Issue
Date Log
Copyright (c) 2025 Muneera Hassan Albuaijan, Hoor Jawad AlQasim, khaled lafi jazi Al-Balawi, Mohammed Salem ALMOTAIRI, Tasneem Hejje ALKHAIBARI, Sahar Rubayyi Albalawi, Awadh Saleh Alamri, Nawal Jadaan Almotairi, Aljawharah Ali Alabsi, Meshal Nashi Ayad Alshaibani, Bayan Osama Muhammed Mugharbel
This work is licensed under a Creative Commons Attribution 4.0 International License.
Enhancing Patient Outcomes in Orthopedic Clinics: The Interdisciplinary Role of Nurses, Physiotherapists, and Medical Secretaries-Pelvic Fracture as a Model
Corresponding Author(s) : Muneera Hassan Albuaijan
Saudi Journal of Medicine and Public Health,
Vol. 2 No. 2 (2025)
Abstract
Background: Pelvic fractures are complex injuries with high risks of hemorrhage, multisystem involvement, and long-term disability. Optimal outcomes depend on coordinated, interdisciplinary care, particularly from nurses, physiotherapists, and medical secretaries, across the continuum from resuscitation to rehabilitation.
Aim: To synthesize role-specific contributions of nurses, physiotherapists, and medical secretaries in orthopedic clinics, using pelvic fracture care as an archetype, and to map these contributions to measurable patient and service outcomes.
Methods: Narrative synthesis of current clinical pathways for pelvic fracture evaluation, stabilization, and rehabilitation; role delineation across care phases (prehospital, emergency, operative, inpatient, rehabilitation, and post-discharge); and identification of outcome domains influenced by each profession.
Results: Nurses drive hemodynamic surveillance, hemorrhage mitigation, early complication detection, patient/family education, and coordination of trauma protocols; physiotherapists deliver staged mobilization, gait training, pelvic floor and core rehabilitation, and functional capacity rebuilding; medical secretaries enable continuity through scheduling, information flow, documentation integrity, benefits navigation, and inter-service logistics. Interdisciplinary alignment is associated with reduced time-to-stabilization, fewer preventable complications, shorter length of stay, earlier mobilization, improved functional scores, and higher patient satisfaction.
Conclusion: In pelvic fracture care, integrating nursing vigilance, physiotherapy-led functional recovery, and medical-secretarial coordination yields superior clinical and operational outcomes. Formalizing shared pathways, handoffs, and metrics should be a strategic priority for orthopedic services.
Keywords
Download Citation
Endnote/Zotero/Mendeley (RIS)BibTeX
- Tiziani S, Dienstknecht T, Osterhoff G, Hand TL, Teuben M, Werner CML, Pape HC. Standards for external fixation application: national survey under the auspices of the German Trauma Society. Int Orthop. 2019 Aug;43(8):1779-1785.
- Gordon WT, Fleming ME, Johnson AE, Gurney J, Shackelford S, Stockinger ZT. Pelvic Fracture Care. Mil Med. 2018 Sep 01;183(suppl_2):115-117.
- Oliphant BW, Tignanelli CJ, Napolitano LM, Goulet JA, Hemmila MR. American College of Surgeons Committee on Trauma verification level affects trauma center management of pelvic ring injuries and patient mortality. J Trauma Acute Care Surg. 2019 Jan;86(1):1-10.
- Hutchings L, Roffey DM, Lefaivre KA. Fragility Fractures of the Pelvis: Current Practices and Future Directions. Curr Osteoporos Rep. 2022 Dec;20(6):469-477
- Roszman AD, John DQ, Patch DA, Spitler CA, Johnson JP. Management of open pelvic ring injuries. Injury. 2023 Apr;54(4):1041-1046.
- Reboli M, Aprato A, Vittori J, Olivero M, Bosco F, Massè A. Reevaluation of the surgical indications for anterior inferior iliac spine avulsion fractures in an acute setting - A narrative review of the current literature. J Orthop. 2023 Apr;38:20-24.
- Lewallen LW, McIntosh AL, Sems SA. Pediatric Pelvic Ring Injuries. Orthopedics. 2018 Sep 01;41(5):e701-e704.
- Barratt RC, Bernard J, Mundy AR, Greenwell TJ. Pelvic fracture urethral injury in males-mechanisms of injury, management options and outcomes. Transl Androl Urol. 2018 Mar;7(Suppl 1):S29-S62.
- Djaja YP, Silitonga J, Dilogo IH, Mauffrey OJ. The management of pelvic ring fractures in low-resource environments: review. Eur J Orthop Surg Traumatol. 2023 Apr;33(3):515-523.
