Treatment for fracture of the pelvic bones. Anatomy and biomechanics of the pelvis

A pelvic fracture is one of the most severe injuries of the musculoskeletal system. This injury is often accompanied by heavy bleeding, damage to internal organs and, accordingly, pain shock. Among people who have received a pelvic fracture, the mortality rate is very high, and many people who managed to survive remain disabled for life.

Most often, a pelvic fracture occurs as a result of its compression in the lateral or anteroposterior position. This can happen when you hit or fall from a great height, as well as in accidents. Depending on how the fractures are placed in relation to the pelvic ring, a pelvic fracture is classified into:

Marginal fracture, while the crest, wing of the ilium are damaged, the awns are torn off, as well as the pearl of the sacrum, coccyx and ischium;

A fracture that passes through the pelvic ring and does not break its continuity: fractures of the ischium or pubis, or a fracture of the ischium on one side and the pubis on the other;

A fracture in which there is a violation of the continuity of the ring. It includes ruptures of the joints, simultaneous fractures of the ischial and pubic bones, fractures of the pelvic bones along with ruptures of the joints;

Fracture of the acetabulum without dislocation or with dislocation of the head femur, fracture as well as other pelvic bones;

Combined fracture of the pelvis, in which damage occurs to the internal organs of the abdomen, skull, chest, spine and limbs.

Fracture of the pelvis: treatment and first aid

When receiving this injury, the victims first of all complain of pain in the pelvic area. These are severe injuries and in every third case a traumatic shock occurs, while there is profuse bleeding. If a combined fracture occurs, then traumatic shock occurs in most victims. When rendering, the health worker should immediately determine the mechanism of injury, which will help to more accurately determine the location of the fracture.

During the first examination, it is necessary to pay attention to the presence of hematomas and abrasions, as well as to the possible visible deformation of the pelvis. Palpation must be carried out very carefully, it will help determine the place of greatest pain and the place where the displacement of the bones occurred.

A patient who has received a pelvic pearl should be asked to urinate, if he is not able, then urine can be drained with a rubber catheter. The presence of blood in the urine may indicate kidney damage, Bladder or urethra. In all cases, when the victims are not able to urinate on their own. If blood is found during the rectum, this may indicate damage to it.

Treatment of a person who has received this injury is possible only in a hospital. To begin with, he undergoes X-ray and instrumental research. Also, the patient undergoes intrapelvic anesthesia according to Shkolnikov - Selivanov, skeletal traction and treatment on a hammock is done.

Fracture of the pelvis: consequences

With the provision of timely and professional medical care, pelvic fractures heal well. If the adjacent tissues were severely damaged during the injury, the patient may limp for quite a long time, as the muscles and ligaments are slowly recovering. In case of violation nervous tissue chronic pain, damage to some joints, and sexual dysfunction may occur.

A pelvic fracture is difficult to initially diagnose, as the victim is usually in serious condition and may have other injuries. This injury requires transport immobilization, which will not allow additional displacement of fragments, as well as shock and bleeding. A person who has received a pelvic fracture should be urgently hospitalized in a specialized hospital.

fracture pelvic bones one of the most dangerous and severe injuries musculoskeletal system, and the severity of such injuries is due to massive bleeding from fragments and soft tissues and the onset traumatic shock, which is provoked by blood loss and intense pain syndrome. Such injuries always need emergency care, stopping bleeding and stopping pain. Subsequently, damage accompanied by nerve damage can lead to urinary incontinence, sexual dysfunction and various neurological complications.

In this article, we will acquaint you with the types of trauma, its symptoms, frequent associated injuries, consequences and methods of first aid, diagnosis and treatment of pelvic fractures. This information will be useful, and you will be able to provide first aid to the victim and ask questions to the doctor.

According to various statistics, such injuries account for 4 to 7% of all fractures and most often occur in children aged 8-14 years. The reason for their appearance can be accidents on roads and railways, collapses of buildings, falls from a height, emergency situations in production and other traumatic cases. Such fractures are often combined with damage to internal organs and blood vessels, which greatly aggravates the condition of the victim. In some cases, a fracture of the pelvic bones as a crack is caused by a sudden and strong muscle contraction (usually such a cause is observed among athletes). As a rule, such injuries are stable and do not cause damage to internal organs.

A bit of anatomy

The pelvis is a system of several bones interconnected in a ring, which are located at the base of the spinal column. It is a support for most of the skeleton, connects the body and legs and performs protective functions for the internal organs located in it.

The pelvic ring is made up of the following bones:

iliac;
pubic;
ischial;
sacrum.

The bones of the pelvic ring are connected by bone sutures and are immobile. The pubic bones join in front and form the pubic symphysis, and the iliac bones are attached to the sacrum in the back. From the outer side, all the pelvic bones are involved in the formation of a part of the hip joint - the acetabulum.

In the pelvic cavity are the reproductive, urinary organs, part of the intestine, large nerves and blood vessels.

Classification

The type of pelvic fracture is determined different mechanisms injury. For example, the nature of the fault will depend on the direction (lateral, anteroposterior) and the degree of compression. Pelvic fractures are divided into the following groups:

Stable. This group includes marginal or isolated fractures that do not cause a violation of the integrity of the pelvic ring.
Unstable. Such fractures cause a violation of the integrity of the pelvic ring. These include vertically and rotationally unstable fractures. With vertical ones, there is a violation of the integrity of the pelvic ring at two points - in its anterior and posterior sections, and with rotational displacement of fragments occurs in a horizontal direction.
Fracture dislocations. Such injuries are combined with dislocation in the sacroiliac or pubic joint.
Fractures of the bottom or edges of the acetabulum. Such injuries can sometimes be combined with a dislocation of the femur.

Collateral damage

With fractures of the pelvic bones, massive bleeding always develops. With an isolated or marginal fracture, it is less significant and amounts to about 200-500 ml, and with unstable vertical fractures, the loss can be from 3 or more liters.

Severe injuries of the pelvic bones are often combined with damage to the organs located in the pelvic cavity. Usually there is an injury to the urethra or bladder, and in more rare cases, the rectum and vagina. When these organs are affected, their contents are poured into the pelvic cavity, infect it and lead to the development of purulent processes.

A number of fractures of the pelvic bones cause compression of the nerve trunks and roots located in lumbar. Subsequently, such injuries lead to neurological disorders.

Symptoms

The severity of symptoms depends on the severity of the injury.

All manifestations of a pelvic fracture can be divided into local and general. Character local symptoms depends on the location of the pelvic ring injury.

local symptoms

Fractures of the pelvic bones are manifested by the following symptoms:

sharp and intense pain in the area of injury;
edema;
hematoma formation;
pelvic deformity.

In some cases, the fragments are mobile and when probing, you can hear their crunch - crepitus.

Pelvic ring injury

With such fractures in the victim, the pain becomes more intense with movements of the lower limb and attempts to squeeze the pelvis in the lateral direction or palpation pelvic area. In the absence of a violation of the integrity of the ring of the pelvic bones, the pain is localized in the perineum.

