Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Fracture, Pelvis


Related Terms

  • Fracture of Pelvic Bones
  • Pelvis Fracture

Differential Diagnosis

Specialists

  • Critical Care Surgeon
  • General Surgeon
  • Gynecologist
  • Occupational Therapist
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist
  • Radiologist
  • Urologist
  • Vascular Surgeon

Comorbid Conditions

  • Blood disorders
  • Chronic obstructive pulmonary disease (COPD)
  • Drug abuse
  • Malnutrition
  • Obesity
  • Osteoporosis
  • Poor physical conditioning
  • Radiation therapy
  • Smoking

Factors Influencing Duration

The severity and stability of the fracture, any associated internal organ damage, and the treatment required (i.e., surgical or nonsurgical) will influence length of disability. Individuals with multiple injuries, with or without complications, may be permanently disabled. Follow-up surgeries to alleviate pain, commonly in the back, may be necessary if conservative treatment is not successful.

Medical Codes

ICD-9-CM:
808.0 - Fracture, Acetabulum, Closed
808.1 - Fracture, Acetabulum, Open
808.2 - Fracture, Pubis, Closed
808.3 - Fracture, Pubis, Open
808.41 - Fracture, Ilium, Closed
808.42 - Fracture, Ischium, Closed
808.43 - Multiple closed pelvic fractures with disruption of pelvic circle
808.49 - Closed Fracture of Other Specified Part of Pelvis
808.51 - Fracture, Ilium, Open
808.52 - Fracture, Ischium, Open
808.53 - Multiple open pelvic fractures with disruption of pelvic circle
808.59 - Open Fracture of Other Specified Part of Pelvis
808.8 - Closed Fracture of Pelvis, Unspecified
808.9 - Open Fracture of Pelvis, Unspecified

Overview

© Reed Group
The pelvis is formed by a group of bones arranged in a large ring. The ilium, ischium, pubis, sacrum, and coccyx form the pelvis (pelvic ring or pelvic girdle), supporting the spine and joining the trunk to the lower extremities. Any or all of these bones can be broken (fractured).

Pelvic fractures can be categorized as low- or high-energy fractures, depending on the amount of force delivered to the pelvic bones. Other classifications of pelvic fractures are defined according to the type, location, and extent of the fracture. A low-energy fracture results in a fracture of an individual bone in the pelvic ring without disrupting pelvic alignment (nondisplaced fracture), while a high-energy fracture disrupts the overall alignment of the pelvic ring (displaced fracture) and is likely to have associated damage to the organs contained within the pelvis.

About half of all pelvic fractures involve minimum to moderate trauma and are less serious in that they do not involve injury to organs of the urinary, reproductive, and digestive systems within the pelvic girdle (Mechem). Bleeding into the back of the lower abdomen (retroperitoneum) may be massive after high-energy pelvic fracture. The cup-shaped socket in the pelvis (acetabulum) where the rounded end (femoral head) of the thigh bone (femur) fits to form a ball-and-socket joint usually requires high-energy impact to fracture.

Incidence and Prevalence: About 3% of all fractures reported in the US are fractures of the pelvis (Mechem). In one large multicenter study, 26.7% of individuals with serious injuries from motor vehicle accidents had sustained a pelvic fracture (Stein).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals using moving equipment or being hit by falling objects are at greater risk for pelvic fractures. Pelvic fractures seen in young adults most often result from direct trauma. Motor vehicle accidents account for 50% to 60% of traumatic pelvic fractures, motorcycle accidents for 10% to 20%, pedestrian vs. car accidents for 10% to 20%, falls for 8% to 10%, and crush injury for 3% to 6% (Mechem). Pelvic fractures in the elderly (especially women) usually result from a fall from a standing position; osteoporosis makes this age group particularly at risk for low-energy pelvic fracture.

Source: Medical Disability Advisor



Diagnosis

History: Significant blunt force trauma is the most common mechanism of injury. Individuals may report a recent serious accident, such as a motor vehicle crash or fall from a significant height. Elderly individuals may report a fall from a standing position.

Physical exam: Touching (palpating) the bony pelvis elicits tenderness and may reveal pelvic laxity and instability. Swelling (edema) may be present. Some individuals try to hold the knee or hip in a particular position to help minimize pain. Some fractures may have associated vaginal, urethral, or rectal bleeding or bruising. Blood may be present in the urine. Nerve damage or impaired circulation (neurovascular deficits) may be detected upon examination. High-energy fractures may be associated with hypotension from massive blood loss, additional soft tissue damage, and additional fractures.