- Schindler CR, Sturm R, Hörauf JA, Marzi I, Störmann P. The sequence of the treatment of combined fractures of the pelvis, spine, and extremities in polytraumatized patients. EFORT Open Rev. 2023 May 09;8(5):372-381.
- Carson JT, Shah SG, Ortega G, Thamyongkit S, Hasenboehler EA, Shafiq B. Complications of pelvic and acetabular fractures in 1331 morbidly obese patients (BMI ≥ 40): a retrospective observational study from the National Trauma Data Bank. Patient Saf Surg. 2018;12:26.
- Siada SS, Davis JW, Kaups KL, Dirks RC, Grannis KA. Current outcomes of blunt open pelvic fractures: how modern advances in trauma care may decrease mortality. Trauma Surg Acute Care Open. 2017;2(1):e000136.
- Alton TB, Gee AO. Classifications in brief: young and burgess classification of pelvic ring injuries. Clin Orthop Relat Res. 2014 Aug;472(8):2338-42.
- Dalal SA, Burgess AR, Siegel JH, Young JW, Brumback RJ, Poka A, Dunham CM, Gens D, Bathon H. Pelvic fracture in multiple trauma: classification by mechanism is key to pattern of organ injury, resuscitative requirements, and outcome. J Trauma. 1989 Jul;29(7):981-1000; discussion 1000-2.
- Young JW, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: value of plain radiography in early assessment and management. Radiology. 1986 Aug;160(2):445-51.
- Burgess AR, Eastridge BJ, Young JW, Ellison TS, Ellison PS, Poka A, Bathon GH, Brumback RJ. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma. 1990 Jul;30(7):848-56.
- Smith W, Williams A, Agudelo J, Shannon M, Morgan S, Stahel P, Moore E. Early predictors of mortality in hemodynamically unstable pelvis fractures. J Orthop Trauma. 2007 Jan;21(1):31-7.
- Tang J, Shi Z, Hu J, Wu H, Yang C, Le G, Zhao J. Optimal sequence of surgical procedures for hemodynamically unstable patients with pelvic fracture: A network meta-analysis. Am J Emerg Med. 2019 Apr;37(4):571-578.
- Chotai N, Alazzawi S, Zehra SS, Barry M. Paediatric pelvic fractures: A review of 2 cohorts over 22 years. Injury. 2018 Mar;49(3):613-617.
- Mennen AHM, Blokland AS, Maas M, van Embden D. Imaging of pelvic ring fractures in older adults and its clinical implications-a systematic review. Osteoporos Int. 2023 Sep;34(9):1549-1559.
- Iyengar KP, Venkatesan AS, Jain VK, Shashidhara MK, Elbana H, Botchu R. Risks in the Management of Polytrauma Patients: Clinical Insights. Orthop Res Rev. 2023;15:27-38.
- Stahel PF, Burlew CC, Moore EE. Current trends in the management of hemodynamically unstable pelvic ring injuries. Curr Opin Crit Care. 2017 Dec;23(6):511-519.
- Rodrigues IFDC. To log-roll or not to log-roll - That is the question! A review of the use of the log-roll for patients with pelvic fractures. Int J Orthop Trauma Nurs. 2017 Nov;27:36-40.
- Shackelford SA, Hammesfahr R, Morissette DM, Montgomery HR, Kerr W, Broussard M, Bennett BL, Dorlac WC, Bree S, Butler FK. The Use of Pelvic Binders in Tactical Combat Casualty Care: TCCC Guidelines Change 1602 7 November 2016. J Spec Oper Med. 2017 Spring;17(1):135-147.
- Lee AK, Lin TL, Hsu CJ, Fong YC, Chen HT, Tsai CH. Three-Dimensional Printing and Fracture Mapping in Pelvic and Acetabular Fractures: A Systematic Review and Meta-Analysis. J Clin Med. 2022 Sep 06;11(18)
- Sebaaly A, Riouallon G, Zaraa M, Upex P, Marteau V, Jouffroy P. Standardized three dimensional computerised tomography scanner reconstructions increase the accuracy of acetabular fracture classification. Int Orthop. 2018 Aug;42(8):1957-1965.
- Borg T, Berg P, Fugl-Meyer K, Larsson S. Health-related quality of life and life satisfaction in patients following surgically treated pelvic ring fractures. A prospective observational study with two years follow-up. Injury. 2010 Apr;41(4):400-4.
- Kastora SL, Eley J, Kounidas G, Dighero I. Fertility and reproductive outcomes following high-energy pelvic fractures: A systematic review and meta-analysis. Int J Gynaecol Obstet. 2023 Aug;162(2):440-448.
- Vallier HA, Cureton BA, Schubeck D. Pelvic ring injury is associated with sexual dysfunction in women. J Orthop Trauma. 2012 May;26(5):308-13.