If the injury is accompanied by a violation of the integrity of the anterior pelvic half-ring, then when the legs move or when the pelvis is squeezed in the anteroposterior or lateral direction, the pain intensifies. In case of fractures near the symphysis, the victim is forced to move the bent legs, and an attempt to breed them provokes the appearance of severe pain. In case of fractures of the upper branch of the pubic or ischium, the victim takes the “frog” position - lies on his back and spreads his half-bent legs to the sides. And in case of fractures of the posterior half-ring, the patient lies on the side opposite to the injury and his leg movements from the side of the fracture are sharply hampered.

pubic bone injury

Such fractures usually do not cause destruction of the pelvic ring and are provoked by compression of the pelvis or with a strong blow. In addition to the usual local symptoms, such injuries are usually combined with damage and dysfunction of the pelvic organs, leg movements and the appearance of a “stuck heel” symptom (lying on your back, a person cannot lift a straightened leg). Injury to the internal organs and the formation of a hematoma in the anterior region abdominal wall causes symptoms to appear.

Anterior superior spine injury

With such fractures, fragments are shifted downward and outward. In this case, the displacement causes shortening of the leg. The victim tries to walk backwards - in this position, the pain syndrome becomes less intense, because the leg does not move forward, but backward. This symptom is called "Lozinsky's symptom".

Injury to the sacrum and coccyx

With such fractures in the victim, the pain intensifies with pressure on the sacrum and the act of defecation becomes difficult. If the injury is accompanied by damage to the nerves of the sacrum, then enuresis and impaired sensitivity in the buttocks may develop.

Injury of the ilium and upper acetabulum

With such fractures, pain is localized in the region of the iliac wing. The victim has dysfunction of the hip joint.

Malgen's fracture

Such injuries are accompanied by a fracture of both the posterior and anterior pelvic half rings. The pelvis becomes asymmetrical, hemorrhages appear in the perineum and / or scrotal region and pathological mobility that occurs with lateral compression.

Acetabular trauma

With such fractures in the victim, the pain increases sharply when trying to axial load or tapping on the thigh. The functions of the hip joint are impaired, and in the presence of a dislocation of the hip, a violation of the location occurs greater trochanter.

General symptoms

In 30% of the injured, isolated pelvic fractures lead to development. And with combined or multiple injuries state of shock present in all victims. Traumatic shock is caused by intense pain resulting from injury or compression of very sensitive nerve endings pelvic area, and massive blood loss. In shock, the victim has the following symptoms:

pallor;
cold clammy sweat;
tachycardia;
arterial hypotension;
loss of consciousness (in some cases).

With injuries of internal organs, the formation of a retroperitoneal hematoma or a hematoma in the anterior abdominal wall, the victim develops a clinical picture " acute abdomen". Injury to the bladder leads to impaired urine output and hematuria, and damage to the urethra is accompanied by urinary retention, bruising in the perineum, and bleeding from the urethra.

First aid

If a pelvic fracture is suspected, the following measures should be taken:

Take the victim to a safe place.
Call an ambulance.
To combat traumatic shock, give the patient to take painkillers: Analgin with Diphenhydramine, Ketorol, Ibufen, etc. It is better to drink tablets with strong warm sweet tea or coffee. If possible, you can intramuscular injection analgesics. Sedative drugs can supplement the action of painkillers and calm the victim: valerian tincture, Valocordin, Corvalol, etc.
In the presence of open wounds process them antiseptic solution and cover with a napkin from a sterile bandage, fixing it with adhesive tape.
Lay the patient in the frog position on a flat hard surface (a wooden shield or a removed door), covered with a not very soft mattress. Subsequently, on the same surface, it can be transported to a medical institution. Place a 60 cm high roller or pillow made from improvised means under bent knees. Raise your head. Cover the victim.
Explain to the patient that it is impossible to move the legs.

Properly rendered first aid in fractures of the pelvic bones many times reduces the risk of complications and the onset of death. It is necessary to transport the patient as sparingly as possible, since it is necessary to perform sufficient immobilization in case of such injuries not in conditions medical institution impossible.

Possible consequences

Fractures of the pelvic bones can lead to the following consequences:

damage to the urinary organs and intestines;
sexual dysfunctions;
damage to nerves, tendons and blood vessels;
paresthesia with compression of the nerves;
open bleeding;
infection with open injuries or damage to internal organs;
, and other diseases of the bone apparatus;
hypo- or muscle atrophy;
the formation of bone growths;
and etc.

With severe fractures, the victim shortens the legs, and the mobility of the lower extremities is impaired (fully or partially). With such injuries, bone healing can be significantly slowed down.

Long-term effects of such injuries may be present for many years or a lifetime.

Massive blood loss that occurs with some fractures of the pelvic bones can cause the onset lethal outcome in the first hours after injury. Mortality in survivors of the first days does not exceed 5%.

Diagnostics

Confirm the diagnosis of a fracture x-ray examination.

After examining and questioning the victim, the traumatologist prescribes an x-ray. If necessary, CT and/or MRI is recommended.

If symptoms of an "acute abdomen" are identified, laparoscopy, laparocentesis, or exploratory laparotomy may be performed. If there is a suspicion of trauma to the urinary organs, then an ultrasound of the bladder and urethrography are performed.

Treatment

After the victim is admitted to the hospital, the first step is to antishock therapy, consisting in the relief of pain, compensation for lost blood and immobilization of the fracture area.

Relief of pain syndrome

Can be used for pain relief narcotic analgesics(morphine hydrochloride, promedol, etc.) and novocaine blockades are performed. Introduction local anesthetic can cause a decrease in blood pressure, so in such situations it can be administered only after compensation for blood loss. In cases of Malgenya fractures, the victim is put into therapeutic anesthesia.

Replenishment of lost blood

With massive blood loss, severe shock and combined injuries, the replacement of the lost blood is performed in the first hours. For this, large volumes of blood are transfused to the victim. With isolated fractures of the pelvic bones, fractional blood transfusions are performed for 2-3 days to compensate for blood loss. Intravenous infusions are supplemented with the introduction of glucose solutions, blood substitutes and blood plasma.

Immobilization

The duration and type of immobilization in pelvic fractures is determined by the location of the injury and the integrity of the pelvic ring. With an isolated or marginal fracture, the victim is fixed in a hammock or on a shield. In more rare cases, rollers for the knee and popliteal region and the Beller splint are used for immobilization. If the integrity of the pelvic ring is violated, skeletal traction is performed.

Conservative therapy

With stable fractures, the fusion of the pelvic bones can occur only when the patient is immobilized and does not require surgical treatment. Additionally, the patient is given drug therapy:

painkillers;
calcium preparations and multivitamin complexes;
antibiotics (for open fractures).

After the fusion of the bones for the patient, a individual program rehabilitation, including physiotherapy exercises, massage and physiotherapy.

