A pelvic fracture involves one or more breaks in the ring of bones that forms the pelvis. This bony structure supports the weight of the upper body and protects vital internal organs. Safe mobilization techniques are crucial to prevent further displacement of fractured bone fragments, which could lead to complications like internal bleeding or nerve damage. Getting out of bed safely requires precise, controlled movements, often supervised by a physician or physical therapist, to maintain alignment and aid the overall healing process.
Essential Safety Clearances and Weight-Bearing Status
Before attempting any transfer, the patient must be fully aware of the specific weight-bearing instructions provided by their medical team. This instruction dictates the entire mobility process and protects the healing fracture. The three primary weight-bearing statuses are Non-Weight Bearing (NWB), Partial Weight Bearing (PWB), and Weight Bearing As Tolerated (WBAT).
NWB means absolutely no weight should be placed on the injured leg, requiring the patient to use their arms and the unaffected leg to bear all body weight during any standing transfer. PWB allows a specified percentage of body weight, requiring the use of an assistive device to accurately gauge the load. WBAT permits the patient to apply as much weight as they can manage without a significant increase in pain.
Environmental preparation is also necessary to create a safe zone for the transfer. Adjust the bed height so the patient’s feet rest flat on the floor when seated, and remove all tripping hazards, such as loose rugs or cluttered cables, from the immediate area.
Safe Transfer Technique: Getting to the Edge of the Bed
The physical movement from a lying to a seated position is executed using a modified technique known as the “log roll.” The fundamental principle of the log roll is to move the head, shoulders, trunk, and pelvis as a single, rigid unit to prevent any twisting or rotational stress on the fractured pelvic ring. The patient should begin by lying on their back and then bending both knees, ensuring their feet remain flat on the bed surface. This initial position helps stabilize the core.
The patient then scoots their entire body toward the side of the bed they intend to exit, using their elbows and feet to push slightly. Next, they must roll onto their side, turning their head, shoulders, and hips simultaneously in the direction of the roll, maintaining the body’s straight alignment. This coordinated turn is done slowly and deliberately to minimize the risk of a sudden, painful shift in the fracture site.
Once on their side, the patient should position the arm closer to the bed edge along their side for support, and place the opposite hand flat on the bed surface near the chest. To sit up, the patient simultaneously pushes down with their upper arm and hand while swinging both legs off the side of the bed. The weight of the legs dropping helps counterbalance the upper body rising, facilitating the transition while maintaining spinal and pelvic alignment.
The final position should be seated upright on the edge of the bed, with feet firmly planted on the floor, allowing a brief pause to check for any dizziness or discomfort before proceeding further.
Transitioning to Mobility Aids and Support
After successfully reaching the seated position at the edge of the bed, the patient must prepare for the vertical transition using the prescribed mobility aids. The choice of device, such as a front-wheeled walker or crutches, is determined by the specific weight-bearing status and the patient’s balance capabilities. A front-wheeled walker generally offers a wider base of support, making it a stable choice for those with significant weight restrictions.
The mobility aid must be placed directly in front of the patient, positioned for easy grasping before the standing motion begins. The patient should use their arms, pushing off the bed surface or a firmly secured bed rail, rather than pulling on the walker, to generate the necessary upward momentum.
The standing technique is directly influenced by the weight-bearing order. For NWB, the injured foot is kept off the floor, and all weight is transferred through the arms and the unaffected leg.
If the status is PWB or WBAT, the patient applies the appropriate amount of pressure to the injured side while standing. The head-hips relationship technique helps shift the center of gravity over the feet during the pivot from sitting to standing. The patient should remain standing briefly, ensuring balance and stability, before starting to ambulate with the aid.
Recognizing Red Flags During Movement
While some discomfort is expected during the recovery process, certain symptoms are warning signs that require immediate cessation of movement. The most concerning red flag is a sudden, sharp, or grinding pain that occurs in the pelvis, groin, or hip, which can indicate a shift in the fracture or potential re-injury. This type of pain is distinct from the general muscle soreness or dull ache associated with early mobilization.
Other serious indications include feelings of instability or an inability to bear the prescribed weight. Systemic symptoms, such as acute dizziness, lightheadedness, excessive sweating, or a rapid, irregular heartbeat, suggest a possible internal complication, such as blood loss or hemodynamic instability.
If any of these red flags appear, the patient must return to the safest possible position, such as sitting or lying down, and call for assistance immediately.