Recovery from Multiple Fractures After a Construction Site Fall: Structured Home Care Case Study
Multiple Orthopedic Injuries After a Fall from Height: How Structured Home Rehabilitation Restored Mobility and Independence
A 38-year-old construction site supervisor in Mohali sustained a pelvic fracture, stable L2 compression fracture, and a displaced left distal radius fracture. After 17 days of hospital treatment including surgery, he was discharged with significant functional limitations. This case study documents his 12-week recovery through professional home healthcare.
Patient Background
Mr. Gurkirat Brar, a 38-year-old male, worked as a site civil supervisor at a construction project in Mohali, Punjab. His job involved walking across uneven surfaces, climbing scaffolding, and supervising labour at various heights. He was married and lived with his wife, aged 35, and his father, aged 64.
Before the injury, Mr. Brar was physically active and had no known chronic medical conditions. He had no history of previous fractures, spinal problems, or musculoskeletal disorders. There was no documented history of smoking, alcohol use, or metabolic bone disease. His baseline functional status was fully independent in all activities of daily living.
His wife took on the role of primary caregiver after the injury. His father, despite being 64 years old, served as the secondary caregiver. The family had no prior experience managing orthopedic injuries or post-surgical care at home. They lived in a standard apartment with basic furnishings, which would later require modifications to support safe mobility during recovery.
Construction workers in India face a disproportionately high risk of fall-from-height injuries. According to occupational health data, falls from scaffolding remain one of the leading causes of multiple orthopedic trauma in the building sector. Younger patients like Mr. Brar typically have good bone health and healing potential, but the combination of spinal, pelvic, and upper-limb injuries creates a complex rehabilitation challenge that requires coordinated care.
Clinical Diagnosis
Mr. Brar fell approximately 12 feet from scaffolding while supervising construction work. He landed on his left side and lower back. Following the fall, he experienced severe lower back pain, pelvic pain, and pain in the left wrist. He was unable to bear weight on his lower limbs.
Injuries Identified
- Stable pelvic ring fracture: The pelvic bones were fractured but the ring structure remained mechanically stable, meaning the fracture did not require surgical fixation and could heal with conservative management.
- Stable L2 vertebral compression fracture: The second lumbar vertebra had a compression fracture. Critically, there was no spinal cord involvement, no nerve compression, and no neurological deficit. This classification as “stable” meant the fracture could be managed with a lumbar brace rather than surgery.
- Displaced left distal radius fracture: The wrist bone near the wrist joint was broken and the fragments were out of alignment. This required surgical correction through Open Reduction and Internal Fixation (ORIF) to restore the anatomy and allow proper hand function.
Associated Medical Conditions
- Acute post-traumatic pain in the lower back, pelvis, and left wrist
- Lumbar muscle spasm around the L2 vertebra
- Mild post-operative anemia, likely related to blood loss during surgery
- Reduced muscle strength in both lower limbs due to pain and immobility
Hospital Treatment
Mr. Brar was taken to the hospital emergency department immediately after the fall. A comprehensive trauma evaluation was performed. This included a physical examination, X-rays of the pelvis, lumbar spine, and left wrist, along with a CT scan to further define the fracture patterns and rule out internal injuries.
He remained in the hospital for 17 days. During this period, the following interventions were carried out:
- Emergency trauma evaluation: Systematic assessment using ATLS principles to identify all injuries and rule out life-threatening conditions such as internal bleeding or organ damage.
- Open Reduction and Internal Fixation (ORIF) of the left distal radius: Surgery was performed to realign the broken wrist bone fragments and secure them with plates and screws. This procedure was necessary because the fracture was displaced, meaning the bone ends were not in proper position for natural healing.
- Conservative management of the pelvic fracture: Since the pelvic ring was stable, surgery was not required. The fracture was managed with rest, pain control, and gradual mobilization as tolerated.
- Lumbar brace application: A custom lumbar support brace was fitted to restrict excessive movement of the L2 vertebra during the healing phase and to provide external stability to the spine.
- Pain management: A combination of oral analgesics was prescribed to control acute pain and allow the patient to participate in early mobilization.
- Deep Vein Thrombosis (DVT) prophylaxis: Blood-thinning medication was administered to reduce the risk of blood clots in the legs, a well-documented complication of prolonged immobility after trauma and orthopedic surgery.
- Physiotherapy assessment: An in-hospital physiotherapy evaluation was conducted to establish baseline mobility, identify functional limitations, and create a preliminary rehabilitation plan.
- Occupational therapy consultation: The occupational therapy team assessed the patient’s ability to perform daily activities and provided guidance on adaptive techniques for the recovery period.