Surgery

Performance surgical operation for fractures of the pelvic bones is recommended in the following cases:

the presence of injuries of the pelvic organs;
rupture of the symphysis and a significant divergence of the pubic bones;
ineffectiveness of conservative therapy in the presence of significant displacement of fragments.

To compare bone fragments, osteosynthesis is performed using pins, screws and metal plates. Usually, an external fixator is used to fix such devices. Such interventions are carried out general anesthesia. During the operation, the surgeon always conducts a thorough revision of the internal organs, nerves and blood vessels and, if necessary, eliminates the identified damage.

After the completion of osteosynthesis, the patient is prescribed drug therapy, and after the fusion of the bones, a rehabilitation program is drawn up.

Rehabilitation

Patients with pelvic fractures during treatment and recovery period should include in your daily diet enough foods that are rich in calcium:

fish;
dairy products;
legumes (green beans, soybeans, etc.);
fresh vegetables and herbs;
nuts, sesame, poppy;
rose hips and other berries;
persimmon and other fruits.

The duration of fusion of the pelvic bones is determined by many factors, and it is impossible to name the exact period for the restoration of their integrity. The rate of their fusion depends on the age, type of bone, area of the fracture, the quality of the blood supply to the damaged area, the presence of concomitant diseases that impede the fusion of bones, bad habits, etc.

Important in the healing of the pelvic bones is the observance of all doctor's recommendations. If such recommendations are not followed, the fragments may grow together incorrectly and cause the development of complications in the future.

Only a doctor guided by X-ray data can name the exact timing of bone restoration. As a rule, the healing period is about 1-1.5 months, and the patient's full recovery is possible several months after the injury.

For full recovery The patient's rehabilitation program includes the following activities:

taking drugs to restore bones;
physiotherapy;
massage;
therapeutic traction;
cryomassage;
use of ointments, creams and gels;
physiotherapy procedures.

After examination by a doctor, the patient is allowed to walk using crutches or a walker. Even after stable fractures, the use of such devices is necessary for 3 or more months. At the same time, the person limps for a while. The duration of walking with such injuries should increase gradually and be recommended by a doctor.

Pelvic fractures

Pelvic fractures are among the most severe injuries of the musculoskeletal system: with isolated fractures of the pelvic bones, 30% of patients are admitted in a state of traumatic shock, mortality is 6%; with multiple fractures of the pelvis, shock is observed in almost all victims, and mortality reaches 20%.

IN last years marked increase in the incidence of pelvic injuries. The most common cause is motor vehicle injuries.

Fracture mechanism pelvic bones in most patients with direct: blows or compression of the pelvis. Persons young age, especially those actively involved in sports, are observed avulsion fractures apophyses as a result of excessive tension of the attached muscles.

Depending on the location of the fracture, the degree of violation of the integrity of the pelvic ring, several groups of injuries to the pelvic bones are distinguished: 1) marginal fractures of the pelvic bones; 2) fractures of the pelvic ring without breaking its continuity; 3) fractures of the pelvic ring with a violation of its continuity (in the anterior section, in the posterior section, in the anterior and posterior sections); 4) fractures of the acetabulum.

In addition, pelvic injuries can be combined with damage to the pelvic organs,

Clinic and principles of diagnostics. Signs of gas bone damage can be divided into 2 groups: general and local. Common signs of pelvic fractures include symptoms of traumatic shock, "acute abdomen", signs of damage to the urinary tract and other organs of the pelvis. Local signs of a pelvic fracture include symptoms of a fracture of a particular bone (pain, hematoma or swelling, bone crepitus with mutual displacement of bone fragments) and functional disorders of the musculoskeletal system.

Common signs of pelvic fractures. Shock in pelvic fractures is observed in approximately 30% of patients with isolated fractures and in 100% of patients with multiple and concomitant injuries.

The cause of shock is massive bleeding from damaged soft tissues and bones with simultaneous damage or compression of the nerve elements. The soft tissues of the pelvic region and the bones of the pelvis have a high pain sensitivity. Therefore, the pain component in the genesis of traumatic shock in pelvic fractures is one of the leading ones. Good blood supply to the pelvic area and anatomical features the structures of the vascular system in the pelvic region cause significant blood loss, which, with isolated fractures of the pelvic bones, reaches 1 liter, and with multiple fractures, much more. Bleeding from pelvic fractures sometimes lasts 2-3 days. Clinical manifestations of shock depend on the rate of blood loss: with isolated fractures, the rate of blood loss is small, with multiple fractures, bleeding becomes profuse. Another reason large blood loss with pelvic fractures - a violation of the blood coagulation system. In the first 2-3 days, hypofibrinogenemia is noted, fibrinolytic activity of the blood increases. These features of hemorrhage in pelvic fractures should be taken into account when conducting therapeutic measures.

Clinic of "acute abdomen" with fractures of the pelvic bones, it can be caused by a hematoma in the anterior abdominal wall with fractures of the pubic bones or retroperitoneal hematoma with fractures of the posterior pelvis, as well as damage to internal organs.

Differential diagnosis of the cause of "acute abdomen" depends on the severity of the victim. In a satisfactory condition of the patient, dynamic surveillance for clinical manifestations of "acute abdomen". Usually, if the cause is a hematoma of the anterior abdominal wall or retroperitoneal, the clinic does not increase. Progression of symptoms of peritoneal irritation is a sign of damage to internal organs. Intrapelvic anesthesia according to Selivanov-Shkolnikov or anesthesia of the fracture site in case of damage to the anterior half ring lead to a significant subsidence of the signs of "acute abdomen" with well-being in abdominal cavity, which is a good differential diagnostic technique.

In a serious condition of the patient, when the clinical picture of trouble in the abdominal cavity can be blurred, expectant management is unacceptable. It is necessary to apply objective diagnostic methods. Some of the most reliable methods are laparocentesis, laparoscopy, lavage of the abdominal cavity with a groping catheter, and in doubtful cases, diagnostic laparotomy.

Symptoms of urinary tract injury. At the time of admission of patients with severe pelvic trauma, if it is impossible to urinate independently, regardless of the presence or absence of signs of damage, in order general research it is necessary to find out the condition of the urinary tract.

Damage to the urethra is characterized by a triad of symptoms: bleeding from the urethra, urinary retention and hematoma in the perineum. The severity of these signs may vary depending on the location of the damage (anterior or posterior urethra), the nature of the damage (penetrating or non-penetrating). In doubtful cases, it is advisable to conduct urethrography.

With extraperitoneal bladder injury patients report pain over the pubic joint. Urination disorders can be different: the impossibility of independent urination, urination in small portions or a weak stream, sometimes patients experience frequent fruitless urges or they end with the release of a large number blood-stained urine or blood. In general, hematuria is a sign of damage to the urinary organs. It is generally accepted that initial hematuria is typical for damage to the urethra, terminal - for damage to the bladder, total - for damage to the kidneys. late signs extraperitoneal damage to the bladder is the development of urinary infiltration of the pelvic tissue: the appearance of swelling over the pubis and pupart ligaments; intoxication clinic.

