Pelvic fractures. Sequelae of a pelvic fracture. Diagnosis using additional methods

A pelvic fracture is an extremely severe type of injury due to pain and a high degree of blood loss.

Very often, this injury is accompanied by pain shock. The presence of multiple fractures in this area in 50% of cases can cause death.

What causes a fracture?

Most of all, the pelvic bones are prone to injury in the elderly (due to their fragility due to calcium leaching), as well as in professional athletes.

In addition, there are a number of factors that can cause this type of damage. These include the following:

• fall from high altitude;
• transport accident, which leads to compression of the pelvic region;
• collision of a car with a pedestrian, in case of impact of the victim by the protruding parts of the car;
• industrial injuries;
• the presence of chronic osteoporosis;
• rail injuries.

How to determine damage?

Bone fractures are accompanied by numerous manifestations that allow you to quickly diagnose the type of injury. These manifestations largely depend on the type and severity of the fracture. To general external manifestations the following characteristic factors can be attributed:

• the occurrence of an extensive hematoma;
• swelling of the injury site;
• strong pain;
• deformation of the pelvic region;
• pain shock followed by sharp decline blood pressure and increased heart rate (occurs in 30% of victims);
• bleeding;
• Verneuil's symptom - pain that occurs with minimal compression of the pelvic region.

separate, specific signs this injury for the most part depending on the severity and type of fracture. Depending on the location of the injury, the following symptoms may occur:

1. In the event of an injury to the symphysis, the patient can bend the legs, but this process is accompanied by severe pain, and the motor functions are limited.
2. Pain in the ilium is observed with damage to the upper pelvic region.
3. In case of violation of the integrity of the pelvic ring, the victim experiences severe pain in the perineal region with a tendency to increase when moving or pressing on the pelvic region.
4. Functioning disorders hip joint, which may be accompanied by sharp pain, are characteristic of fractures of the so-called acetabulum.
5. In cases of coccygeal lesions, there are difficulties in the process of defecation, lack of gluteal sensitivity, urinary incontinence, sacral pain.
6. With a fracture of the sciatic or upper branches of the pubic bone, the patient usually experiences a severe pain shock from all over. concomitant symptoms. In addition, this type of damage is accompanied by the so-called frog posture.
7. With injuries in the posterior semiring of the pelvis, pain in the area of ​​injury, bruising and increased mobility half rings when they are squeezed.
8. With detachments of the pre-upper axis, fragmental displacement is observed, leading to external shortening of the lower limb.

Often pelvic fractures are accompanied by damage internal organs or the formation of a retroperitoneal hematoma. This process is accompanied additional manifestations. These include the following factors:

• violations of urination and stagnation of urine are characteristic of injury to the urethra;
• hematuria, which usually occurs when the bladder ruptures;
• acute abdomen;
• constipation;
• bleeding from the perineum or urethra occur when these organs are injured.

Varieties of damage

Fractures of the pelvic bones differ in a number of their manifestations and forms. They also differ depending on the location. The classification includes the following types of injuries:

1. Unstable fractures of the pelvic ring. AT this case the pelvic bones are displaced in a horizontal or vertical direction.
2. Fracture dislocation.
3. Damage to the bottom or edge of the acetabulum, accompanied by femoral dislocation.
4. Partial pelvis. The presented injury is characterized by a violation of the integrity of individual bone fragments, but practically does not affect the area of ​​the pelvic ring.

In addition, a distinction is made between open and closed damage. open injury pelvic bones is usually observed in the case of a direct blow and represents a violation of the integrity of the pelvic bones near the sacral canal. The presented injury is accompanied by pain shock and intense bleeding.

They are damage to the pelvic ring, which does not damage the internal organs or nearby tissues. Such injuries can be single or multiple.

The following subspecies are included in the classification:

• fracture with displacement of bones (this damage is especially dangerous for the patient);
• fractures without displacement.

In addition, pelvic injuries are divided into uncomplicated and complicated. The latter is accompanied by damage to internal organs.

Possible consequences

Fractures of the pelvic bones are a severe injury, which is not only extremely dangerous to health, but also poses a threat to the life of the patient. The fact is that they are fraught not only with damage to bone tissue, but also often cause a violation of the integrity of internal organs. This, in turn, leads to serious disorders in the patient's body. Most often, the following manifestations are recorded in victims:

• peritonitis;
• fecal phlegmon;
• violations of the defecation process;
• stasis of urine;
• internal bleeding;
• purulent infections;
• hemorrhages in the cavity of internal organs;
• tendon ruptures, which can cause lameness.

In order to minimize the risk of developing pathological consequences, the patient must be provided with prompt and competent first aid, to provide him with the correct treatment process.

First aid

If you suspect a fracture in the pelvic area, you should immediately call an ambulance. And before the arrival of the brigade of medical workers, it is recommended to take the following measures:

1. By applying a tourniquet and a splint, stop bleeding, which is usually observed in case of an open fracture.
2. Disinfect the edges of the damage. This manipulation is necessary to avoid the penetration of infection, possible inflammation, blood poisoning.
3. Immobilization (ensuring the immobility of the injury site) is an indispensable condition for the success of subsequent treatment. Therefore, when transporting the victim, it is necessary to lay him on a flat stretcher, placing a dense roller under his feet.
4. In case of ruptures and fractures of the symphysis, it is necessary to ensure the immobility of the hips and the pelvic region by tightly tightening these parts of the body; in this case, the transport tire is not superimposed. This can be done with an ordinary sheet or clothing items.