Tests: Blood tests may be administered to monitor for potential effects of excessive blood loss. Urinalysis will detect blood in the urine. Pregnancy tests may be administered in females of childbearing age to detect pregnancy as a potential source of vaginal bleeding.

Anteroposterior pelvic x-rays are commonly used to detect pelvic fracture. Individuals with associated traumatic injury are likely to undergo CT scans of the pelvis and abdomen. Ultrasonography may be used to visualize the pelvis for bleeding or accumulation of fluid. Urethrography may be used to study associated injuries to the urethra. Arteriography may be used to detect sources of internal bleeding, and cystography to determine reasons for blood in the urine.

Source: Medical Disability Advisor



Treatment

If the pelvic fracture is only minimally displaced, bed rest and subsequent walking (ambulation) with crutches may be sufficient treatment along with pain medication (analgesics). Individuals must minimize the weight they place on the affected extremity for as long as three months. Surgery (external fixation or open reduction with internal fixation [ORIF]) may be needed to treat an unstable, displaced fracture. Emergency surgery may be needed to control bleeding or repair damage to the intestinal or urinary systems. This may take precedence over treatment of the pelvic fracture. Individuals with suspected disruptive injury to the bowel, vagina, or urinary tract may be treated with antibiotics. Some individuals may receive medication to lessen the likelihood of deep vein thrombosis (DVT). A less common pelvic fracture originates from cancer in the bone that may be treated with radiation therapy and ORIF.

Source: Medical Disability Advisor



Prognosis

Outcome depends on the severity of the fracture and any associated injuries. The majority of those with nondisplaced fractures will be pain-free and without organ dysfunction after treatment. If pelvic distortion remains, the majority of individuals will have continued pain and dysfunction.

Open pelvic fractures are the most serious due to the potential for hemorrhage and systemic infection (sepsis). They have a mortality rate of up to 20% (Mechem). Overall, of those individuals with an open fracture, one-third will experience some sexual dysfunction, and one-third will change jobs because of the injury. For acetabular fractures, the best guide to outcome comes one year following the injury through clinical appraisal and radiographic findings.

Source: Medical Disability Advisor



Rehabilitation

The rehabilitation protocol for a fracture of the pelvis depends on the severity and type of fracture. These fractures vary from stable and uncomplicated fractures, such as a nondisplaced fracture of the pubic ramus, to severe displaced fractures of the weight-bearing portion of the pelvis with associated major injuries to the gastrointestinal tract and/or genitourinary tract.

When weight bearing is indicated, the physical therapist will teach ambulation skills with assistive devices, such as crutches or a walker, as needed (Chapman). If necessary, upper extremity general conditioning exercises are taught to allow for use of assistive devices for gait. Once the fracture is stable, trunk and lower extremity exercises to restore strength, flexibility and endurance are appropriate. As a period of limited function and weight bearing may be necessary, a comprehensive reconditioning program for the lower trunk and lower extremities will be needed to restore function once the fracture is healed (Chapman).

Occupational therapy may be indicated to instruct in transfers and activities of daily living and provide assistive devices needed for independence (Chapman).

Due to the variation of possible pelvic fractures, specific therapy instructions will be determined by the treating physician, based on many factors related to the fracture site and associated injuries.

Bone healing may occur within 6 to 12 weeks; however, the bone strength and the ability of the bone to sustain a heavy load may take up to a year (Chapman). Once healing has occurred, the individual may resume full activities of daily living. It is important to instruct the individual not to overload the fracture site until the bone has regained its full strength. The treating physician should guide the resumption of heavy work and sports.

Individuals who sustain pelvic fractures may expect up to 6 to 12 months of recovery before returning to heavier work (Chapman). A vocational counselor might be necessary for those who are unable to return to their previous occupation due to residual impairment (Bucholz).

FREQUENCY OF REHABILITATION VISITS
Nonsurgical
SpecialistFracture, Pelvis
Physical TherapistUp to 24 visits within 16 weeks
Note on Nonsurgical Guidelines: Hospitalization is often required, even though surgery is not required. If surgery is required, it is not an uncomplicated case.
The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice.

Source: Medical Disability Advisor



Complications

Immediate complications include hemorrhage and shock seen in a serious pelvic injury, especially an open pelvic fracture. The bladder or urethra may be traumatized and torn. There may be laceration or perforation of the rectum, anus, and small or large bowel, which may require a temporary colostomy. Lacerations may occur to the genitalia that may be overlooked in women. Individuals with pelvic fractures may have concomitant injuries to the head, chest, abdomen, or limbs.