With intraperitoneal rupture of the bladder victims note pain in the lower abdomen, which then becomes diffuse. Urination disorders can be in the form of frequent fruitless urges, sometimes a small amount of bloody urine or blood is excreted. Sometimes independent urination is preserved, but the urine stream is sluggish.

If a bladder injury is suspected or if the patient is in a serious condition, when the victim is unable to urinate on his own, catheterization must be performed. If the bladder is damaged, there may be no urine, it may stand out in a weak stream, you can get a small amount of urine stained with blood. The nature of the damage to the bladder is specified by performing retrograde cystography: after catheterization of the bladder, up to 200 ml of a 10% solution of sergosin with antibiotics (5,000,000 IU of penicillin) is injected, x-rays are taken in two projections, then contrast agent remove and repeat radiographs. Repeated images allow you to quite clearly determine the localization of streaks that could be blocked by the contours of the bladder.

Principles of treatment common manifestations pelvic fracture.

Treatment of traumatic shock. The most important anti-shock measures for pelvic injuries are general and local anesthesia, adequate replacement of blood loss, and proper immobilization of the fracture.

General anesthesia achieved with the use of medical anesthesia. Local anesthesia is carried out using anesthesia of the fracture site, intrapelvic anesthesia according to Selivanov-Shkolnikov or intraosseous anesthesia. In case of marginal fractures of the pelvis, fractures of the pelvic ring without discontinuity or with discontinuity in the anterior section, it is advisable to use local anesthesia the introduction of a concentrated solution of anesthetic (50-60 ml 1-1, 5% novocaine solution) into the fracture area. Anesthesia can be repeated when the pain syndrome resumes. In case of pelvic fractures with discontinuity of the pelvic ring in the posterior region, as well as in the anterior and posterior regions, it is advisable to perform anesthesia according to Selivanov-Shkolnikov or intraosseous anesthesia. However, it must be remembered that novocaine has a hypotensive effect, and therefore the introduction of a large amount of it in shock until the volume of circulating blood is replenished is not indifferent.

The technique of intrapelvic anesthesia: 1 cm medially from the anterior-superior spine with a thin needle, anesthesia of the skin is performed, then a long needle (12-I cm) penetrates into the internal iliac fossa. In this case, the needle is turned with a cut to the wing of the ilium and its advancement in depth is carried out next to the bone with the simultaneous introduction of a solution of novocaine. With a unilateral fracture, 200-300 ml of 0.25% novocaine solution are injected; With a bilateral fracture, 150-200 ml of an anesthetic solution are injected from each side.

Intraosseous anesthesia is performed by injecting an anesthetic solution through a needle inserted into the iliac wing crest. To slow down the resorption of the anesthetic solution, V. A. Polyakov proposed intraosseous administration of a mixture of 10 ml of a 5% solution of novocaine and 90 ml of gelatinol. The solution is injected 50 ml into both wings. There comes a persistent analgesic effect up to 24 hours. In addition, filling vascular bed Gelatin helps stop bleeding.

Bleeding in isolated pelvic fractures is characterized by a slower rate and less blood loss, patients rarely come in severe shock, so blood transfusion should be carried out in fractional portions during the first 2-3 days after injury.

At severe degrees shock, significant blood loss is noted, and therefore close to adequate blood replacement should be carried out at a high volumetric transfusion rate in the first hours after injury. With continued profuse bleeding from damaged tissues, surgical methods for stopping bleeding are indicated - ligation of both internal iliac arteries.

In connection with severe hypocoagulation, hypofibrinogenemia and increased fibrinolytic activity of the blood in the first hours after the injury, it is necessary to take measures to increase blood coagulation, which is achieved by using epsilon aminocaproic acid, fibrinogen, and direct blood transfusion.

Immobilization for pelvic fractures with a violation of the continuity of the pelvic ring and the displacement of bone fragments is achieved by using a system of constant skeletal traction. The use of only bed rest with orthopedic laying of limbs on standard splints or with the help of rollers in the popliteal regions without fracture reposition is unacceptable.

Treatment of urinary tract injuries. For non-penetrating urethral ruptures, conservative therapy: appoint antibacterial drugs for disinfection of the urinary tract, plentiful drink, cold on the perineum. With urinary retention, patients undergo bladder catheterization in compliance with the strictest asepsis rules (danger of introducing infection) or a permanent catheter is inserted. Healing of damage to the urethra occurs within 1.5-2 weeks. The development of scar tissue during healing of the urethra can lead to the formation of a stricture, which is clinically manifested by difficulty urinating. The narrowing of the urethra is eliminated by bougienage, which begins 2 to 4 weeks after the injury. Sometimes you have to resort to repeated courses of bougienage. For penetrating urethral ruptures medical measures should solve the following tasks: restoration of the anatomical integrity of the urethra, urine diversion and elimination of urinary infiltration of paraurethral tissues. These tasks can be solved simultaneously and in stages. The volume of surgical intervention depends on several factors: the severity of the patient's condition, the presence of conditions and the possibility of a primary urethral suture. Primary urethral suture can be performed only with persistent removal of the patient from shock, full compensation of blood loss and sufficient experience of the surgeon in carrying out such surgical interventions. Surgery performed under general anesthesia, it is advisable to start with a suprapubic section of the bladder. Epicystostomy allows not only to divert urine into postoperative period, but also - retrograde conduction of the catheter in urethra. The place of rupture of the urethra is exposed by a perineal incision. The paraurethral hematoma is emptied, the urethra is sutured over the catheter, the paraurethral tissue is drained. A permanent catheter is left in the urethra for 2-3 weeks. Prevention and treatment of urethritis is carried out by daily administration of a concentrated solution of antibiotics into the urethra. If the ends of the urethra cannot be sewn together, the catheter is left for 6-8 weeks, that is, for the entire period of scar formation and restoration of the urethral defect. If there are no conditions for the primary urethral suture (the patient's serious condition, the absence of an experienced surgeon), surgical intervention on the urinary tract is carried out in 2 stages. At stage I, surgery is performed to prevent life-threatening complications (urinary leakage) - epicystostomy and drainage of urohematoma. Restoration of the integrity of the urethra is carried out after the fusion of the fracture of the pelvic bones.

Treatment of bladder injuries. With non-penetrating ruptures (rupture of the mucous membrane), conservative therapy is carried out. Patients are prescribed drugs for disinfection of the urinary tract. With urinary retention, leave a permanent catheter or conduct periodic catheterization. With penetrating ruptures of the bladder, surgical treatment is performed, the task of which is to suture the bladder, divert urine and drain paravesical tissue in the presence of urinary streaks.

With an intraperitoneal rupture of the bladder, it is sutured with two-story sutures. Diversion of urine is carried out by inserting an indwelling catheter for several days. In case of insufficient tightness of the seam, it is advisable to strengthen it with a free gland. In the presence of urinary peritonitis, drainage of the abdominal cavity is performed.

