Melanie Cole, MS (Host): Welcome to Bryan Health Podcast. I'm Melanie Cole and joining me today is Dr. Alesha Scott. She's the medical director of Bryan Orthopedic Trauma, and she's here to highlight a percutaneous pelvic fixation procedure, an advanced surgery to help patients with pelvic fractures recover and return to their life.

Dr. Scott, thank you so much for joining us today. I'd like you to start by telling the listeners a little bit about the prevalence of pelvic fractures, or sometimes they're called pelvic ring fractures, because the bones that make up our pelvis come together and form that pelvic ring. Anything you can tell us about how these fractures happen, who it happens to, and how often you see them would be great.

Alesha Scott, DO: Well, firstly, thanks for having me. These injuries are common in patients who've had a traumatic event. Young patients have pelvic ring injuries from the result of a high-energy trauma like a car accident or falling off a roof. But these happen a lot in elderly patients just from a simple trip and fall. And sometimes, they don't even know they have a broken bone. They just have pain for a long time and no real cause of it. So, we see these all the time. In fact, this weekend I was on call and I did five of these procedures. And it's not just because I'm looking for surgeries to do. It's because these patients have injuries that limit their walking. They can't even get out of bed. And so by fixing their pelvic ring fractures, they're able to get up and move around and get back to their life as quickly as possible.

Melanie Cole, MS: Well, that's certainly true. Those pelvic fractures can impact the quality of life so severely. So, I'd like you to tell us about the percutaneous pelvic fixation hip procedure. And as I understand it, Dr. Scott, you brought this procedure to Lincoln and are one of the very few providers that perform it and it's life-changing. Tell us about it.

Alesha Scott, DO: Yeah. Well certainly since coming here to Lincoln, myself and my partners at Bryan Orthopedic Trauma do the majority of this procedure in the area. I wasn't the first person in the state to do it, but fully percutaneous, being fixing the front and the back of the pelvis, I am the first person to bring that here to Bryan. And now, our group is the only group that performs it fully percutaneously.

Now, what that means is, you know, starting from the beginning, the pelvis is made up of three bones: the tailbone, which is the sacrum and the two iliac bones on the side. It's a very strong unit with lots of ligaments that hold it into place. And when it breaks, it's very rigid. And so, it breaks kind of like a pretzel. If you imagine that, it's hard to break a pretzel in just one spot. It's going to break in the front and in the back as well. Percutaneous fixation means fixing the pelvis through small little miniature open incisions. And so, this is one of the minimally invasive procedures that are available to perform for patients with traumatic injuries, broken bones. Often times, when we fix broken bones, we have to make an incision large enough to put plates and screws in. But since this is able to be done in an operating room using a live x-ray machine, we're able to do this safely through very small incisions with just one little incision per screw.

Melanie Cole, MS (Host): Dr. Scott, are there any comorbidities like obesity, age, osteoporosis that would preclude someone from getting this surgery? And while you're telling us that, tell us a little bit about why you would choose this procedure over total hip replacement

Alesha Scott, DO: There really aren't any comorbidities that a patient has that would preclude them from having this procedure. These fractures happen in elderly patients who have osteoporosis or cancer. It can happen as a result of a simple fall or it can happen over time just from the bone being weak. And so, regardless of how many or how few medical problems a person has, they would potentially be a candidate for this percutaneous fixation if their fracture pattern would allow it. Now, we would choose this fixation technique if a patient has pelvic fractures that are not wide open. And so, there's something called an open book pelvis injury, which means the pelvis is kind of opened in the front and that happens from, say, a motorcycle crash or fall from a great height. Those patients need to have an open procedure done and place plates and screws inside. But when a person falls or gets hit from the side and their bones are not widely displaced or shifted, they may be candidates for this minimally invasive procedure.

Melanie Cole, MS: How might someone know? What would they feel if they suffered a pelvic fracture?

Alesha Scott, DO: A person might know or be suspicious that they might have a pelvic fracture if they have persistent hip pain, groin pain, lower back or pelvis pain after a fall or just pain that develops over time that doesn't go away. Something that gets sprained will probably get better on its own and that pain should diminish over time. But if there's a pain that persists and just does not get better or if it gets worse, then there could be a bone that's broken.

Melanie Cole, MS (Host): After someone's had this procedure, what is recovery like?

Alesha Scott, DO: Bones typically will take about six weeks to heal. So, the pain that a person has prior to this injury, you know, when they hurt every time they shift, sometimes they can't even stand, it can be excruciating to sit the pain that they have from those bones being unstable and shifting with every small movement will be gone right after surgery. And often, patients will describe this as a night and day difference That pain from the unstable bones will be gone after surgery. Now, there will be surgical pain, obviously, from incisions and all of that, but the pain from the bones being broken will be much improved. Then after about six weeks, those fractures themselves will be healed, and so the pain that was present before will be greatly diminished.

Melanie Cole, MS: Dr. Scott, what should someone do if they've been feeling this pain, maybe it's pretty severe, it's truly affecting their quality of life, what comes next?

Alesha Scott, DO: Patients who have this persistent hip, groin, or lower back, and pelvis pain should see their doctor and be evaluated for why. Lots of things could be causing hip pain. It could be arthritis in the hip. It could be a labral tear. It could be a problem in the low back. So if all of those things have been investigated and there has not been a source of the pain identified, then it would be reasonable to order pelvic x-rays and see if maybe there's something going on.

Then, if an x-ray doesn't show a break in the bone that's obvious, typically, we diagnose these based on a CT scan, which is a 3D image of the bones that can show things that an x-ray does not show. So if a person has had x-rays that are negative and they still have pain, they shouldn't feel discouraged, but they could seek out other opinions and see if maybe there's something that we as orthopedic trauma surgeons are trained to look for and treat, and see if there's something we can do to help.

Melanie Cole, MS: Do you have any final thoughts you'd like to leave listeners with about this life-changing procedure that you're performing at Bryan

Alesha Scott, DO: Yeah. I want to let people know that this procedure exists, that there is a treatment option for pelvic fractures. Before modern surgeries to fix pelvic fractures were common, these were almost treated all non-operatively or without surgery. Patients were restricted to bed rest for six weeks or more until their bones healed. By that point, they'd be so debilitated from not moving around that recovery was very difficult. And elderly patients who are stuck in bed would develop all sorts of problems like pneumonia, bed sores, urinary tract infections, and blood clots, and often this was a death sentence. So since the mid-90s, this procedure has been widely studied and used. And with Orthopedic Trauma fellowships, which are an extra year of training after a five year Orthopedic Surgery residency, we're trained as Orthopedic Trauma surgeons to diagnose and treat these. This procedure exists, and we can help someone who has this fracture. And we just want our patients to get back to being active back to their lives as soon as possible.

Melanie Cole, MS: Thank you so much, Dr. Scott, for joining us today and sharing your incredible expertise. And for more information, or to listen to more podcasts from our experts, please visit bryanhealth.org/podcasts. That concludes this episode of Bryan Health Podcast. Please always remember to subscribe, rate, and review Bryan Health Podcast on Apple Podcasts, Spotify, iHeart, and Pandora. I'm Melanie Cole. Thanks so much for joining us today.