In 30% of cases, pelvic injury is accompanied by traumatic shock, and with multiple and open fractures this figure reaches 100%. Exactly this manifestation often causes the death of the victim even before the arrival of the ambulance. Therefore, it is extremely important to recognize traumatic shock and alleviate its symptoms.

signs traumatic shock:

• profuse bleeding is possible;
• tachycardia;
• heart rhythm disturbances;
• loss of consciousness;
• sharp blanching of the skin;
• drop in blood pressure up to a hypotensive crisis;
• shallow and difficult breathing;
• general lethargy and confusion.

How to provide first aid for traumatic shock?

1. Give the victim's body as much comfortable position and give him as much rest as possible.
2. You can reduce pain with the help of analgesics or other painkillers.
3. Strong and sweet hot tea will help relieve some of the pain.
4. Immobilization is also indicated for manifestations of traumatic shock associated with traumatic injuries. For this, any improvised means are suitable.
5. Traumatic shock is often accompanied by hypothermia, which occurs regardless of weather conditions. To avoid this, you should properly wrap the victim in warm clothes.

How to diagnose an injury?

A pelvic fracture is diagnosed based on the overall clinical picture and symptoms. The presence of damage can also be determined using the method of palpation. However, in order to avoid errors in the diagnosis, to establish the type and degree of fracture, the following procedures are prescribed to the patient:

• radiography of the pelvic region, which allows to determine exact location damage and its severity;
• CT scan required to study the state of adjacent nerve endings, blood vessels, nearby tissues and internal organs.

How to treat damage?

Treatment of this type of injury largely depends on the severity of the injury and the presence of associated complications. Therapy is prescribed by a traumatologist. This is an individual process, which is based on an accurate diagnosis, the general clinical picture and the personal characteristics of the victim. Generally therapeutic process It is subdivided into two main groups: conservative and surgical.

Conservative treatment is usually used for closed or single integrity violations. bone tissue and is as follows:

• the use of crutches in order to reduce the pressure of the patient's weight on the pelvic region;
• bed rest;
• immobilization;
• blood transfusion (if necessary);
• painkillers;
• taking drugs that help reduce blood clotting;
• the use of an external fixator, which gives doctors the opportunity to control the state of internal organs, nerve endings and blood vessels in the pelvic region.

Surgical treatment is an operation accompanied by the insertion of special internal fixators into the pelvic bones. This technique is used for complicated fractures, in case of damage to nearby internal organs.

rehabilitation period

The recovery process after a fracture of the pelvic bone lasts from three to five months, depending on the severity of the injury and the general health of the victim. During the first month, the victim is shown bed rest. Further recovery includes the following:

• massage;
• physical therapy, which contributes to the speedy recovery of damaged muscle tissues and tendons;
• the use of calcium supplements;
• physiotherapy.

Prevention is based on the observance of simple rules by the patient:

1. Strengthen your body with regular exercise.
2. Observe necessary measures safety when traveling by transport and when playing sports.
3. Make sure you have enough calcium in your diet. This substance is necessary for strengthening bone tissue.

A fracture in the pelvic area can cause disability and even death of the patient. Therefore, at the slightest suspicion of this type of injury, you should immediately consult a doctor and strictly follow all his recommendations.

Fracture of the pelvic bones is one of the most severe traumatic destructions with severe blood loss and blurred consciousness. A fracture of the pelvis can provoke damage to the organs of internal systems, therefore, in order to preserve life and work capacity, it is very important to provide competent assistance in case of injury.

Anatomical characteristics

The pelvis is located at the base of the vertebral system of the skeletal region, it provides traction lower extremities with the body, is a support and a bone reservoir to accommodate vital organs. It is formed by two pelvic bone sections: the sacrum and the coccyx, which are connected by joints into a bone circle with an internal cavity.

Until adulthood, the bones of the iliac, pubic and ischial regions are linked by cartilage, which eventually become ossified, grow together, forming the pelvic bone.

Paired bone formations are connected by the pubic and sacral ear-shaped surfaces, creating the sacral iliac joints. Each of the bony sections of the pelvis is fastened with three sections, which ultimately create an acetabular notch that is intended for the bone-femoral head.

The pelvis is divided by a boundary line into two sections: upper (large) and lower (small). The space of the large pelvic region is the lower part of the peritoneum, it houses the organs of the lower section abdominal cavity. The small area of ​​the pelvis contains urinary organs and rectum.

Muscle fibers of the abdomen, back, spinal system and some muscle tissues of the legs are attached to the bones of the hip area.

Classification of destructions of the pelvic bones

In most cases, the mechanism of fracture of the bone site occurs as a result of compression or impact on the pelvic region.

In active sports, avulsion traumatic injuries are common due to the constant tension of the attached muscle fibers of the lower extremities.

The generally accepted classification of pelvic fractures is divided into several groups and depends on the location of the injury:

• Marginal destruction of internal articular areas.
• Traumatic lesions of the ring without breaking the integrity.
• Fractures of the circular area with the destruction of integrity.
• Traumatic fracture of the pubic bone of the pelvis.
• Fracture of the acetabulum.

