Impairment due to Pelvic Fractures

Has the patient had a fracture involving the pelvic bones?

Yes

Indicate which bones were fractured and how they healed, by selecting an appropriate answer

Symphysis pubis

Sacrum

Coccyx

Left ramus

Right ramus

Left ilium

Right ilium

Left ischium

Right ischium

Is there displacement or separation of the pubis due to fracture?

Yes

Does the sacral fracture involve a sacroiliac joint?

Yes

Is the nonunion or excision with the coccygeal fracture?

Yes

Is the left ischial fracture displaced 1 inch or more?

Yes

Does the left ischial fracture involve the left acetabulum?

Yes

How much whole person impairment is seen due to restricted movement in the left hip? (from 0 to 100)

percent

Is the right ischial fracture displaced 1 inch or more?

Yes

Does the right ischial fracture involve the right acetabulum?

Yes

How much whole person impairment is seen due to restricted movement in the right hip? (from 0 to 100)

percent

Evaluation

Results

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Interpretation and Description

References

Next Steps in Evaluation

Diagnosis

Patient Concerns

Specialty

Objective

ICD-10

Purpose: To identify the impairment caused by fractures involving the pelvic bones.