With an extraperitoneal rupture of the bladder, a suprapubic section of the bladder is performed. The bladder wound is sutured if access to it does not require wide exposure of the bladder. Drainage of perivesical tissue is carried out by various approaches: through the obturator openings, through the perineum, above the pupart ligament, in front of the coccyx. The method of drainage is determined by the prevalence of urinary infiltration and the intensity of development purulent infection. Urine is drained through the suprapubic fistula into an indwelling catheter. The permanent catheter is removed when spontaneous urination is restored.

Marginal fractures of the pelvic bones

TO marginal fractures pelvic bones include fractures of the coccyx, fractures of the sacrum distal to the sacroiliac joint, fractures of the iliac wing and apophyses (antero-superior and anterior-inferior pelvic spines, ischial tuberosity).

Tailbone fracture

It comes from a direct blow or a fall on the buttocks. Fracture-dislocations in the sacrococcygeal joint are more often observed.

Clinic. Disturbed by pain in the coccyx, aggravated by palpation, walking, defecation. Sometimes swelling or hematoma is locally determined. The pain is aggravated by rectal examination. Radiological confirmation of damage is not always possible, so the diagnosis should be based on clinical signs.

Treatment with fractures of the coccyx, it consists in anesthesia and rest for several days. Pain is relieved by local anesthesia, laying the patient in a circle. If the pain syndrome recurs, the anesthesia is repeated. Indications for surgical treatment fracture-dislocations of the coccyx occur when improperly fused fractures of the coccyx with displacement into the cavity of the small pelvis when preventing the departure physiological functions or severe pain syndrome. Surgical intervention is to remove a fragment of the coccyx. Ability to work with fractures of the coccyx is restored after 2-4 weeks.

Fractures of the apophyses of the pelvic bones

Often come from indirect violence - excessive muscle tension, and this damage is typical for young people involved in sports. These fractures may be based on degenerative-dystrophic processes in the apophyses. Less often, a fracture occurs from the direct application of a traumatic force, and the damage is not limited to the awn only, but also captures part of the main bone. Most often, damage to the anterior-superior iliac spine occurs, and fractures of the ischial tuberosity are less common.

Clinic of these injuries is quite characteristic: patients complain of pain in the apophysis area, swelling or hematoma is also determined here. Functional disorders touch the muscles starting from the corresponding apophysis. So, with a fracture of the anterior-upper spine, it is difficult to move the patient forward and raise the straightened limb. Sometimes there is a symptom of "reverse" - the pain when moving the patient forward is more pronounced than when moving backward. With a fracture of the apophysis of the ischium, the function of the leg flexors is disrupted, and when they are strained, the pain intensifies.

Treatment. The fracture site is anaesthetized. The limb is laid in such a way as to maximally relax the muscles attached to the apophysis. So, with a fracture of the anterior-upper spine, the limb is bent at the hip joint and retracted; with a fracture of the ischial tuberosity, extension in the hip joint and flexion of the lower leg are achieved. The correct position is ensured by laying on the rails or by using a permanent adhesive stretching system. Bed rest continues for 2-3 weeks, working capacity is restored after 3-4 weeks. Persons who are actively involved in sports need to limit training loads for six months. Indications for surgical treatment are extremely rare with significant displacement of fragments and severe pain or dysfunction.

Fractures of the iliac wing

They occur more often and arise from direct trauma or compression of the victim with localization of pressure in a limited area.

Clinic. Patients note pain at the fracture site, swelling is noticeable, and a few hours after the injury - a hematoma, which causes the smoothness of the contours of the pelvis on the side of the fracture. The pain increases with movement, especially with tension of the oblique muscles of the abdomen and gluteal muscles,

Treatment with fractures of the iliac wing, it consists in anesthesia, which is achieved by introducing an anesthetic into the fracture site, and providing bed rest for 3-4 weeks. Muscle relaxation is achieved by orthopedic laying on standard splints or by using a permanent adhesive traction system. Ability to work is restored after 5-6 weeks.

Fractures of the pelvic ring with a violation of its continuity in the anterior section

This group of fractures includes unilateral or bilateral fractures of the pubic and ischial bones. The biomechanical feature of these fractures is that they are accompanied by a violation of the mechanical strength of the pelvic ring and, under load, the half of the pelvis can be displaced at the level of the fracture due to mobility in the sacroiliac joints. Therefore, the load on the limbs can be resolved only after a sufficiently strong union of the fracture - after 6-8 weeks. The mechanism of injury: compression of the pelvis, a fall from a height or from a direct blow.

Clinic. The general condition of patients with unilateral fractures of the pelvic ring suffers little, the effects of traumatic shock are rare. The pain in the area of the fracture is aggravated by an attempt to move the limb. Swelling in the area of the anterior half-ring of the pelvis, expressed in the first hours after the injury, after 2-3 days is replaced by bruising in the surrounding tissues. With bilateral fractures of the anterior half-ring of the pelvis, the general condition of the patient is unsatisfactory. Typically forced position of the patient with bent and divorced limbs. The diagnosis is clarified by X-ray examination.

Treatment should consist in anesthetizing the fracture and ensuring immobilization. The effect of anesthesia is achieved by intrapelvic anesthesia according to Selivanov-Shkolnikov on one or both sides. Immobilization is carried out using a permanent adhesive stretching system on one or both sides. The need for skeletal traction usually does not arise, since significant mixing in length due to muscle retraction is not observed due to the integrity of the posterior pelvis. The duration of bed rest is 6-7 weeks, followed by the resolution of a dosed load, full load is possible from the 8th week. Ability to work is restored after 10-12 weeks.

Pelvic ring fractures with discontinuity in the posterior region

These injuries are extremely rare in the form of a vertical fracture of the sacrum or ilium and are accompanied by severe pain and significant blood loss, causing disturbances in the general condition of the patient. The mechanism of injury often consists in compression of the pelvis in the anterior-posterior direction.

Clinic. The general condition of the patient is significantly impaired, most patients are diagnosed with shock. Disturbed by pain in the posterior pelvis, the support function is impaired, the patient's position is passive. Possible manifestations of the clinic "acute abdomen" due to retroperitoneal hematoma. The diagnosis is confirmed by radiography.

Treatment. Pain relief is achieved by intrapelvic anesthesia. In case of fractures without displacement, a system of permanent adhesive traction is applied on the side of the injury. If there is a shift in width, the latter is eliminated by using a hammock. Given that the posterior pelvis carries a significant static load, patients are allowed to walk with crutches no earlier than after 10 weeks, and full load is allowed after 12-14 weeks. Ability to work is restored after 14-16 weeks.