Characteristic signs of destruction

Traumatic destruction of the pelvic bones manifests itself, like all other fractures: pain, extensive hematomas, deformation of bone tissue, limitation of motor functions. With a fracture of the pelvic bone, the shock condition of the victim is most often observed, which is expressed in increased pallor of the skin, increased heart rate, hypotension, and attacks of short-term loss of consciousness.

Specific signs of destruction of a particular bone in the pelvic region depend on the location:

• Injury to the pubic bone is accompanied by a symptom of "stuck heel". In this case, the injured person is unable to lift the limb. Pain is aggravated by spreading the legs, therefore, when the pubic region is fractured, the patient's limbs are tightly pressed against each other.
• Vertical destruction of the pelvis is manifested by shortening of the lower extremities.
• A bilateral fracture is expressed by the fact that the victim is in the "frog" position.
• Traumatic injury to the coccyx or sacrum is mainly accompanied by destruction of nerve endings, with observed involuntary urination and defecation, as well as other neurological dysfunctions of the lower peritoneum and genitourinary system.
• Traumatic injury of small pelvic bones with organic lesion internal organs is expressed in urinary retention, blood formation in the urine. This injury is considered extremely dangerous, since the rupture of the tissue of the bladder and intestines leads to the release of contents into the peritoneal cavity, which causes blood poisoning, peritonitis and, as a result, death.
• With a marginal or isolated fracture of some bones, the victim can remain on his feet, destruction is expressed in pain during movement and palpation.
• Destruction of the bone structures of the iliac region is revealed in the fact that it is easier for the victim to walk backwards ( reverse): moving backward is not accompanied by pain, while moving the limb forward causes severe pain.

Important! Minor injuries may not be expressed by severe pain and limitation of motor functions, as a result of which the victims do not turn to a traumatologist, this inaction can provoke the development of negative consequences.

Shock in trauma

With multiple injuries of the pelvic region, a state of shock is observed in 100% of cases, closed uncomplicated injuries cause shock in 30% of injured people. The cause of shock is massive internal bleeding from organs, soft tissues, bone structures with simultaneous compression of the nerve bundles. The internal organs of the pelvic region are characterized by increased susceptibility to pain, so this syndrome is one of the main indicators indicating the degree of destruction of the region.

Physiological characteristics of construction vascular system in the peritoneum guarantee significant hemorrhages. With isolated destruction, blood loss can be one liter of fluid, multiple destructions cause up to 2-2.5 liters of blood loss. Internal bleeding can continue for two days.

The clinic is directly dependent on the amount and speed of blood loss:

1. A closed pelvic fracture is characterized by a slow rate of bleeding.
2. Numerous deformities are due to a significant rate of hemorrhage.

The cause of prolonged hemorrhage is a violation of blood clotting, while in the first days extensive bruising is formed and fibrinolytic characteristics increase.

"Acute abdomen" is formed due to internal bruising in the anterior wall of the peritoneum (pubic area) with damage to the pubic bone, accumulation of blood clots in the retroperitoneal region, deformation of the posterior sections of the pelvis and internal organs.

Attention! The shock state of the patient with pelvic injuries always indicates significant damage in the peritoneal cavity. In these situations, expectant practice is unacceptable; urgent diagnostics and surgical intervention.

Clinical principles of diagnosis

The primary diagnosis is established after a thorough visual examination of the damaged area, analysis of the circumstances of the incident and palpation of the site. During pressure on the hip joint, mobility of the bone areas and a characteristic crackling sound can be observed. Severe injuries the pelvic region is not diagnosed by palpation, since further tissue damage, rupture of blood vessels and increased internal hemorrhage may occur when pressed. Therefore, in complicated injuries, other diagnostic methods are used.

Instrumental methods for diagnosing injured areas:

• Radiography. A picture of the pelvis is made in two or three projections to detect fractures and displacement of bone processes, as well as to determine fragmentation fractures.
• Ultrasound examination. This method diagnostics allows you to identify the degree of damage to soft tissues and organs of the genitourinary system and intestines.
• Magnetic resonance imaging. With its help, the damaged area is examined in detail.
• Computed tomography, x-ray of the urethra, rectal scanning, laparoscopy are used as auxiliary methods of examination. These methods allow you to examine in detail the degree of damage to individual organs.

Conservative and surgical methods

First aid for a fracture of the pelvic bones is the need for anti-shock rehabilitation, since long-term condition shock complicated by coma. Used for anti-shock therapy intravenous administration painkillers. The next stage: restoration of the amount of lost blood (transfusion) and immobilization of the patient.

Constant profuse bleeding is stopped with the help of surgical operations: ligation of the internal iliac veins.

Due to excessive hypocoagulation, hypofibrinogenemia and fibrinolytic blood abilities, the use of fibrolytics is indicated for the first time after injury.

Immobilization: in case of a pelvic fracture, treatment is carried out by means of skeletal traction, splinting of the lower extremities and a special device for the kneecaps. The method is applied only after the destruction is repositioned.

Treatment of damaged urinary tracts

Uncomplicated and non-penetrating injuries of the urethra are treated with an ice pack, antibiotics to prevent infection. plentiful drink for natural cleaning of the canal and auxiliary regeneration of vascular tissue.