Not all fractures require surgical fixation. The decision to manage the pelvic and L2 fractures conservatively was based on their “stable” classification. A stable fracture means the bone fragments are not likely to shift further if the area is protected. Surgical fixation carries its own risks, including infection, bleeding, and prolonged anesthesia. When the fracture pattern allows, conservative management with bracing and gradual mobilization is the clinically preferred approach because it avoids additional surgical trauma while achieving the same healing outcome.
At discharge, Mr. Brar was clinically stable. His surgical wound was healing. Pain was controlled with oral medication. He was advised supervised home rehabilitation with regular orthopedic follow-up visits.
Condition After Discharge
Despite being medically stable, Mr. Brar’s functional status at the time of discharge was significantly limited. The transition from hospital to home is often a vulnerable period for trauma patients, and his situation illustrated this clearly.
Symptoms at Discharge
- Severe lower back pain during any movement
- Difficulty standing for more than a few minutes at a time
- Pain while sitting for extended durations
- Noticeable weakness in both lower limbs
- Reduced balance, creating a high risk of falls
- Limited use of the left wrist due to post-surgical stiffness and pain
- Difficulty performing basic household activities
Functional Assessment
| Activity Level | Activities |
|---|---|
| Dependent | Outdoor mobility, household cleaning, driving, carrying heavy objects |
| Required Assistance | Bathing, dressing (lower body), meal preparation, hospital follow-up visits |
| Independent | Feeding, communication, personal decision-making |
He could walk only short distances using a walker and required supervision during all transfers from bed to chair and back. He could climb stairs only with another person assisting him and with handrail support. This level of dependency in a previously independent 38-year-old created significant practical and emotional challenges for the entire family.
Why Home Healthcare Was Needed
The treating team recommended professional home nursing and physiotherapy at home for several clinically sound reasons.
Mr. Brar had three simultaneous fractures affecting different body regions. Each fracture had its own healing timeline and rehabilitation requirements. The pelvic fracture needed protected weight-bearing and pain management. The lumbar fracture needed strict spinal precautions and core stabilization. The wrist fracture needed surgical wound care and gradual range-of-motion recovery. Managing all three simultaneously in an unsupervised home setting would have been unsafe.
By day 17, Mr. Brar was medically stable. His surgical wound showed no signs of infection. His pain was manageable with oral medication. Prolonged hospital stays beyond medical necessity are associated with increased risks of hospital-acquired infections, deconditioning, and psychological distress. The clinical question was not whether he needed to stay in the hospital, but how to safely transfer his ongoing rehabilitation needs to the home setting. This is precisely where post-hospital recovery at home becomes the appropriate standard of care.
The family had no training in wound care, spinal precautions, or safe transfer techniques. His wife, the primary caregiver, needed practical support. His father, at 64, was not physically equipped to assist with transfers. Without professional home support, the risk of a second fall, wound infection, or delayed fracture healing would have been unacceptably high.
Families in Mohali and the broader Delhi NCR region, including those in Maholi and Gurgaon, increasingly face this exact situation: a loved one is discharged from the hospital but still needs clinical supervision that the family cannot safely provide on their own. Professional home healthcare bridges this gap by bringing trained nurses, physiotherapists, and attendants into the patient’s home.
Home Care Plan by AtHomeCare
A structured, multi-disciplinary home care plan was designed based on the hospital discharge summary, the physiotherapy assessment, and the family’s living situation. The plan addressed wound care, pain management, mobility rehabilitation, and caregiver support.
Home Nursing (Three Visits Per Week)
A registered nurse visited three times per week to perform the following clinical tasks:
- Vital signs monitoring: Blood pressure, heart rate, temperature, and oxygen saturation were checked at each visit to detect early signs of infection or other complications.
- Surgical wound assessment: The ORIF wound on the left wrist was inspected for signs of infection including redness, swelling, warmth, discharge, or wound dehiscence.
- Dressing changes: Sterile dressing changes were performed as per the surgical team’s protocol until the wound was sufficiently healed.
- Pain assessment: Pain levels were documented using a standardized scale. The nurse tracked whether pain was improving, stable, or worsening, and communicated findings to the treating doctor.
- Medication review: The nurse verified that the patient was taking prescribed medications correctly, including analgesics, DVT prophylaxis, and any supplements for bone healing.
- Monitoring for pressure injuries: Because the patient spent significant time in bed and in a hospital bed at home, skin integrity checks were performed to prevent pressure sores, a concern addressed in detail in pressure ulcer prevention guidelines.
