Malgenya fractures. Fractures of the pelvic ring of Malgenya and the type of bucket handle. Diagnosis and treatment Symptoms and diagnosis

Malgenya fracture is one of the types of damage to the pelvic bones.

All fractures of the pelvic bones are classified according to their severity, and the amount of damage received is also taken into account. This injury is one of the most severe fractures and, according to the classification of pelvic injuries, belongs to type C. In the absence of timely medical care, the injury in almost any case leads to death.

Anatomical features of the pelvic bones

The pelvis is formed by two bones: nameless or those. Each of these bones, in turn, is formed by three bones fused together - the ilium, ischium, and pubis. These bones fuse during adolescence.

The bones of the pelvis are connected to each other, forming a ring. The walls of this ring are a protection for the organs located inside it, in addition, it is a support element for the entire human body.

On both sides, the pelvic ring is divided into two half rings by the acetabulum:

1. The posterior half ring is located behind the acetabulum. It includes the back of the ilium, the cross-iliac joints, the sacrum.
2. The anterior half ring is located in front of the acetabulum. It is formed by the symphysis and branches of the pubic bones.

The stability of the pelvis is provided, first of all, by a semi-ring located behind. With a Malgenya fracture, two pelvic semirings are damaged. Damage can be unilateral or bilateral, accompanied by ligament rupture. With such an injury, the pelvis turns back or forward and shifts upward.

Causes of pathology

A Malgenya fracture can occur as a result of an extremely intense impact of a damaging force that is directed to the lateral surfaces of the pelvic bones.

This can happen in the following cases:

• when under a blockage resulting from the collapse of residential premises, an avalanche;
• major rail or road accidents;
• falling from a very great height.

That is, it is an uncommon injury, but it is characterized by severe manifestations and a high frequency of deaths.

Symptoms

In most cases, with a Malgenya fracture, the patient is in an extremely serious condition. The victim has symptoms of pain, hemorrhagic shock:

1. Significant drop in blood pressure.
2. Thready or rapid pulse.
3. Oppression of consciousness.
4. Discharge of cold clammy sweat.
5. Paleness of the skin.

Among the characteristic signs of such an injury to the pelvic bones are the following:

• Severe pain on palpation of the pelvic region.
• Puffiness, the occurrence of growing hematoma in the sacrum and perineum.
• Asymmetric arrangement of bony pelvic protrusions.

Fracture of the pelvis of Malgenya is accompanied by the formation of a large retroperitoneal hematoma. The spilled blood can reach the level of perirenal fiber. As a result of this phenomenon, palpation of the abdomen makes it possible to detect symptoms of peritoneal irritation - a positive symptom of Shchetkin, board-like muscle tension.

A characteristic sign of such an injury is a pronounced dysfunction of the lower extremities. Fragments of bones can damage organs located in the pelvis - the uterus in women, the rectum, and the bladder. As a result of damage, pelvic peritonitis may develop, which is an inflammatory process in the pelvic peritoneum.

Fracture diagnosis

To clarify the diagnosis of a fracture of the Malgen type, the traumatologist prescribes an X-ray examination. The picture is taken when the patient lies on his back, while his legs should be extended. This position allows you to provide an overview of all pelvic structures. A more accurate study is carried out by computed or magnetic resonance imaging.

Methods of therapy for this pathology

How to treat a pelvic fracture like Malgenya? Therapeutic measures for such an injury are divided as follows:

• prehospital;
• basic;
• rehabilitation.

Each stage has a specific instruction for therapeutic measures.

Prehospital care

A double fracture of the pelvic bones is accompanied by pain shock and massive bleeding. Therefore, prehospital care is to minimize all movements of the victim. The patient is transported using a wooden shield or a rigid stretcher.

To immobilize the patient, traumatologists use special suits or transport tires. During transportation, intensive hemostatic and anti-shock therapy is carried out.

Treatment of a Malgenya pelvic fracture in a hospital

The main therapy begins with the elimination of conditions that threaten the patient's life. It is necessary to stabilize hemodynamics, compensate for blood loss, anesthetize the injured part of the body.

To eliminate the pain shock, an intrapelvic blockade according to Shkolnikov is indicated. The doctor, using a long needle, injects Novocaine into the iliac fossa. This technique allows not only to fully anesthetize the injured area, but also to stop the bleeding.