With urinary retention, a temporary or permanent catheter is inserted into the bladder. Regeneration of damaged channels occurs within 14 days. If healing has occurred with newly formed stickers, then as additional therapy produce channel bougienage.

Complicated, penetrating destruction of the urethra is reconstructed until the integrity of the structure is restored, urine is diverted and infiltrations of the paraurethral tissue are eliminated. The recovery operation can be carried out in several stages. Reconstruction of the canal is performed only after the fusion of the bone tissue of the small pelvis, in particular, the pubic area.

urinary organ

When the mucous membrane of the bladder is deformed, conservative treatment is performed:

• anti-inflammatory drugs and antibacterial drugs;
• intermittent or permanent catheterization.

Severe damage to the membrane requires surgical intervention to stitch the damaged walls, divert urine and drain the paravesical tissue.

Edge fractures of the pelvis

Treatment consists of anesthesia and immobilization of the patient. Surgical intervention is used in case of combining a fracture and dislocation of the coccyx, improperly fused bones with displacement, problematic urination and defecation, severe pain. In these cases, fragments of the bone tissue of the coccyx are removed.

General treatments for pelvic bone destruction

Treatment is carried out mainly in a conservative way:

• immobilization of the patient and fixation of the damaged areas: with the destruction of the anterior upper part of the bone, the lower limbs are bent in the pelvic region;
• fractures of the ischial tuberosities: the patient is unbent limbs in the hip region, but at the same time the legs are bent. Proper installation is fixed with tires and adhesive.

Medication is also indicated: antibacterial drugs and agents according to individual characteristics.

An indication for surgical intervention can only occur as a result of a significant displacement of the bones, impaired functionality, and prolonged pain.

Fractures and dislocations with displacement

In the case of a strong displacement, the bones are inserted under general anesthesia. Uncomplicated destruction in postoperative period requires adhesive stretching, flexion and abduction of limbs according to indications.

If the reposition of the bone site does not occur, the fragmented fragment is not compared with the base, and tissue regeneration is not observed, then surgical intervention is performed with manual comparison of the fragments and screw fixation of the bone tissues.

Post-traumatic rehabilitation

Restoration of working capacity and normal rhythm of life is impossible without a competent course of rehabilitation work:

1. It is obligatory to wear a bandage to restore normal blood circulation, fix bone areas, and restore the patient's posture.
2. Therapeutic and physical culture complex. Is in breathing exercises, exercise to restore the functionality of the limbs.
3. Massage.
4. Physiotherapeutic measures: electrophoresis, magnetotherapy, laser stimulation.
5. Multivitamin complex with elevated content potassium, magnesium and vitamin D.
6. Certain diets prescribed by doctors.

Important! Compliance with all the instructions of a traumatologist, neurologist and other narrowly focused specialists will help restore the functionality of the body and prevent Negative consequences and complications of the post-traumatic period.

Final history

Traumatic injury to the hip areas and internal organs, even with competent treatment and timely rehabilitation measures, can result in disability. This is due to improper fusion of bone fragments, multiple injuries of internal organs, and a long rehabilitation period. In pathologies, muscle tissue becomes thinner, the hip joint degenerates, damaged organs and blood vessels do not fully restore functionality. Pain persists for many years after a traumatic event varying degrees severity, the appearance and gait of the patient are disturbed.

Common complications after a fracture:

1. Atrophy muscle tissue lower limbs.
2. Limited joint mobility.
3. Purulent-necrotic processes in skeletal systems and damage to the roots of the spinal cord.
4. In the anamnesis - a violation of the functionality of the intestines and bladder.
5. Infectious lesions of the body.

Important! Pelvic destruction - very serious pathology. In case of injury to the site, it is necessary to take Urgent measures, conduct an examination in a stationary mode and follow the instructions of the doctor. Only in this way can the negative consequences of the post-traumatic period be reduced.

A pelvic fracture is a common injury that is very dangerous and severe. The severity of the injury is based on the large loss of blood that flows from the soft tissues and bone fragments. In addition, traumatic shock develops due to pain syndrome. Located in the pelvic region important organs, therefore, damage is fraught with complications. Based on this, it is necessary to provide the first medical care, immobilization and proceed to subsequent treatment.

The anatomy of the pelvis is such that three paired bones and the sacrum form a closed pelvic ring. It houses the internal organs: uterus, bladder, prostate and appendages. The pelvis is the support of the human skeleton, it protects everything that is in it. These three bones are fixed relative to each other. In front there is a pubic symphysis, which is formed by articulation pubic bones. Behind the sacrum, the iliac bones are connected, which from the sides form the acetabulum. It is part of the hip joint. As you can see, everything is interconnected in this area, so any damage significantly affects health, especially when it comes to fractures.

The reasons

A fracture of the pelvic bones most often reflects the strength of the traumatic effect, which is obtained due to traffic accidents. This is especially true when vehicles collide with pedestrians. If the injury occurs as a result of a collision vehicle, basically there is a direct blow to the protruding parts. Subsequent throwing of the victim may also occur.

Damage also occurs due to falls from great heights. This happens mostly in everyday life. In this case, occurring closed injuries due to falls, such as from windows, from scaffolding, etc. Fractures are observed in the mining industry when blockages and compression by massive weights occur.