Fracture-dislocation of the pelvis

Fractures of the pelvic ring with a violation of its continuity in the anterior and posterior sections - fracture-dislocation of the pelvis

These injuries are among the most severe pelvic fractures: in all patients they are accompanied by shock caused by pain and severe blood loss, often combined with damage to the internal organs of the abdomen or urinary tract, as well as damage to the limbs. Injuries often occur as a result of compression of the pelvis, less often when falling from a height. Several variants of damage to the anterior and posterior pelvis with discontinuity are possible: a vertical fracture of the anterior and posterior pelvis, a fracture of the pubic and ischium and a vertical fracture of the sacrum, vertical fractures in the anterior and posterior sections on opposite sides - diagonal fractures, ruptures of the pubic and sacral iliac joints - isolated or combined. There are practically no “pure” isolated ruptures of the pelvic joints, since mixing in one of them can occur only under the condition of partial or complete violation ligamentous apparatus in another. The exception is the "rupture" of the symphysis that occurs during childbirth.

Clinic. Signs of a serious general condition of the patient come to the fore. The position of the victim is passive - the limbs are bent and hip joints, somewhat retracted and rotated outward on the side of the injury. The movements of the limb on the side of the injury are sharply limited and painful. When the half of the pelvis is displaced, asymmetry is noticeable, swelling and hematoma quickly appear at the fracture sites. For diagnostic purposes, compression of the pelvis recommended by some authors in the sagittal or frontal planes is not advisable, since this can lead to secondary displacement of the fragments and an increase in the shock reaction. The diagnosis is confirmed by radiography.

Treatment

With vertical fractures of the pelvis without displacement treatment is carried out by the method of constant skeletal traction with small loads for 8 weeks in the average physiological position of the limbs. A dosed load on the limb from the side of the injury is allowed after 10 weeks, a full load - after 3-4 months. Ability to work is restored after 5-6 months in the absence of concomitant pathology.

With vertical fractures of the pelvis with displacement reposition of the fracture is carried out using constant skeletal traction for the limb on the side of the displacement of the half of the pelvis (the pin is inserted behind the epicondyles of the femur), on the opposite limb, skeletal or cuff traction is performed to prevent pelvic distortion when significant loads are applied on the main skeletal traction. Since the displacement of the half of the pelvis in length may be accompanied by a displacement in width, it is important to follow the sequence in eliminating individual components offset. Offset but length can be with a divergence of the halves of the pelvis and with overlap. When the half of the pelvis is displaced with a divergence of the fragments along the width, the displacement along the length is first eliminated by stretching along the axis of the limbs, and then the halves of the pelvis are brought together with the help of a hammock. In case of displacement with overlapping of fragments but in width, it is first necessary to eliminate the displacement of the pelvis in width. This is achieved by using lateral traction with a loop at the base of the lower limb or by using skeletal traction on the greater trochanter or pelvic wing. After eliminating the offset in width, increase the weights along the axis and eliminate the offset in length. To eliminate the displacement along the length, loads of the order of b-10 kg are used. After eliminating the displacement along the length, the weights gradually decrease and the value of the holding weight is equal to half the sum of the initial and maximum weights. The duration of traction is 8-10 weeks. A dosed load on the limb on the side of the displacement of half of the pelvis is allowed after 10-12 weeks, a full one - after 3.5-5 months, depending on the degree of the former displacement, the reduction achieved, the severity of reparative changes, and the weight of the victim. The recovery period varies considerably. Often patients go on disability.

With ruptures of the pubic joint carry out constant axial traction for both lower limbs within 6-8 weeks. The elimination of mixing in width is achieved simultaneous application hammock or skeletal traction for the wings of the ilium. After the termination of immobilization, the pelvis is fixed with a soft-elastic bandage, which must be used for six months. A dosed load on the limbs is carried out after 8 weeks, a full load is allowed after 10 weeks. Ability to work is restored after 3 months.

With dislocations of half of the pelvis (rupture of the pubic and sacroiliac joints) reposition along the length is carried out using constant skeletal traction for the epicondyle of the thigh on the side of dislocation and adhesive countertraction for the opposite limb. After eliminating the offset in length, the offset in width is repositioned using a hammock. The duration of traction and further management of the patient, as in case of fracture-dislocation of the pelvis. Patients should be advised to wear a pelvic brace for 1 year after injury.

Fractures of the acetabulum

Acetabular fractures are intra-articular injuries. They can be in the form of isolated fractures of the body of the ilium penetrating through the acetabulum, transacetabular fractures of the pelvis with angular displacement, fractures of the acetabular floor with displacement of the femoral head into the pelvic cavity (central hip dislocation), fractures of the upper-posterior edge without displacement of the femoral head and fractures of the upper posterior edge with displacement of the head (dislocation) of the femur. Mechanism of injury: fall on area greater skewers, compression of the pelvis in the frontal plane or frontal impact in a car accident.

Clinic. Complaints of pain in the hip joint. With fractures without displacement, active movements in the joint are possible, leading to increased pain, and partial support of the limb is rarely preserved. With displaced fractures, active movements of the limb are sharply limited, often it is in a vicious position: flexion and external rotation in case of transacetabular fracture of the pelvis, flexion and internal rotation in case of central hip dislocation, flexion, adduction and internal rotation in case of posterior hip dislocation. In fractures with displacement of the femoral head, the contours of the hip joint are violated: with posterior hip dislocations, the greater trochanter is displaced anteriorly, with a central dislocation, it sinks deep. The nature of the damage is clarified by radiography in 2 projections, since the displacement can also be in the anterior-posterior direction.

Treatment.

With isolated fractures of the iliac body penetrating into the acetabulum , the joint is unloaded using a system of permanent skeletal or adhesive traction in the average physiological position of the limb for 4 weeks. Movements in the joint begin when the acute pain syndrome subsides (after 5-7 days). A subsidized load is allowed after 4-5 weeks, a full load - after 8-10 weeks. Ability to work is restored after 10-12 weeks.

With transacetabular fractures of the pelvis there comes an angular displacement of fragments towards the pelvic cavity - the diagonal size entering the cavity of the small pelvis decreases. Reposition of fragments can be achieved by the method of constant skeletal traction for the limb of the damaged side. The needle is carried out behind the epicondyle of the thigh, the initial load is 4 kg, the comparison of fragments usually occurs with loads of 6-7 kg. The duration of traction is 8 weeks, after 2-3 weeks from the moment of injury, therapeutic exercises for the hip joint begin. Subsidized load on the limb of the injured side is possible 10-12 weeks after the injury, full load - after 4-6 months. Ability to work - after 5-7 months.

In case of fractures of the bottom of the acetabulum without displacement of the head impose a system of permanent skeletal traction for 4 weeks, therapeutic exercises begin on the 3rd-4th day, a dosed load is possible 8 weeks after the injury, full - after 12-14 weeks. Ability to work is restored after 4-5 months.