The main method of therapy for a pelvic fracture of the Malgenya type is the repositioning of displaced pelvic semirings. For this purpose, the patient is placed in a hammock, and then, using a Behler splint, a skeletal traction of the pelvis is carried out by the condyles of the femurs. A sixteen-kilogram load is suspended on one side, and a load weighing up to 6 kilograms is suspended on the other. Traction takes an average of 8-9 weeks. It is allowed to give a full load on the lower limbs no earlier than after 4.5 months.

The most effective method of therapy, which allows to reduce the period of immobilization, is bone osteosynthesis using metal plates. After such a surgical intervention, patients are allowed to get up after a couple of weeks.

What is the rehabilitation period?

Rehabilitation measures should begin in the hospital. Their main goal is to alleviate the well-being of the victim, speeding up his recovery.

The main directions of rehabilitation are physiotherapeutic procedures, therapeutic exercises and massage.

In addition, patients with fractures of the pelvic bones need to eat well, and the diet should be enriched with minerals, vitamins, calcium. Every day the patient should consume dairy products.

Additionally, calcium can be obtained using drugs such as Calcium-D3, Calcemin. In them, in addition to the named element, there is vitamin D, which contributes to better absorption of calcium into bone tissue.

The prognosis for this pathology

The prognosis of the outcome of such an injury strongly depends on the correctness and timeliness of the provision of medical care. With a fracture of Malgenya, cases of death of the patient were also noted, but most of the injuries have a favorable outcome.

After an injury, the patient may develop some complications. These include:

1. Complications during pregnancy and childbirth in women.
2. Pathology of the activity of the pelvic organs.
3. neurodystrophic disorders.
4. Gait disorders.
5. Chronic form of pain syndrome.

Thus, a Malgenya fracture requires urgent hospitalization and intensive care.

Malgenya fracture is a polyfocal injury characterized by discontinuity of the anterior and posterior halves of the pelvic ring and loss of connection between the sacrum and part of the pelvis along the fracture line. Clinicians distinguish several types of damage: one- and two-sided vertical, diagonal, fracture-dislocation with a violation of the integrity of the pubic symphysis or sacroiliac ligaments.

Symptoms and Diagnosis

Instrumental diagnostics

Disruption of the continuity of bone structures is visualized thanks to the methods of radiation diagnostics:

• Plain radiography in direct, oblique caudal projection.
• Computed tomography.

Treatment

To treat a displaced Malgenya pelvic fracture, skeletal traction for both legs is used. In case of a unilateral injury, a weight of 4–6 kg is suspended from a healthy limb, and a heavier one is suspended from the limb on the side of the injury. Bilateral vertical fracture requires weights up to 12 kg. Traction is carried out for the condyles of the femur.

Non-displaced fractures do not require skeletal traction. Treatment of the injury is carried out in the supine position on the roller with the limbs divorced and bent at the hip and knee joints.

For pelvic fractures such as malgenya, it is indicated observe bed rest. It is set for 6–8 weeks after a non-displaced fracture, up to 10 weeks after an injury with displacement.

Recovery

After removing the patient from shock, several stages of therapeutic exercises are included in rehabilitation. Its goals are:

• Relaxation of the muscles of the girdle of the lower extremities for proper consolidation of the fracture.
• Prevention of muscle contractures.
• Elimination of post-traumatic edema.
• Maintenance of smooth muscles of the pelvic organs, stimulation of intestinal motility.

Working capacity is restored within 4-6 months after the injury. After torn sacroiliac ligaments or pubic symphysis, rehabilitation may be longer.

Timely immobilization, removal of the patient from shock, restoration of damaged pelvic organs make the prognosis favorable.

A Malgenya fracture is a severe form of fracture in the ankle or pelvis. This type of fracture is named after the surgeon and anatomist J. F. Malgaigne. He described its characteristics and method of treatment as early as the eighteenth century.

In this case, the ankle bone breaks, tucking the foot inward. In this case, there is a rupture of the binding material in the joint area. As the process of pressing on the ankle continues and the foot continues to bend inward, the bone breaks at an oblique angle or vertically. Outward subluxation of the foot with this type of fracture is extremely rare.