The most severe pelvic injuries, combined with a violation of the integrity of the organs located inside, are observed during compression between the coupling devices of the carriage, the train, the sides of the vehicles and the platform.

Pelvic fractures often occur in the elderly. In this case, the fragility of the bones is increased and even with a slight fall, an injury occurs.

In any case, it is necessary to provide first aid, immobilize and take the injured person to the hospital. However, it is not always possible for others to immediately determine that a pelvic injury has occurred. It is not difficult to do this, since the symptoms are quite obvious. The further condition of the patient depends on how quickly and correctly the first aid is provided, therefore, important attention should be paid to symptoms that can be used to identify fractures of the pelvic bones or a fracture of the pelvic bone. Of course, the exact diagnosis is established by a specialist in the hospital after an examination, which helps to determine the type of damage in accordance with the classification, which we will also talk about a little later.

Symptoms

The symptoms of a fracture can be divided into two groups.

1. local signs. These include sharp pain, deformity of the pelvis, swelling or soft tissues. The mobility of bone fragments is accompanied by bone crepitus. If there is a detachment of the anterior superior spine, a shortening of the limb will be visually observed. This symptom is due to the displacement of the fragment. By moving the foot back, a person feels less pain, so he tries to walk with his back forward. Much depends on where exactly the pelvic fractures occurred.

1. General symptoms. Pelvic fracture accompanied common features, which also help to determine the presence of damage. For example, if an isolated fracture of the pelvic bones occurs, thirty percent of the victims develop traumatic shock. In all patients, the same symptom is observed with multiple and combined injuries. Shock develops due to massive blood loss, which is combined with damage or compression of sensitive nerve elements. In shock, pallor of the skin and sticky sweat are observed. In addition, an increased heart rate and decreased arterial pressure. The victim may lose consciousness.

Sometimes there may be signs of damage to internal organs. This may be due to their trauma or retroperitoneal hematoma. If the urethra is damaged, there is urinary retention, bruising in the perineum, and bleeding from the urethra. Bladder rupture is accompanied by hematuria.

As you can see, the signs depend on the specific damage. The classification of pelvic fractures includes several types of injuries.

1. fractures individual bones. In this case, the pelvic ring is not broken. There are isolated and marginal fractures. They occur due to the influence of an external force. Such lesions are stable and heal well, so the rehabilitation period is not very long, provided that the patient adheres to the pastel regimen and adheres to the prescribed treatment after a thorough examination.
2. Unstable fractures with violation of the pelvic ring. There are rotational fractures in which the displacement of the pelvic bones is horizontal. There are also vertical injuries where the pelvic ring is broken in two places, back and front. Fragments are displaced vertically.
3. Fracture of the acetabulum. Usually its bottom or edges break. This can lead to dislocation of the hip.
4. Fracture dislocations.

The classification of pelvic injuries includes bilateral and unilateral fractures. If a direct impact occurs, there is a fracture near the sacral canal, most often called an open fracture.

Effects

To understand how important it is to provide first aid, immobilization and follow the prescribed treatment, one should consider the consequences that pelvic fractures can lead to. I would like to note right away that with combined and severe fractures of the pelvic bones, mortality is observed in half of the cases. During acute period death rate is associated with profuse bleeding which is observed very often.

However, the danger is not only bleeding, but also the broken integrity of the internal organs, which are located in the pelvic area. These are the bladder, intestines, urethra, ovaries, rectum, vagina, and uterus. On the basis of damage to these organs, such dangerous consequences, like fecal phlegmon, peritonitis, urinary streaks and so on. They cause severe purulent-septic infections, which often lead to lethal outcome. If a person recovers, even after rehabilitation past trauma makes itself felt and becomes the cause of permanent disability.

However, not all consequences are so severe. In many situations, pelvic fractures heal fairly well. If the injury was accompanied by damage to adjacent tissues, the patient will have lameness for a long period of time, as the tendons, muscles and ligaments recover gradually. It is very important to follow the recommendations of the doctor and adhere to the prescribed treatment. It happens that damage nervous tissue leads to pain chronic nature, joint damage and sexual dysfunction.

It is necessary not to delay treatment and be able to provide first aid in case someone finds himself in an emergency. At the same time, it is important to remain calm and remember how immobilization is done correctly.

Treatment

Pelvic fractures require careful attention. In the process of treatment, two periods are important - pre-hospital and inpatient. The prehospital period is based on immobilization. The best option is laying the patient on his back. The lower limbs should be slightly apart and bent at the hips and knee joints. To do this, you can put a folded pillow under your knees.

However, it is important to understand that the “frog” position during immobilization is sometimes contraindicated. If the fracture is accompanied by a divergence of the broken fragments from the midline outward or multiple fractures have occurred and even a slight spread of the legs causes severe pain, and repeated displacement of the fragments leads to additional trauma, therefore, in these cases, the above immobilization is contraindicated. Usually in such situations, the patient is placed on a stretcher and a pillow is placed under the knees. You can also bandage the limbs to each other.

Putting a person in the “frog” position, depending on the fracture

For pelvic injuries, vacuum immobilizing stretcher mattresses are very effective. Once the air is pumped out, they become a good tire. They are placed on stretchers. If pelvic fractures are accompanied by massive bleeding, a compression suit is used. External compression leads to hemostasis and mobilizes blood volumes from peripheral to central vessels, which improves brain and heart perfusion. It should be borne in mind that pneumocompression can lead to respiratory disorders. A pelvic bandage can be applied to reduce bleeding.