In case of fractures of the bottom of the acetabulum with displacement of the head into the pelvic cavity (central hip dislocation) reposition is achieved by using a system of constant skeletal traction: the pin is passed behind the supracondylar region of the thigh with an initial load on a skeletal traction of 4 kg. The limb is placed in the position of adduction and flexion in the hip and knee joints. To eliminate the displacement of the head, traction is carried out along the axis of the neck using a loop to the proximal end of the thigh (with a shallow penetration of the head) or skeletal traction for the region of the greater trochanter with an initial load of 4 kg. The build-up of loads is carried out initially only along the axis of the femoral neck until the dislocation of the head is eliminated. After reduction is achieved, the weights are gradually transferred to skeletal traction along the axis of the limb, leaving the initial load along the axis of the neck. After achieving reposition, the limb is gradually (within a week) retracted to an angle of 90-95°. Duration of traction -8-10 weeks. Movements in the joint are allowed after 1-2 weeks upon reaching reposition. Dosed load on the limb is possible after 2.5-3 months, full - after 4-6 months. Ability to work is restored after 5-7 months. In case of fractures of the posterior-upper edge of the acetabulum without displacement of the head (without displacement of the fragment), a system of permanent adhesive traction is applied for 4 weeks. Movements in the joint begin from the 2nd week. A dosed load is allowed after 6 weeks, a full load - after 8-10 weeks. Ability to work is restored after 3 months.

In case of fractures of the posterior superior edge of the acetabulum with displacement of the femoral head (upper and posterior hip dislocations) under general anesthesia, the dislocation is eliminated. If the reduction is stable (upon cessation of traction along the length and passive movements in the joint, the recurrence of dislocation does not occur), the joint is unloaded using constant adhesive traction for 4 weeks in the position of moderate flexion, abduction and external (with upper-posterior dislocations) or internal ( with anterior dislocations) rotation. The position of rotation contributes to the approach of the bone fragment torn off together with the capsule to its bed. Usually, stable reposition is observed when a small fragment of the edge of the acetabulum is fractured, which is not under load and such a fracture is tear-off. Therefore, after the cessation of traction, the patient is allowed a dosed load, and a full load is possible after 6-8 times. Approximately in the same period, working capacity is restored.

If hip dislocation is accompanied by a fracture of a large fragment of the roof of the acetabulum, which is located in the load zone of the head, the position of the head is unstable - the dislocation recurs after the cessation of traction along the length and adduction of the hip. Therapeutic tactics in such cases depends on whether the reposition of the bone fragment occurs during the reduction of the femoral head or the fragment does not match. If, when eliminating the dislocation, the comparison of the bone fragment is also achieved, then the stabilization of the position is achieved by using a system of constant skeletal traction for the femoral epicondyles with the use of holding weights (6-7 kg). The duration of skeletal traction is 6-8 weeks. Then, within "2-4 weeks, adhesive traction is carried out with therapeutic gymnastics in the hip joint. Dosed load is possible after 10-12 weeks, full - after 4-6 months. If, with an unstable position of the femoral head, there is no comparison of the bone fragment, which is observed with the rotational nature of its displacement, it is necessary to promptly compare the fragment and fix it with screws,

In the postoperative period, it is advisable to unload the joint using constant adhesive traction for 6-8 weeks with early therapeutic exercises. Dosed load is allowed after 10-12 weeks, full - after 4-6 months. Ability to work is restored after 5-7 months.

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Knee ligament injurySpinal column injuries

A pelvic fracture is a life-threatening condition. In terms of their distribution, these injuries are quite common. Most of the bones are located under a powerful muscular frame, because of this, there are difficulties in making a diagnosis. The statistics are inexorable, discrepancies in intravital and post-mortem diagnoses differ by almost half.

A pelvic fracture is almost always complicated by a state of shock, the mortality rate is very high, about 8%. With multiple injuries, only four out of ten survive. Closed fracture the pelvis is accompanied by large bleeding, sometimes it can reach three liters.

Anatomy

The adult pelvis consists of two pelvic or innominate bones, which are connected with the help of the sacrum, together forming a bone ring. The pelvis connects to the legs, and inside contains important organs, protecting them from various negative influences. Along the acetabulum, the ring is divided into half rings, anterior and posterior. To the back, you can include the ilium, sacrum, joints and ligamentous apparatus. The rear half ring transfers the load to the legs. The anterior branches of the pubic bone, symphysis.

The ring remains stable due to the posterior half ring, muscular frame, joints and ligamentous apparatus.

Traumatic pelvic pathology is multifaceted. Fractures are combined only by the excessive force applied to cause them. The pelvis is a well-innervated and vascularized area, which explains the occurrence of shock conditions. Severe shock has a violation of both rings, massive hemorrhage from the spongy tissue. At the same time, up to two or three liters of blood accumulate in the fiber.

Mechanism of injury

There is a certain classification of fractures.

Pelvic fractures can be divided into several types:

Type A - with this type, the integrity of the ring is not broken;
Type B - damage to the anterior half ring with preservation of the posterior and its ligaments, which prevents vertical displacement;
Type C - complete rupture of both half rings.

Consider some of the groups of fractures. Their classification:

Type A2 pubic bone fracture on one or both sides. Even if a bilateral fracture occurs, the ring is usually held in place by the sit bones.

As we have already said, with a type B fracture, damage occurs to the anterior semicircle (fracture of the pubic, ischium, symphysis), and the posterior semicircle may also be damaged. The consequences of such damage is a blockade in the sacroiliac joint.

Type B1 is also called an “open book”, occurs when the force is directed from front to back, while the pelvis is compressed, the pubic symphysis is torn, the bones rotate and takes on the appearance of an open book. When the discrepancy in the symphysis is not more than two centimeters, we can say that the joint is intact, if more, then the sacrospinous and anterior sacroiliac ligament is torn.

Type B2 is also called a "closed book", the consequences of compression of the pelvis from the side.

Type C is characterized by a complete rupture of the semirings, the consequences of a rupture both on one and on both sides. This fracture is called Malgenya. Why Malgenya you ask? Malgenya is a well-known traumatologist who was the first to describe this type of pelvic injury, namely, due to rotational and vertical instability, the displacement of the damaged half upwards.

Acetabular her fractures

The classification of this injury has several varieties:

Marginal fracture with dislocation of the hip backwards and upwards;
Bottom fracture, displacement, as a rule, does not happen;
Bottom fracture, in which the thigh is displaced inside the pelvis.

These fractures are severe, transportation is carried out only by special vehicles. Assistance should be provided directly at the scene of the incident with the next stage already in the hospital.

Diagnostic measures

The acute period requires urgent measures, since the patient quickly develops a state of shock, it is almost impossible to fully assess and conduct examinations. The diagnosis is then made on the basis of the history and clinical picture. It is necessary to pay attention to the asymmetry of the pelvis, the presence of hemorrhages, usually they are localized in front and on the sides. It is necessary to try to reduce or separate the pelvic bones, all this must be done very carefully, assess the divergence of the symphysis.

Sometimes, due to an extensive retroperitoneal hematoma rising up, the muscles tense up, and a symptom of an acute abdomen occurs. There are cases when it is necessary to perform laparoscopy to exclude intra-abdominal bleeding.

Severed anterior superior spine. Patients at the same time note a sharp pain, swelling at the site of injury. On examination, attention is drawn to the shortening of the injured leg.