During the diagnosis of a bone fracture, signs of a tumor in the ankle joint are visually observed. Sensation of severe pain when ligaments are torn. During the examination with the help of an X-ray machine, you can see how the fracture was made. The fracture is set by hand and a plaster cast is applied.

With a pelvic fracture, the injury falls on the iliac bones or the pubic and ischial bones. in one and the second cases, the integrity of the continuous bone is broken. Fractures of the pelvic bone are accompanied by large bruises, the occurrence of a shock state. In most cases, a fracture is accompanied by a rupture of internal organs.

When diagnosing, deformation in the pelvic region is visible, the navel is significantly shifted to the side. An x-ray shows the location and type of fracture. It is treated with traction, while using a load of six to ten kilograms, which is fixed from the side of the injury. On the other hand, a load of four or six kilograms is attached. Treatment continues for six months.

The reasons

The causes of the fracture are injuries of various types. It could be:

• falling from a great height;
• during an injury resulting from a car accident;
• if a person is under the rubble of a destroyed building;
• during accidents.

What type of fracture occurred, you can only determine the field of inspection of the direction of its line and displacement of the bone.

Mechanism of Education

Depending on the mechanism of injury formation, a fracture classification is carried out. The nature of the fracture depends on the direction of the fracture, as well as the force with which the bone was squeezed. There are such types of fractures:

1. Stable, during which the bone breaks only at the edges. The pelvic bone remains intact.
2. Unstable. In this case, the pelvic ring loses its integrity.
3. Fracture, which is accompanied by a dislocation of the joint.
4. Fracture of the bottom and acetabulum. In this case, a dislocation in the femoral joint is possible.

With a fracture of Malgenya, the victim loses a large amount of blood. In most cases, this loss is about three liters.

Big Medical Encyclopedia

Malgenya fractures are complex types of fractures of the ankles and pelvis. They are described by the French surgeon J. Malgen in 1847-1855.

J. Malgen described a pelvic fracture in 6 places:

• fracture of both iliac bones parallel to the sacroiliac joints,
• bilateral fracture of the pubic and ischial bones.

This type of fracture is extremely rare. Unilateral fractures or dislocation fractures in the posterior pelvis are much more common in combination with unilateral or bilateral fractures in the anterior pelvis or with a rupture of the pubic symphysis. Common to these types of damage to the pelvic ring is the simultaneous disruption of its continuity in the posterior and anterior sections.

All such injuries, in contrast to injuries only in the anterior or posterior sections of the pelvic ring, are called fractures or fracture-dislocations of the Malgen type. With a fracture of the anterior and posterior sections of the pelvic ring on the one hand, they speak of vertical fracture pelvis Malgenya. With a fracture in the posterior part of the pelvic ring on one side, and in the anterior part on the opposite side - about diagonal fracture.

Fractures of the anterior and posterior sections on both sides are called bilateral fractures pelvis Malgenya. If there is not a fracture, but a rupture of the ligaments of the sacroiliac joint or pubic symphysis with a displacement of half of the pelvis, they speak of fracture-dislocation.

Malgenya pelvic fractures are the most severe injuries, as they are always accompanied by extensive retroperitoneal hematomas, the development of severe shock, and often damage to the pelvic organs.

Diagnostics

In the diagnosis of these fractures, examination and palpation of the pelvis are important, which reveal:

• asymmetry of the halves of the pelvis,
• displacement of the navel from the midline,
• "reversal" of one of the halves of the pelvis with external rotation of the leg of the same side.

With bilateral fractures, a kind of “flattening” of the pelvis is visible - a significant expansion of it in diameter. When radiography in one anteroposterior projection, attention is paid to fractures of the pubic and ischial bones, rupture of the pubic symphysis, longitudinal fracture of the ilium, or rupture of the sacroiliac joint.

The height of the displacement of half of the pelvis is determined. X-ray studies also play a leading role in monitoring the correctness of reposition.

Treatment

The main treatment for Malgenya pelvic fractures is bilateral skeletal traction behind the tibial tuberosity and the femoral condyle. Load on the displacement side 6-10 kg, on the opposite side 4-5 kg. Traction is often supplemented by hanging the patient's pelvis in a hammock.

