobilize and stabilize the bone. Depending on whether the break is near the near or middle/upper portion of the femur, a patient may need to wear a leg cast or body cast to support and protect the break.
In a study of mature patients who suffered a fractured femur, a Canadian Journal of Surgery study reported that “disability following a fracture of the femoral shaft is prolonged, even when bone union occurs without complication”. Recovery occurs most rapidly during the first 6 months and many people are largely healed by this time; however, the study found that there are measurable “residual deficits” 12 months after the injury occurred. One of the most common lasting symptoms is knee pain which is “a substantial functional problem” and can cause long-term disability. Major injury to the ligaments in the knee is also associated with injury to the femur and this injury is often missed during initial diagnosis and treatment and can cause long-term pain and mobility issues. An extended period of disability can also be caused by residual fracture malalignment. Finally, the study found that the causes of disability and process of recovery are poorly understood and don’t take a predictable path for every patient.
Pelvic fractures
Fractures to the pelvis are relatively uncommon and occur far less frequently than fractures to the femur or tibia. As with the other leg bones, a fractured pelvis typically results from a high-impact and forceful event such as a car accident or pedestrian accident. However, persons with a condition causing weak bones (such as osteoporosis) or the elderly may sustain a fractured pelvis from a lower-impact event, such as a relatively minor fall.
Fractures of the pelvis are painful. If the bones were not displaced or only minimally displaced, the patient may not require surgery. In such a case, the individual typically requires a walking aid, such as walker or wheelchair, to avoid putting weight on the legs for several months or until the injury has healed. Persons with an unstable pelvic fracture, on the other hand, will require one or multiple surgeries. The pelvic bones may need to be realigned into their normal positioning before pins or screws are inserted in order to stabilize the injured pelvis.
In addition to the risks inherent in any surgery, a person healing from a fractured pelvis may suffer infection as the wound tries to heal, damage to blood vessels or nerves, and blood clots including pulmonary embolism (a clot in the lungs). As with the other major leg fractures, patients typically require medication to deal with the pain and blood thinners are often prescribed to prevent clotting. Once they have healed sufficiently to begin walking, patients need a walking aid and there will be weight-bearing restrictions until the break is well healed. Patients also undergo physical therapy to rebuild strength and flexibility. The muscles around a fractured pelvis often take a year to regain their strength, and the outcomes are strongest for stable pelvic fractures. However, damage to organs and nerves that may be associated with a fractured pelvis can, for some people, result in long-term problems including impaired mobility, chronic pain and/or sexual disfunction.
The 57-year-old cyclist who suffered a broken pelvis after being hit by a car was fortunately eligible for long-term disability benefits through his employer while he was unable to work, and this helped to alleviate his financial burden during recovery and the period of unemployment. He also received compensation from the at fault driver who was negligent and under the influence of alcohol when he struck the cyclist. If you sustained a serious fracture as a result of a motor vehicle accident or other trauma, talk to an experienced personal injury lawyer to find out if you are eligible for damages, disability benefits and/or no-fault accident benefits.
Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2556524/
https://orthoinfo.aaos.org/en/diseases–conditions/pelvic-fractures/
https://orthoinfo.aaos.org/en/diseases–conditions/tibia-shinbone-shaft-fractures/
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