Other complications include infection, which may occur secondary to outside contamination of the overlying skin wound and/or intestinal leakage from associated internal trauma. Peritonitis or retroperitoneal abscess can result from laceration of the rectum with possible sepsis. Bowel obstruction can occur either from a reflex ileus or entrapment of bowel in the fracture. Blood clots can form in pelvic veins and then spread through the circulation (thromboembolism).

Later complications include bowel dysfunction or sexual dysfunction, including erectile dysfunction. Malunion of the fracture may result in an abnormal gait, difficulty sitting, and back pain. Low back pain also may result from a fracture involving the sacroiliac joint. Damage to lumbar and sacral nerves can leave weakness or disturbed sensation, resulting in a gait disturbance. Fracture healing that results in a deformed pelvis can interfere with future vaginal deliveries and necessitate a Caesarean delivery.

If the fracture involves the hip joint (acetabulum), degenerative arthritis of the hip may develop. Complications to fractures of the acetabulum include post-traumatic arthritis, femoral head osteonecrosis, neurovascular injury, sciatic nerve palsy, and deep vein thrombosis.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Standing, walking, and sitting all may need to be temporarily limited. The pelvis supports the weight of the upper body during standing and sitting; therefore, a fracture will make these functions painful until healing occurs. Allowances should be made for individuals to change positions frequently.

During early recovery, wheelchair ambulation or a walker, crutches, and, eventually, a cane may be required for standing and walking. Safety issues and workplace access need to be addressed with the use of assistive devices. Stair climbing also is difficult during the recovery period and may require adaptations or limitations until healing occurs. Company policy on medication usage should be reviewed to determine if pain medication use is compatible with job safety and function.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Did individual report a fall or serious accident?
  • How old is individual?
  • Does he or she have osteoporosis or other bone-weakening disorder?
  • Did the fracture result from low- or high-energy impact?
  • Were organs within the pelvic girdle damaged?
  • Did x-ray reveal pelvic fracture?
  • In the event of associated injuries, was a CT scan of the pelvis and abdomen performed? Was ultrasound used to detect internal bleeding or fluid accumulation?
  • Was urethrography used to study any associated injuries to the urethra.
  • Was arteriography used to detect sources of internal bleeding?
  • Was cystography used to assess causes for blood in the urine?
  • Were other conditions, such as avascular necrosis of the hip region, osteomyelitis, and cancer ruled out?

Regarding treatment:

  • Was pelvic fracture minimally displaced or seriously displaced?
  • Was surgery necessary to repair any damage?
  • Was there bleeding or other damage to the intestinal or urinary systems that required emergency surgery?
  • Were physical therapy or occupational therapy prescribed?

Regarding prognosis:

  • Was individual pain-free and without organ dysfunction after treatment?
  • Is individual actively participating in rehabilitation program?
  • Is individual using a wheelchair, walker, cane, or crutches?
  • Is individual still taking pain medication?
  • Is individual elderly or obese?
  • Does individual smoke?
  • Did individual undergo prior radiation therapy?
  • Does individual have malnutrition, blood disorders, or osteoporosis?
  • Does individual have a gait disturbance, difficulty sitting, back pain, or degenerative arthritis?

Source: Medical Disability Advisor



References

Cited

Bucholz, Robert, and James D. Heckman. Rockwood and Green's Fractures in Adults. 6th ed. Philadelphia: Lippincott, Williams & Wilkins, 2005.

Chapman, Michael W. Chapman's Orthopaedic Surgery. 3rd ed. Philadelphia: Lippincott, Williams & Wilkins, 2001.

Mechem, Crawford. "Fractures, Pelvis." eMedicine. Eds. Michelle Ervin, et al. 11 Aug. 2008. Medscape. 17 Feb. 2009 <http://emedicine.medscape.com/article/825869-overview>.

Stein, D. M., et al. "Risk Factors Associated with Pelvic Fractures Sustained in Motor Vehicle Collisions Involving Newer Vehicles." Journal of Trauma 61 1 (2006): 21-30. National Center for Biotechnology Information. National Library of Medicine. 3 Jan. 2009 <PMID: 16832246>.

General

"Fracture of the Pelvis." American Academy of Orthopaedic Surgeons. Sep. 2007. American Association of Orthopaedic Surgeons. 17 Feb. 2009 <http://orthoinfo.aaos.org/topic.cfm?topic=A00223>.

Source: Medical Disability Advisor






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