Traction is continued for up to 2.5-4 months, depending on the magnitude of the displacement and the time of onset of reposition. Immobilization by skeletal traction for torn ligaments of the sacroiliac joint or pubic symphysis lasts longer than for fractures.

Forecast

Ability to work after fractures of the pelvis of Malgenya is restored on average after 4-6 months. after injury.

Fracture of the ankles of Malgenya refers to supination-adduction fractures, in which the foot, under the influence of the load, is tucked inwards - a mechanism opposite to the mechanism of the Dupuytren's abduction fracture of the ankles (see Ankle joint, Dupuytren's fracture). In this case, there is a rupture of the lateral ligaments of the ankle joint or a detachment of the base of the lateral ankle at the level of the joint space; with the ongoing displacement of the foot inwards at the time of injury, the talus, pressing on the medial malleolus, causes its fracture with an oblique or more often vertical fracture line extending to the epimetaphysis of the tibia (Figures 1 and 2). Subluxation of the foot medially and displacement of the lateral malleolus with this type of fracture is usually rare. If rotation of the lower leg joins the supination of the foot, then, in addition to a fracture of the fibula, a partial rupture of the tibiofibular ligaments may occur, leading to diastasis of the tibiofibular syndesmosis.

During clinical examination, there is a significant swelling of the ankle joint, sharp pain in the area of ​​the fracture of the lateral malleolus or rupture of the lateral ligaments. The fracture line of the medial malleolus is more clearly visible on the anteroposterior radiograph, the lateral one on the lateral radiograph.

With fresh fractures of the ankles such as Malgenya with displacement of fragments, their manual reduction is indicated, as a rule, under local anesthesia. It is produced by pressure on the foot from the inside with simultaneous longitudinal traction and counterstop from the outside of the lower leg. Fixation with a plaster bandage lasts 10-12 weeks. Ability to work is restored in 3-4 weeks after the plaster is removed.

In case of unsuccessful closed reduction, when the displacement of fragments and subluxation of the foot remains, as well as in case of chronic fractures with subluxation of the foot (up to 2½-3 months after the injury), surgical intervention is performed (open reduction and fixation of fragments with metal structures).

The prognosis for a Malgenya ankle fracture is usually favorable.

Fracture of the pelvis Malgenya. Zh. Malgen described a fracture of the pelvis in 6 places: a fracture of both iliac bones parallel to the sacroiliac joints, a bilateral fracture of the pubic and ischial bones (Figure 3, 1). This type of fracture occurs extremely rarely. Much more often, unilateral fractures or fracture-dislocations are observed in the posterior pelvis in combination with one or bilateral fractures in its anterior segment or with a rupture of the pubic symphysis. Common to these types of damage to the pelvic ring is the simultaneous disruption of its continuity in the posterior and anterior sections. All such injuries, in contrast to injuries only in the anterior or posterior sections of the pelvic ring, are called fractures or fracture-dislocations of the Malgen type (Figure 3, 2-5). With a fracture of the anterior and posterior sections of the pelvic ring, on the one hand, they speak of a vertical fracture of the pelvis of Malgenya; with a fracture in the posterior part of the pelvic ring on one side, and in the anterior part on the opposite side - about a diagonal fracture. Fractures of the anterior and posterior sections on both sides are called bilateral fractures of the pelvis of Malgenya. If there is not a fracture, but a rupture of the ligaments of the sacroiliac joint or the pubic symphysis with a displacement of half of the pelvis, they speak of fracture-dislocation.

Malgenya pelvic fractures are the most severe injuries, as they are always accompanied by extensive retroperitoneal hematomas, the development of severe shock, and often damage to the pelvic organs.

In the diagnosis of these fractures, examination and palpation of the pelvis are important, in which the asymmetry of the halves of the pelvis, the displacement of the navel from the midline, the “turn” of one of the halves of the pelvis with external rotation of the leg of the same side are revealed. With bilateral fractures, a kind of “flattening” of the pelvis is visible - a significant expansion of it in diameter. When radiography in one anteroposterior projection, attention is paid to fractures of the pubic and ischial bones, rupture of the pubic symphysis, longitudinal fracture of the ilium, or rupture of the sacroiliac joint.