This review is based on the literature published between 2000 and 2023 and presents an up-to-date evidence-based discussion of anatomical considerations relevant to the management of pelvic trauma. In addition, it discusses the significance of the pelvic ligaments in stabilizing the pelvic ring and of bone mineral density (BMD) in fragility fracture of the pelvis (FFP), which is becoming increasingly common in today’s aging societies. Following an overview of the anatomy and function of the sacroiliac joint (SIJ), the pubic symphysis, and the surrounding ligaments, the suitability of the widely-used Young-Burgess classification (YB) of high-energy impact pelvic ring fractures, which emphasizes the role of the ligaments in pelvic ring injuries, is discussed. Based on the current body of knowledge, using 2.5 cm of pubic symphysis diastasis as the determinant for surgical intervention in anterior-posterior compression fracture is questioned, and evaluation under anesthesia and lateral stress radiography for accurate diagnosis and treatment planning is proposed instead. The review underscores the need for further research on how the pelvic ligaments can provide optimal stability in the treatment of various types of pelvic fracture. On the other hand, for fragility fracture of pelvis (FFP) in older adults caused by low-energy trauma, the emphasis is on the fragility of the bones. To better manage FFP, the importance of understanding the distribution of BMD in the pelvis is highlighted. Dual-energy X-ray absorptiometry is a common method for measuring BMD, but it has drawbacks. The advantages of measuring BMD using Hounsfield units on computed tomography scans as an alternative method are discussed. An understanding of these issues may lead to better management of the increasing number of FFP cases in older people with reduced BMD.

Rehabilitation protocols for treating pelvic fractures lack uniformity due to variations among patients, injury mechanisms, and fracture types. The incidence of pelvic fragility fractures in the elderly has risen in recent years, prompting discussions on treatment strategies, including conservative approaches. This article aims to conduct a literature review of rehabilitation practices following pelvic fractures reported up to September 2023, to elucidate the current state of the field. We conducted a search on PubMed for literature published prior to September 2023. No systematic selection was applied to articles published thereafter. The search criteria excluded non-English publications, case reports, pediatric fractures, and studies where the primary outcome did not focus on clinical aspects of pelvic fractures. We included a total of 201 papers, narrowing it down to 35 through title and abstract screening. This article described loading protocols, sexual dysfunction, mental dysfunction, surgical techniques and methods of functional assessment. Rehabilitation policies vary, often determined on a case-by-case basis, specifically by individual surgeons or treatment centers. No unified protocols exist at present, but future research will hopefully lead to significant progress.

Few studies have examined how to strengthen the muscles around the pelvis after trauma and none mention the trunk. This narrative review focuses on rehabilitation after pelvic trauma and discusses it from the perspective of muscle strengthening. The literature was searched to identify methods for strengthening muscles around the pelvis (i.e., the trunk to the lower extremities). We also examined the reference lists of the papers captured by our literature search to identify additional potentially relevant research. Our review proposes methods for strengthening each muscle around the pelvis. At present, it is not possible to establish a clear strengthening method for the diaphragm and pelvic floor muscles. We recommend exercise within the bodyweight range starting immediately after pelvic fracture surgery. Muscle strengthening exercises should be started after about 12 weeks when the sutured muscles have fused.

The purpose of this narrative review is to outline pelvic injuries caused by sports and to clarify their trends, treatment, and management. We describe the rehabilitation for sports injuries of the pelvis, with a focus on pelvic avulsion injuries and pelvic bone stress fractures. This narrative review of fifteen articles published in the last 10 years (from 2013 to 2023) reveals a dearth of new rehabilitation knowledge regarding sports-induced pelvic injuries.

Pelvic fractures, accounting for 2–8% of skeletal injuries, present a significant burden in patients with trauma. High-energy incidents often result in severe pelvic trauma accompanied by comorbidities leading to high mortality rates. Managing these complications adds complexity to the treatment process, particularly in older patients who experience longer recovery times and higher injury severity. To improve the long-term quality of life, a multidisciplinary approach is essential. However, rehabilitation feasibility is influenced by the patient’s condition and pelvic fixation stability, necessitating individualized treatment. This study investigated the rehabilitation status and long-term outcomes of older patients with severe polytrauma and pelvic ring fractures caused by high-energy trauma. The results revealed that 79.2% of the patients achieved full weight-bearing, with a median time of 41.5 days, and eventually 58.3% were discharged home. Complications were observed in 83.3% of the patients, with various challenges affecting successful home discharge. Multidisciplinary rehabilitation programs are promising for optimizing outcomes and facilitating recovery in vulnerable patient populations. Still, larger, more focused studies are needed to gain more comprehensive insights into the treatment and recovery of older patients with pelvic ring fractures and severe polytrauma. Understanding these factors is crucial for guiding clinical decision-making and improving long-term outcomes in this population.