- Vallier HA, Cureton BA, Schubeck D. Pregnancy outcomes after pelvic ring injury. J Orthop Trauma. 2012 May;26(5):302-7.
- Metze M, Tiemann AH, Josten C. Male sexual dysfunction after pelvic fracture. J Trauma. 2007 Aug;63(2):394-401.
- Collinge CA, Archdeacon MT, LeBus G. Saddle-horn injury of the pelvis. The injury, its outcomes, and associated male sexual dysfunction. J Bone Joint Surg Am. 2009 Jul;91(7):1630-6.
- Skitch S, Engels PT. Acute Management of the Traumatically Injured Pelvis. Emerg Med Clin North Am. 2018 Feb;36(1):161-179
- Schwartsmann CR, Macedo CAS, Galia CR, Miranda RH, Spinelli LF, Ferreira MT. Update on open reduction and internal fixation of unstable pelvic fractures during pregnancy: case reports. Rev Bras Ortop. 2018 Jan-Feb;53(1):118-124.
- Davis DD, Tiwari V, Kane SM, Waseem M. Pelvic fracture. InStatPearls [Internet] 2024 Feb 29. StatPearls Publishing.
- Nagai Y. Rehabilitation of pelvic fracture. The Journal of Physical Fitness and Sports Medicine. 2024 Jul 25;13(4):105-9.
References
Tiziani S, Dienstknecht T, Osterhoff G, Hand TL, Teuben M, Werner CML, Pape HC. Standards for external fixation application: national survey under the auspices of the German Trauma Society. Int Orthop. 2019 Aug;43(8):1779-1785.
Gordon WT, Fleming ME, Johnson AE, Gurney J, Shackelford S, Stockinger ZT. Pelvic Fracture Care. Mil Med. 2018 Sep 01;183(suppl_2):115-117.
Oliphant BW, Tignanelli CJ, Napolitano LM, Goulet JA, Hemmila MR. American College of Surgeons Committee on Trauma verification level affects trauma center management of pelvic ring injuries and patient mortality. J Trauma Acute Care Surg. 2019 Jan;86(1):1-10.
Hutchings L, Roffey DM, Lefaivre KA. Fragility Fractures of the Pelvis: Current Practices and Future Directions. Curr Osteoporos Rep. 2022 Dec;20(6):469-477
Roszman AD, John DQ, Patch DA, Spitler CA, Johnson JP. Management of open pelvic ring injuries. Injury. 2023 Apr;54(4):1041-1046.
Reboli M, Aprato A, Vittori J, Olivero M, Bosco F, Massè A. Reevaluation of the surgical indications for anterior inferior iliac spine avulsion fractures in an acute setting - A narrative review of the current literature. J Orthop. 2023 Apr;38:20-24.
Lewallen LW, McIntosh AL, Sems SA. Pediatric Pelvic Ring Injuries. Orthopedics. 2018 Sep 01;41(5):e701-e704.
Barratt RC, Bernard J, Mundy AR, Greenwell TJ. Pelvic fracture urethral injury in males-mechanisms of injury, management options and outcomes. Transl Androl Urol. 2018 Mar;7(Suppl 1):S29-S62.
Djaja YP, Silitonga J, Dilogo IH, Mauffrey OJ. The management of pelvic ring fractures in low-resource environments: review. Eur J Orthop Surg Traumatol. 2023 Apr;33(3):515-523.
Schindler CR, Sturm R, Hörauf JA, Marzi I, Störmann P. The sequence of the treatment of combined fractures of the pelvis, spine, and extremities in polytraumatized patients. EFORT Open Rev. 2023 May 09;8(5):372-381.
Carson JT, Shah SG, Ortega G, Thamyongkit S, Hasenboehler EA, Shafiq B. Complications of pelvic and acetabular fractures in 1331 morbidly obese patients (BMI ≥ 40): a retrospective observational study from the National Trauma Data Bank. Patient Saf Surg. 2018;12:26.
Siada SS, Davis JW, Kaups KL, Dirks RC, Grannis KA. Current outcomes of blunt open pelvic fractures: how modern advances in trauma care may decrease mortality. Trauma Surg Acute Care Open. 2017;2(1):e000136.
Alton TB, Gee AO. Classifications in brief: young and burgess classification of pelvic ring injuries. Clin Orthop Relat Res. 2014 Aug;472(8):2338-42.
Dalal SA, Burgess AR, Siegel JH, Young JW, Brumback RJ, Poka A, Dunham CM, Gens D, Bathon H. Pelvic fracture in multiple trauma: classification by mechanism is key to pattern of organ injury, resuscitative requirements, and outcome. J Trauma. 1989 Jul;29(7):981-1000; discussion 1000-2.