The hospital creates a compression of the damaged pelvic fragments. In addition to immobilization and fixation, the goal of doctors is to eliminate pain, so they use methods of anesthesia and analgesia. After immobilization and first aid, the victim is taken to the hospital, where a thorough examination is carried out and a diagnosis is made based on the classification and general condition of the patient.

Pelvic fractures are a serious injury that requires special attention. All prescribed treatment and rehabilitation period can take a very long time, but you must strictly adhere to all recommendations. It is best to be careful and try to avoid all situations that can lead to such a serious injury. This means that you should carefully cross the road, do not climb windows and be careful in all potentially dangerous places. Take care of your life and health!

Injuries of the musculoskeletal system in the pelvic area are the result of accidents, traffic accidents, compression under the influence mechanical force. Over 75% of damages are integrity violations pubic symphysis, joints connecting the lower spine with the pelvic girdle (including such a pathological condition as a fracture of the ilium); about 20% - deformation of the acetabulum. All of them are accompanied by severe pain, pose a danger to life (in severe forms can be fatal), require immediate medical attention.

Pelvis - located at the bottom (base) of the spine support system skeleton, protecting the internal organs (urinary, reproductive, rectum) and acting as a link between the trunk and legs.

The structure of the complex includes:

• sacrum;
• motionless, connected by bone sutures 3 paired bones (sciatic, pubic, ilium).

The latter, fastening in the outer-lateral part, form the acetabulum (BB) - constituent element hip joint.

The pubic bones, closing in front, form the pubic symphysis.

The continuity of the system is provided by the sacroiliac joints, through which the ilium bones articulate with the sacrum.

Classification of fractures of the pelvic bones

In addition to unilateral and bilateral injuries, pelvic injuries are also systematized according to the type of localization. According to the descriptive pathological anatomical characteristics, the following are distinguished:

1. Fractures of Malgenya (posterior, anterior half ring), BB and other elements of the connecting link.
2. Edge, or isolated, deformations.
3. Fractures with violation of the integrity of the system.
4. The above pathological condition, characterized by the preservation of the continuity of the complex.

Read also: Applying a splint to the ankle in case of a fracture or dislocation

Modern medicine classifies injuries into 3 types: stable (group A), rotationally unstable (B), unstable, accompanied by a complete rupture of the joints of the sacrum with the ilium (C). Among the latter - vertical rear, front. Additional type are fracture-dislocations.

Systematization of fractures of the pelvic elements additionally highlights open (including gunshot and inflicted with cold weapons), closed injuries; deformities with organ disorders.

Collateral damage

Any type of injury is accompanied by bleeding, aggravating the patient's condition. Marginal fractures cause relatively small blood loss (up to 500 ml). Group C deformities of the vertical type are characterized by the loss of more than 3 liters of body fluids in a short time.

Row pathological conditions is distinguished by the occurrence neurological disorders due to compression of the nerve endings located in the lumbar region.

Severe injuries may be associated with ruptures of the rectum, bladder, vagina, or urethra; when the contents of the organs enter the pelvic cavity, infectious processes develop.

Clinical manifestations

The main signs of the presence of fractures are: deformation of the musculoskeletal system and pain in the area under consideration, swelling and subcutaneous hematomas, traumatic shock. The latter is accompanied by symptoms, including:

• pallor of the skin;
• a sharp decrease in blood pressure;
• cardiopalmus;
• cold sweat;
• loss of consciousness.

Tissue injury, hemorrhage in the abdominal cavity can be determined by the manifestation of the clinical picture of "acute abdomen" and severe swelling. In case of damage to the rectum, urethra, vagina, bleeding from these areas is observed. Bladder deformities are detected by the presence of blood in the urine.

Read also: How to remove leg swelling after a fracture?

Local symptoms accompanying different kinds fractures are shown in the table below.

The severity of the symptoms described above is determined by the severity of the damage.

Isolated injuries of the pelvic bones are accompanied by the development of traumatic shock in a third of patients (of the total number of those examined); severe (multiple) deformities - the appearance of the above syndrome in 100% of patients.

Diagnosis of pathology

When visiting the clinic primary diagnosis exhibited by the doctor after questioning and examining the victim. Additional examinations include:

• radiography;
• computed tomography;
• urethrography;
• Ultrasound of the organs of the excretory system.

Read also: Treatment of wounds on the leg at home

In difficult cases (if there are signs of an "acute abdomen"), a diagnostic laparotomy, laparoscopy is performed.

The treatment regimen, which includes taking medications, a complex of surgical procedures and physiotherapy procedures, is prescribed by the attending physician upon completion of all necessary studies.

Methods of treatment of fractures of the pelvic bones

The causes of fractures are many factors - car accidents, a person falling from a height, being in an emergency zone (landslides, earthquakes, explosions, etc.). Often deformations occur due to awkward movements, shocks, excessive stresses. If a pelvic fracture is suspected, call ambulance and try to alleviate the condition of the victim. Therapy can only be prescribed by a specialist (traumatologist surgeon).