Torn off anteroinferior spine. Sharp pain in the groin. Patients practically can not walk, because bending the hip causes a sharp pain.

Diagnosis using additional methods

The patient needs to make an x-ray of the pelvic bones, while he should lie on his back. To identify damage to the coccyx or sacrum, you need to make an x-ray in a lateral projection. Oblique projection helps to diagnose acetabular fractures

How additional research methods are used computed tomography, which allows you to view all fracture lines, as well as MRI to determine soft tissue damage.

Giving help

First aid is based on the right tactics. Immobilization of the pelvis must be achieved, for this, splints or special suits are used.

Transportation is carried out only on the shield, when immobilization and anesthesia have already been performed.

First aid involves adequate anesthesia, the introduction of solutions intravenously, timely hospitalization in a hospital.

Therapeutic measures

Treatment usually begins with the fight against shock, replenishment of circulating blood volume.

A good analgesic effect is given by intrapelvic blockade. At the same time, infiltrated into soft tissues anesthetic solution relieves pain and stops bleeding. How much to inject anesthetic? This will require about three hundred milliliters of novocaine.

Infusion therapy is carried out various solutions, with significant blood loss, treatment requires the use of blood products.

Immobilization is achieved by various methods:

Immobilization by position;
Immobilization by traction;
The imposition of the rod apparatus.

Creating stability of fragments by position, while the patient should lie on his back with legs bent at the knees and legs apart at the hip joints, a roller “frog pose” is placed under the knees. Patients stay in the frog position for about a month. Treatment in a hammock is also widely used, in which the bones are fused due to their compression by their own weight.

If the patient is treated by traction, then he will have to stay like this for two months, followed by walking on crutches.

The best stabilization can be achieved with the help of surgery, the use of rods, plates. After a few days, the patient can be activated, while rehabilitation is much faster.

Recovery period

Rehabilitation after damage to the pelvic bones begins immediately after first aid is provided. A full-fledged set of measures, which includes rehabilitation, should contain physiotherapy exercises prescribed from the first days. The first week of recovery is the most difficult, patients need to deal with severe pain, a feeling of instability in the legs. All exercises should be carried out under the strict supervision of your doctor. How long will the recovery period take? Much depends on the patients themselves, if all prescriptions are correctly adhered to, then this period is significantly reduced.

What complications can occur?

If the patient is given timely and correct assistance, then it is possible to minimize various complications. Let's take a look at the most common ones:

Traumatic shock;
Massive blood loss;
Damage to the pelvic organs;
Thrombo and fat embolism.

With the wrong tactics of treatment, unsuccessful comparison and fusion of bones, pain, unsteadiness when walking, violation of urination, defecation can occur.

If a fracture occurs in a woman, then problems may arise during childbirth.

Preventive actions

They come down to observing safety precautions in production, where there is a risk of being squeezed between moving mechanisms. Compliance with the rules traffic behind the wheel. Prevention of various diseases of the musculoskeletal system. Be healthy.

The pelvis is the ring structure of the lower part of the spine. Both sides of the pelvis are actually made up of three bones (ilium, ischium, and pubis). Strong ligaments attach to the pelvis a small triangular bone called the sacrum. This whole structure has a bowl-shaped appearance with two cavities, called the acetabulum, which are the sockets for the hip joints.

Inside the pelvic ring are the digestive and reproductive organs, as well as large nerves and blood vessels leading to the legs, pass through the pelvis. The pelvis serves as an attachment point for the muscles of not only the legs, but also the upper body. With all these vital structures working through the pelvis, a pelvic fracture can cause severe bleeding, nerve damage, and injury to internal organs.

Pelvic fractures are most common in adolescents involved in sports and older people with osteoporosis.

There are very frequent cases when, while playing sports, a teenager thinks that he pulled a muscle, and meanwhile he had a fracture of the pelvis, like a crack. These fractures are caused by sudden muscle contraction. Since the muscles of the back of the thigh are very strong (in athletes, especially), their contraction can pull the ischium so much that a crack will occur there or even a small piece will be torn off from it. Usually, with such fractures, the pelvis remains stable and the internal organs are not damaged.

Since many older people suffer from osteoporosis, they can fracture their pelvic bones even when they are just standing, getting out of the bath, or walking down stairs. As a rule, with such fractures, although one of the pelvic bones is broken, its structural integrity is not violated.

But most pelvic fractures occur in accidents and falls from a height. Depending on the direction and degree of force, these injuries can be life-threatening and require surgery to treat.

Symptoms of a pelvic fracture

A pelvic fracture is a very painful phenomenon, besides, the site of the injury immediately swells and turns blue.

Usually, when a pelvic injury occurs, a person tries to give himself a forced position in which the hips and knees are bent, and thus reduce pain. If the fracture occurred during an accident, or when falling from a height, the victims, in addition to problems with the pelvic bones, are noted, the abdomen, and. In addition, serious bleeding is added that can cause a shock in the victim. Therefore, if a pelvic fracture is suspected, the best thing that people around can do is stabilize the pelvis and quickly take the person to the hospital.

Diagnosis of a pelvic fracture

If you suspect a pelvic fracture, be sure to prescribe:

X-ray examination of the pelvis of the victim;
Computed tomography (to determine the severity of the pelvic injury and other combined damage to blood vessels and nerves, if any).

Treatment

Non-surgical treatment

Stable fractures, such as an avulsion fracture of a small piece of the pelvic bone, during a collision of athletes with each other, as a rule, heal without surgical intervention. The victim is offered to use crutches or a walker to reduce the pressure of body weight on the pelvis and legs. Usually, a person has to walk this way for three months or until the fracture heals. Medications include painkillers and drugs that reduce blood clotting, such as aspirin.

Surgery

Pelvic fractures resulting from car accidents and falls from a height are considered very dangerous, as they can cause extensive internal bleeding Therefore, such victims are operated on.

Most often, surgeons use an external fixator to stabilize the pelvis. This device has long screws that are inserted into the pelvic bones from both sides and are fixed on the outside, on a special frame. An external fixator allows doctors to monitor the condition of the internal organs, blood vessels and nerves located in the pelvic area.

How the recovery will go depends on the type of fracture and the general condition of the patient. Each case must be evaluated individually, especially when it comes to unstable fractures. Some pelvic injuries are such that a person has to be put on traction, and when the above methods to fix the pelvic bones do not help, doctors have to perform an operation and insert internal fixators such as plates and screws into the pelvic bones.

Forecast

Stable pelvic fractures most often heal without problems.

Pelvic fractures that occurred during an accident or a fall from a height are quite dangerous and fraught with many complications, the main of which are:

severe internal bleeding;
damage to internal organs;
damage to nerves and blood vessels;
infections.

If doctors manage to cope with all these complications, then the fracture heals well. A person, after all the fixators are removed, limps for several months. This is due to damage to the muscles surrounding the pelvis, but then everything passes.