- Education regarding spinal precautions: The nurse reinforced proper body mechanics, the importance of wearing the lumbar brace, and movements to avoid during the healing phase.
Physiotherapy (Five Sessions Weekly)
Five physiotherapy sessions per week were prescribed. This high frequency was necessary because the patient had multiple injury sites requiring simultaneous attention. The customized rehabilitation program included:
- Core stabilization exercises: Gentle exercises targeting the abdominal and back muscles were introduced progressively. A strong core provides internal support to the lumbar spine, reducing the load on the healing L2 vertebra. These exercises are a cornerstone of home-based physiotherapy for spinal fractures.
- Progressive gait training: Walking was gradually increased in distance and complexity. The patient started with the walker, progressed to a walking stick, and worked on normalized gait pattern without assistive devices.
- Pelvic strengthening: Exercises targeting the hip girdle and pelvic floor muscles were included to support the healing pelvic fracture and improve weight-bearing tolerance.
- Lower limb strengthening: Quadriceps, hamstrings, gluteal, and calf muscles were strengthened to address the documented weakness and improve the patient’s ability to stand, walk, and climb stairs.
- Wrist range-of-motion exercises: After the surgical wound healed sufficiently, gentle wrist and finger exercises were started to prevent stiffness and restore the range of motion needed for daily tasks.
- Balance training: Static and dynamic balance exercises were introduced to reduce the documented fall risk. This is particularly important for patients with lower limb weakness and spinal injuries, as discussed in fall prevention guidelines.
- Transfer training: The physiotherapist taught the patient safe techniques for moving from bed to chair, chair to standing, and on and off the toilet. Proper transfer technique protects both the fractures and the caregiver.
- Functional mobility exercises: Task-specific exercises simulating real-life activities such as picking objects from the floor, reaching overhead, and navigating tight spaces were incorporated as the patient progressed.
Patient Attendant (12-Hour Daily Assistance)
A trained patient care attendant was provided for 12 hours each day. This was essential because the patient’s wife and father could not safely manage all his physical needs alone. The attendant provided:
- Assistance with personal hygiene including bathing while maintaining spinal precautions
- Support during all transfers, ensuring the lumbar brace was worn correctly
- Walking assistance using the walker, providing steady support and preventing falls
- Meal assistance, including help with food preparation and serving
- Medication reminders to ensure prescribed drugs were taken on time
- Supervision of home exercises as directed by the physiotherapist
- Escorting the patient to hospital follow-up appointments, managing logistics of travel with a mobility-impaired person
With three active fracture sites, Mr. Brar needed physical assistance for nearly every activity during the early recovery phase. The risk of attempting to move independently was a fall that could displace the healing pelvic fracture or worsen the spinal injury. A trained patient care attendant provides a level of physical support and safety awareness that family members, despite their best intentions, typically cannot match. The 12-hour coverage during daytime addressed the period of highest activity, while family members managed nighttime needs with guidance from the nursing team.
Medical Equipment Provided at Home
All equipment was arranged through medical equipment rental services, reducing the financial burden on the family while ensuring clinical-grade support at home.
Risks Actively Monitored
Rehabilitation Goals
Short-Term Goals (Weeks 1 to 4)
- Reduce pain to a manageable level
- Improve sitting tolerance from baseline
- Increase walking distance safely
- Restore basic wrist movement
- Improve transfer ability with less assistance
Long-Term Goals (Weeks 5 to 12)
- Achieve independent walking without walker
- Restore functional use of the left upper limb
- Return to work with activity modification
- Improve spinal stability through core strength
- Maintain long-term functional independence
Family Education
- Safe spinal movement techniques to avoid stressing the L2 vertebra during daily activities
- Proper use and fitting of the lumbar brace and walker to ensure they provided the intended support
- Surgical wound care principles including signs of infection to watch for between nurse visits
- Fall prevention strategies specific to their home environment, including removing loose rugs, ensuring adequate lighting, and keeping pathways clear
- The importance of attending all prescribed physiotherapy sessions and not skipping exercises
- Nutrition guidance emphasizing adequate calcium and protein intake to support bone healing
- Recognizing warning signs that require immediate medical attention: increasing back pain, new numbness or weakness in the legs, fever, wound discharge, or leg swelling
Recovery Timeline
The home care team arrived before the patient’s discharge to set up the hospital bed, walker, raised toilet seat, and shower chair. The patient attendant was briefed on the care plan. When Mr. Brar arrived home, the nurse conducted an initial assessment including vital signs, wound inspection, and pain scoring.