Young JW, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: value of plain radiography in early assessment and management. Radiology. 1986 Aug;160(2):445-51.
Burgess AR, Eastridge BJ, Young JW, Ellison TS, Ellison PS, Poka A, Bathon GH, Brumback RJ. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma. 1990 Jul;30(7):848-56.
Smith W, Williams A, Agudelo J, Shannon M, Morgan S, Stahel P, Moore E. Early predictors of mortality in hemodynamically unstable pelvis fractures. J Orthop Trauma. 2007 Jan;21(1):31-7.
Tang J, Shi Z, Hu J, Wu H, Yang C, Le G, Zhao J. Optimal sequence of surgical procedures for hemodynamically unstable patients with pelvic fracture: A network meta-analysis. Am J Emerg Med. 2019 Apr;37(4):571-578.
Chotai N, Alazzawi S, Zehra SS, Barry M. Paediatric pelvic fractures: A review of 2 cohorts over 22 years. Injury. 2018 Mar;49(3):613-617.
Mennen AHM, Blokland AS, Maas M, van Embden D. Imaging of pelvic ring fractures in older adults and its clinical implications-a systematic review. Osteoporos Int. 2023 Sep;34(9):1549-1559.
Iyengar KP, Venkatesan AS, Jain VK, Shashidhara MK, Elbana H, Botchu R. Risks in the Management of Polytrauma Patients: Clinical Insights. Orthop Res Rev. 2023;15:27-38.
Stahel PF, Burlew CC, Moore EE. Current trends in the management of hemodynamically unstable pelvic ring injuries. Curr Opin Crit Care. 2017 Dec;23(6):511-519.
Rodrigues IFDC. To log-roll or not to log-roll - That is the question! A review of the use of the log-roll for patients with pelvic fractures. Int J Orthop Trauma Nurs. 2017 Nov;27:36-40.
Shackelford SA, Hammesfahr R, Morissette DM, Montgomery HR, Kerr W, Broussard M, Bennett BL, Dorlac WC, Bree S, Butler FK. The Use of Pelvic Binders in Tactical Combat Casualty Care: TCCC Guidelines Change 1602 7 November 2016. J Spec Oper Med. 2017 Spring;17(1):135-147.
Lee AK, Lin TL, Hsu CJ, Fong YC, Chen HT, Tsai CH. Three-Dimensional Printing and Fracture Mapping in Pelvic and Acetabular Fractures: A Systematic Review and Meta-Analysis. J Clin Med. 2022 Sep 06;11(18)
Sebaaly A, Riouallon G, Zaraa M, Upex P, Marteau V, Jouffroy P. Standardized three dimensional computerised tomography scanner reconstructions increase the accuracy of acetabular fracture classification. Int Orthop. 2018 Aug;42(8):1957-1965.
Borg T, Berg P, Fugl-Meyer K, Larsson S. Health-related quality of life and life satisfaction in patients following surgically treated pelvic ring fractures. A prospective observational study with two years follow-up. Injury. 2010 Apr;41(4):400-4.
Kastora SL, Eley J, Kounidas G, Dighero I. Fertility and reproductive outcomes following high-energy pelvic fractures: A systematic review and meta-analysis. Int J Gynaecol Obstet. 2023 Aug;162(2):440-448.
Vallier HA, Cureton BA, Schubeck D. Pelvic ring injury is associated with sexual dysfunction in women. J Orthop Trauma. 2012 May;26(5):308-13.
Vallier HA, Cureton BA, Schubeck D. Pregnancy outcomes after pelvic ring injury. J Orthop Trauma. 2012 May;26(5):302-7.
Metze M, Tiemann AH, Josten C. Male sexual dysfunction after pelvic fracture. J Trauma. 2007 Aug;63(2):394-401.
Collinge CA, Archdeacon MT, LeBus G. Saddle-horn injury of the pelvis. The injury, its outcomes, and associated male sexual dysfunction. J Bone Joint Surg Am. 2009 Jul;91(7):1630-6.
Skitch S, Engels PT. Acute Management of the Traumatically Injured Pelvis. Emerg Med Clin North Am. 2018 Feb;36(1):161-179
Schwartsmann CR, Macedo CAS, Galia CR, Miranda RH, Spinelli LF, Ferreira MT. Update on open reduction and internal fixation of unstable pelvic fractures during pregnancy: case reports. Rev Bras Ortop. 2018 Jan-Feb;53(1):118-124.
Davis DD, Tiwari V, Kane SM, Waseem M. Pelvic fracture. InStatPearls [Internet] 2024 Feb 29. StatPearls Publishing.
Nagai Y. Rehabilitation of pelvic fracture. The Journal of Physical Fitness and Sports Medicine. 2024 Jul 25;13(4):105-9.