It is forbidden to independently move the patient: transportation without special devices cause complications.

First aid

After an injury, a person should be carefully examined.

Weakening pain syndrome contributes to the adoption of the correct position (tightly folded clothes, a blanket are placed under the knees, and a hard pillow under the body), oral use of analgesics (if medical knowledge is available, intramuscular administration of drugs is allowed).

Suspicion of the development of traumatic shock requires the provision of air flow (loosening of belts, belts). If necessary, you need to use ammonia.

If the damage is accompanied by bleeding, it is necessary to stop the blood (apply dressings indicating the time of fixing the tourniquet), process skin antiseptic.

When providing first aid, one should not forget the importance of sedatives. Valerian tincture, Corvalol will help the patient relax and calm down.

Relief of pain syndrome

Pain medications are administered only by a doctor. Antishock Therapy carried out by using promedol, morphine and other narcotic analgesics.

One of the most common injuries severe complications considered to be a pelvic fracture. The difficulty of transporting the victim, Great chance that will be damaged soft tissues, as well as, long-term treatment and rehabilitation - all this creates unfavourable conditions for a person with a fracture of the pelvic bones.

The structure of the pelvic bones

The pelvic bone is such only in adults.

Before adolescencethe pelvic ring is formed from three paired bones: iliac, pubic and ischial. As you grow older cartilage tissue between these bones is replaced by bone.

Photo 1. The pelvic ring consists of three paired bones. Source: Flickr (Robert Heng).

Only pubic bones separated by a semi-joint - the pubic symphysis.

Iliac bones limit the cavity of the large pelvis, they are connected to sacrum with the help of a joint. On their lateral surface there is an articular cavity, which takes part in the formation of the hip joint.

Pubic and sit bones form a frame to which muscles and ligaments are attached, all these tissues form the walls of the small pelvis.

It is important! With an injury to the pelvic bones, there is a high risk of massive blood loss due to rupture large vessels. First of all, the victim must be examined for massive bleeding, and if any, stop.

Possible reasons

Pelvic bones healthy person very durable. For their fracture to occur, it is necessary to apply great strength. Most often this happens in car accidents, if a person falls from a great height or if a heavy object falls on the person from above.

But there are cases when a simple fall from a small height or a blow leads to a fracture of the pelvic bones. This is possible if there are factors that contribute to the destruction of the bone:

• osteomalacia;
• osteoporosis;
• osteomyelitis;
• rickets;
• tumors, etc.

Types of pelvic fractures

They can be classified depending on the location of the violation of the integrity of the bone.

Pelvic ring fracture

If, as a result of an injury, the integrity and shape of the pelvic skeleton are violated, then we are talking about a fracture with a violation of the continuity of the pelvic ring. These fractures can be either unilateral or bilateral. It usually happens displacement of bone fragments with pelvic deformity.

In addition to the fracture itself, such people have ruptures and sprains that strengthen the pelvic skeleton.

Fracture of the pubic bone

A fracture of the pubic bone can be single (isolated) - the shape of the pelvis does not change, or a component of a fracture of the pelvic ring. In the latter case, the following types can be distinguished:

• fracture of the above bones with displacement (unilateral);
• bilateral fracture;
• rupture, stretching or divergence of the pubic joint.

They are not necessarily accompanied by pathologies of gait or severe pain.

It is important! bright sign violations of the integrity of the pubis - the presence of blood in the urine (hematuria). This means that one of the fragments damaged the bladder or urinary tract.

Ischial fracture

A sign of a fracture of the ischium - inability to sit. The patient tries to take a lying or even standing position.

This bone rarely breaks alone. Its branches tend to break along with the pubic bone. There are such types:

• violation of the integrity of the vertical branches of the ischial and pubic bones;
• vertical fracture complicated by a fracture of the sacrum;
• diagonal fracture: diagnosed when the integrity of the pubic and ischium(on one side) and iliac (on the other).

Fracture of the ilium

The injury can be unilateral or bilateral. Also the fracture is often combined with other injuries. The most common case is a fracture of the iliac wing - its flat part, a typical fracture when falling on its side.

Traumatization lends itself to the front spines. These are protrusions of the bone to which the tendons of the muscles of the anterior surface of the thigh are attached. In an unsuccessful fall, the spines can come off due to pathologically increased muscle contraction.

Symptoms

When differentiating the injuries of the victim, it is important to note the main signs of a violation of the integrity of the pelvic bones in order to avoid mistakes in their next steps. These include:

• visible deformity of the pelvis;
• sharp pain, which increases when you try to move;
• hematoma;
• crepitus(characteristic crunch of bone fragments);
• shortening of the leg (observed when the iliac spine is torn off);
• inability to move;
• urinary incontinence(in rare cases);
• traumatic shock (rapid heartbeat, severe drop in blood pressure, pallor, confusion);
• pathological muscle tone of the anterior wall of the abdomen (“acute abdomen”) is observed with injuries of internal organs.

The presence of these symptoms (not necessarily all) indicates a fracture of one or more pelvic bones.

Note! With severe pelvic fractures, a person cannot walk and sit, but with single fractures, motor function can be preserved. This makes initial diagnosis difficult. It is necessary to pay attention to the nature of the gait, because in stressful situation he may not feel pain.