He was in significant pain, could not sit for more than a few minutes, and required maximum assistance for all transfers. The lumbar brace was fitted and its use was reinforced.
Nursing Family BriefingThe physiotherapist conducted a detailed baseline assessment of range of motion, muscle strength, balance, and functional mobility. Very gentle core activation exercises were introduced while the patient lay in bed. Wrist exercises were limited to finger movements only, as the surgical wound was still fresh.
The patient could walk approximately 10 metres with the walker with maximum assistance. Pain was scored at 7 out of 10 during movement.
PhysiotherapyThe daily routine stabilized. The attendant assisted with morning hygiene and breakfast. Physiotherapy sessions focused on bed-based core exercises, gentle lower limb movements, and assisted sitting at the edge of the bed. Walking distance increased to approximately 15 to 20 metres per session.
The nurse noted the surgical wound was clean and dry with no signs of infection. Pain medication was being taken as prescribed. The family reported that the patient was more comfortable with the routine but frustrated by his dependence.
Nursing Physiotherapy Family ObservationSitting tolerance improved to approximately 25 minutes. The physiotherapist introduced standing exercises with support and began transfer training from bed to chair. Core exercises progressed from lying down to sitting position.
Walking distance reached approximately 25 metres with the walker and supervision. The patient could perform basic finger and thumb movements on the left hand. The first orthopedic follow-up visit was completed, with imaging showing fracture alignment was maintained.
Physiotherapy Doctor ReviewBy the end of the first month, the patient could sit for approximately 40 minutes without severe discomfort. Walking distance with the walker had increased to approximately 100 metres. He began stepping up and down with support as a precursor to stair climbing.
Wrist mobility improved significantly. Grip strength exercises were introduced using a soft ball. The patient could now assist with feeding using the left hand and perform light upper-body tasks. Pain during movement had reduced from 7 to approximately 4 out of 10. The nurse discontinued routine wound dressings as the surgical site had fully closed. DVT prophylaxis was reviewed and adjusted based on the doctor’s assessment of mobility improvement.
Nursing Physiotherapy Doctor ReviewCore stabilization exercises became more dynamic. The patient could perform exercises in standing position with support. Walking progressed from the walker to a walking stick for shorter distances. Balance training included single-leg standing with support and weight-shifting exercises.
Wrist mobility improved significantly. Grip strength exercises were introduced using a soft ball. The patient could now assist with feeding using the left hand and perform light upper-body tasks. Stair climbing was practiced with the walking stick and handrail, progressing from assisted to supervised.
The attendant’s hours were gradually reduced as the patient’s independence increased. The family was educated on how to supervise exercises and assist only when needed.
Physiotherapy Nursing Family EducationFollow-up imaging confirmed satisfactory healing of both the pelvic and wrist fractures. The L2 compression fracture showed signs of consolidation. The treating orthopedic surgeon cleared the patient for progressive return to activities.
Walking endurance had improved from approximately 25 metres with a walker to nearly 450 metres using a walking stick with minimal supervision. Lower back pain had reduced significantly through structured core strengthening. Left wrist mobility and grip strength allowed independent self-care and light household tasks. Sitting tolerance increased from 15 minutes to nearly 90 minutes.
The patient returned to office-based supervisory duties with temporary restrictions on heavy physical activity. No falls, neurological complications, surgical site infections, or hospital readmissions occurred during the entire 12-week home healthcare period.
Doctor Review Physiotherapy NursingClinical Progress Documentation
Mobility Progression
| Parameter | At Discharge | Week 4 | Week 12 |
|---|---|---|---|
| Walking Device | Walker (maximum assistance) | Walker (supervision) | Walking stick (minimal supervision) |
| Walking Distance | Approx. 10-25 metres | Approx. 100 metres | Nearly 450 metres |
| Sitting Tolerance | Approx. 15 minutes | Approx. 40 minutes | Nearly 90 minutes |
| Stair Climbing | Assistance + handrail | Supervised with handrail | Walking stick + handrail |
| Transfer Ability | Maximum assistance | Minimal assistance | Supervision only |
Pain Progression
| Pain Site | At Discharge | Week 4 | Week 12 |
|---|---|---|---|
| Lower Back | Severe during movement | Moderate, improving | Significantly reduced |
| Pelvis | Severe on weight-bearing | Moderate on weight-bearing | Mild, tolerable |
| Left Wrist | Moderate to severe | Mild to moderate | Mild |
Functional Status Progression
| Activity | At Discharge | Week 12 |
|---|---|---|
| Feeding | Independent | Independent |
| Bathing | Required assistance | Independent (with shower chair) |
| Dressing (lower body) | Required assistance | Independent with adaptive techniques |
| Meal Preparation | Required assistance | Independent (light tasks) |
| Household Cleaning | Dependent | Light tasks independently |
| Outdoor Mobility | Dependent | Independent with walking stick |
| Driving | Dependent | Not yet cleared (temporary restriction) |
| Work | Unable | Office duties resumed with restrictions |
Visual Progress Indicators
Supporting Clinical Documents
The following clinical documents formed the basis of this case study. All patient-identifiable information has been removed to protect privacy.
- Hospital discharge summary: Contained the complete diagnosis list, surgical details, medication prescriptions, and follow-up instructions. This document guided the entire home care plan.
- Operative notes for left distal radius ORIF: Detailed the surgical approach, hardware used, and post-operative wound care instructions.
- Radiology reports: X-ray and CT imaging reports confirming the fracture patterns, the stable classification of the pelvic and spinal fractures, and the post-operative position of the wrist hardware.
- Follow-up imaging (Week 12): X-rays confirming satisfactory healing of the pelvic and wrist fractures and consolidation of the L2 compression fracture.
- In-hospital physiotherapy assessment: Baseline evaluation of mobility, strength, and functional status at the time of discharge.
- Medication prescription: List of prescribed medications including analgesics, DVT prophylaxis, and supplements.
Recovery Outcome
Remaining Challenges
At the 12-week mark, some limitations persisted. Driving had not yet been cleared due to the left wrist’s ongoing recovery and the need for full grip strength and reaction time. Heavy lifting and construction site supervision involving physical activity remained restricted. Long-term core strengthening would need to continue independently to maintain spinal stability and reduce the risk of chronic lower back pain.
Long-Term Care Considerations
The patient was advised to continue core strengthening exercises independently. Regular orthopedic follow-ups were scheduled to monitor fracture healing and guide the gradual lifting of activity restrictions. The treating surgeon would determine when Mr. Brar could safely return to full on-site construction supervision. The family was educated that the recovery trajectory for compression fractures can extend beyond 12 weeks and that patience with the process was important.
The patient’s wife reported that having a structured home care plan reduced her anxiety significantly. She stated that knowing a nurse was monitoring the wound and a physiotherapist was guiding the exercises gave her confidence that her husband was recovering safely. The attendant’s presence allowed her to manage household responsibilities and care for her father-in-law without feeling overwhelmed.
Key Clinical Learnings
The following observations are drawn from this case and are relevant to healthcare professionals and families managing similar injuries:
- Multi-site fractures require coordinated rehabilitation timing. The wrist could not begin active exercises until the surgical wound healed. The spine required bracing before core exercises could begin. The pelvis needed protected weight-bearing before gait training could progress. A single physiotherapist managing all three sites ensured that progress in one area did not compromise another.
- The hospital-to-home transition is a high-risk period. Patients are often discharged when they are “stable” but still highly vulnerable. In this case, the patient could not sit, stand, or walk safely without assistance. Without a pre-arranged home care plan, the first few days at home could have resulted in a fall or wound complication.
- Core stabilization is not optional for lumbar compression fractures. The lumbar brace provides external support, but long-term spinal stability depends on the strength of the surrounding muscles. Starting core exercises early and progressing them systematically was a key factor in the patient’s pain reduction and functional improvement.
- Family education directly affects outcomes. Families who understand spinal precautions, fall prevention, and warning signs are better equipped to support safe recovery. In this case, the family’s adherence to the education provided likely contributed to the zero-complication outcome.
- A walking stick is not a sign of failure. Progressing from a walker to a walking stick at 12 weeks represented meaningful functional improvement. The goal of rehabilitation is safe, functional independence, not the complete elimination of all assistive devices within an arbitrary timeframe.
- Return to work is a clinical decision, not just a patient desire. The patient returned to office duties only after imaging confirmed fracture healing and the treating surgeon provided clearance with specific restrictions. Premature return to physical construction work could have compromised the healing pelvis or spine.
Frequently Asked Questions
Contact AtHomeCare
Recovery after a fall from height involving pelvic, spinal, and upper-limb injuries requires a carefully coordinated rehabilitation program even after hospital discharge. Home nursing, physiotherapy, caregiver education, assistive devices, and gradual functional training help promote fracture healing, restore mobility, prevent complications, and support a safe return to independent living and employment. This case demonstrates that with appropriate clinical support at home, even patients with multiple orthopedic injuries can achieve meaningful functional recovery without the need for institutional rehabilitation admission.