First aid

Algorithm of actions in case of a pelvic fracture:

1. , if any. Arterial bleeding from the vessels of the thigh stops when a tourniquet is applied above the site of rupture of the vessel. If the localization of bleeding does not allow the application of a tourniquet, then it is stopped by tightly pressing the vessel in the wound and tightly packing the wound with a dressing or hemostatic material.
2. call an ambulance help.
3. Lay down the patient on the hard surface, put soft rollers under your knees. Try to move the victim as little as possible.
4. To give .

It is important! If the patient is bleeding, then drugs that affect blood clotting (for example, aspirin) should not be given to him.

5.Transport the person to the hospital required in the supine position. He needs to bend his legs at the hip and knee joints ("frog pose").

Methods for diagnosing a fracture and its complexity

Assessing the patient's condition, the doctor, on the basis of manifestations typical for a pelvic fracture, prescribes additional research to clarify the diagnosis and clarify the details.

The main diagnostic method for pelvic injuries is radiography. It is necessary to take several pictures in different planes so that the doctor can assess the condition of the bones from different angles.

If soft tissue injury is suspected, x-rays will not be sufficient. To assess the condition of the vessels, it is recommended computed tomography with contrast, and to assess the state of internal organs Ultrasound, CT or MRI(magnetic resonance imaging).

Laparocentesis- puncture of the abdominal cavity with a needle to collect fluid (if any). It is carried out in order to detect blood or exudate in the peritoneal cavity.

Data general analysis blood(hematocrit, red blood cell count, hemoglobin) give an idea of ​​the general condition of the patient. At strong decline These indicators are a reason to suspect the presence of internal bleeding.

The complexity of diagnosing all injuries in a fracture of the pelvic bone is a large number of various structures that can be damaged by bone fragments (intestines, main arteries and veins, large nerves, uterus, prostate gland, bladder, etc.).

Treatment

Directed treatment of pelvic fracture starts with anesthesia with help novocaine blockade large nerves or the administration of potent general anesthetics.

After establishing accurate diagnosis the doctor determines the method of treatment. For small single fractures without complications, they resort to skeletal traction and conservative treatment . If the patient has multiple fractures and soft tissue injuries, then this is an indication for surgical intervention.

Surgery

The operation is performed under general anesthesia. During the intervention, the surgeon revision of the abdominal organs and the cavity of the large and small pelvis. In the presence of bleeding and damage, the doctor eliminates them.

When the patient is no longer at risk of bleeding from injured organs, doctors move on to osteosynthesis- comparing the fragments and fastening them with special knitting needles, screws, pins.

Depending on the severity of the injuries and the extent of the operation the rehabilitation period can last from a couple of months to a year.

Immobilization

To provide optimal conditions in which bone regeneration will occur, it is necessary to completely immobilize the fracture site. This can be achieved through plastering, overlays special tires or commits sick on the "shield"- a special surface on which the pelvis acquires an anatomical shape.

Together with immobilization resort to skeletal traction. To do this, the injured limb is placed 30-40 cm above the body and a load is attached to it (first 1 kg, after a while 2-3). This leg position helps proper fusion and stimulates bone growth at the site of injury.

Conservative treatment

This link of therapy includes the reception of such groups:

• painkillers;
• antibiotics - to prevent the spread of infection;
• vitamin-mineral complexes - calcium, phosphorus and vitamin D salts are especially important;
• immunostimulants for the prevention of congestive pneumonia in bedridden patients.

Effects

Negative consequences are possible with extensive injuries, rough transportation of the victim, or with inadequate treatment of a pelvic fracture. Possible complications:

• irreversible disturbances in the functioning of internal organs, which leads to the need for their resection or removal;
• malfunctions of the genitourinary system;
• violation motor function one or two legs;
• shortening one or two legs;
• loss of skin sensitivity below the fracture site;
• massive blood loss;
• joining the infection;
• fusion of bones in the wrong position.

Despite the high risks and wide range possible complications pelvic fracture responds well to treatment. Main danger lies in wait for the victim at the stage of injury until the ambulance arrives. Often the patient's life depends on the quality of first aid provided by ordinary passers-by.

Rehabilitation

The recovery period after a fracture often determines the degree of functioning of the lower extremities in the future. At this time, it is very important to follow all the recommendations of the doctor and diligently perform physical exercises.

How long does rehabilitation take

The recovery time of the patient depends on the severity of the injuries and the method of treatment. If there was surgery, then this period is significantly lengthened and complicated. Average time for bone fusion 1-1.5 months. In children, this period is shorter - up to 3 weeks, in older people it is longer - about 2 months.

Full recovery of leg function can be observed 3-5 months after the injury.

Exercise therapy and exercises for the development of the pelvis

About a month after the fracture, the doctor allows you to stand up and walk using a walker. load on a sore leg increasegradually.

On the initial period physiotherapy done in bed, before the patient gets up. Recommended lifts healthy leg, rotational movements (turns inward), neat crossing of the limbs in the air.

After removing the immobilization, it is allowed to perform more amplitude movements, as well as muscle contraction without movement of the limbs (isometric).

When the doctor allows you to get up, the main load is presented in the form walk. It should not bring severe pain or discomfort.

At the last stage, when walkers are no longer required for walking, you can make circular motions pelvis, squats, leg swings, etc.