Functions of the ischium. Ischium: anatomy. Pain in the hip joint when sitting

Fracture of the ischium is a violation that leads to loss of integrity of the pelvic bone. Anatomically, the pelvis is two bones without specialized names. The ischium is responsible for coordinating leg movements. Violation of its integrity limits the movement of a person, causes discomfort and problems. In some cases, a fracture of the ischium brings consequences that adversely affect human health.

In people under the age of 16, experts anatomically divide the pelvic bone into three separate parts - the pubic, ischial,. When a person reaches the age of 16, they fuse together with the pelvic cavity through cartilage. This is how the pelvic ring is formed, which is the border of the small and large pelvis. Gradually this connection disappears. Already at the age of 20-21, ossification can be observed almost completely.

The pelvis is at the base of the body. He is his important part. The sacrum is the end of the spinal column. This bone is a kind of protective shell for human organs, which are concentrated in the buttocks - in the small pelvis. The lower limbs are also attached there.

The acetabulum is involved in the formation of the hip joint, where the ischium is located. It is represented by two components - the body and branches that go to the pubic bones. One of important elements bones - a protrusion or ischial tuberosity. The branches and the body form an obturator opening through which vital neurovascular bundles pass.

Classification

Fracture of the ischium of the pelvis has several classifications:

Fracture open and closed.
Fracture of the ischium with and without displacement.
Single or .

Single - a fracture presented only in the anterior pelvic half ring. Multiple implies violations of the integrity of both the ischial, and. Often there is asymmetry of the pelvis or complete break rings.

ICD 10 injury code

By international classification diseases ICD 10 damage to the sciatic nerve - a fracture, corresponds to the code S32. The universal classifier code includes all fractures of the pelvic bones, including damage to the ischium.

The reasons

A fracture of the ischial bone usually occurs after a fall, but it can be difficult for a person who is not familiar with medicine to understand the cause of the pain.

To the main causative factors fracture can also include:

Injuries resulting from exercise professional views sports.
Falling from high objects, if the impact fell on the buttocks.
Excessive pressure in the pelvic area in any plane. Most often this is observed in various disasters, for example, accidents, natural disasters.

Often, a bone fracture is accompanied by a vertical fracture of the pelvis. It can be localized on one or both sides. Rarely, an isolated fracture occurs. With a very strong muscle contraction, there is a possibility of tearing off the ischial tuberosity.

Symptoms

Fracture of the ischium is about 8-10% of total skeletal damage. The main symptoms and signs of a fracture of the ischial tuberosity are as follows:

Swelling, bruising, hematoma.
Strong pains.
Problems with the control of the muscles of the legs - involuntary lifting of the legs in a supine position.
Mobility disorder.
The appearance of bleeding from urethra if the urethra is torn.
Retention of urine and feces.
The presence of a crunch in the damaged area.
The appearance of blood from the anus in violation of the integrity of the rectum.
High chance of fainting.

This increases the likelihood of problems with large vessels and sciatic nerve disorders. Internal bleeding may occur.

If violated sciatic nerve, there are signs of numbness, the sensitivity of certain parts of the body increases or decreases, often the legs, buttocks, feet, thighs, which have a local location.

Specific symptoms also develop:

Pelvic asymmetry - visible externally or diagnosed with the help of specialists. This happens due to the pronounced pain syndrome, development of diastasis between fragments.
Stuck heel symptom. It implies the inability to raise the leg located on the side where the injury occurred. The symptom is diagnosed when the victim is in the supine position.
Reflex urinary retention, the cause is pain shock.
Inability to sit, feeling of sharp pain when probing the buttocks.

First aid

Ischial fracture pelvic ring requires immediate help. It must be provided by a medical officer. You need to call an ambulance promptly. While waiting for the doctor, do the following:

The patient is placed on his back on a hard surface.
A small roller is placed under the knee joints, which can be made from clothes or other fabric.
It is necessary to give the victim an anesthetic that is available. They wash it down plain water. Subsequently, the name of the drug and its dosage are voiced by the ambulance doctor.
It is necessary to create an ice compress. Ice is used, a container with cold water, frozen meat or fish. The compress must be applied through the fabric so that it does not come into contact with bare skin. It is important to exclude the possibility of water, which will melt when holding the compress, into the wound. Maximum duration holding the compress at the site of injury - 15 minutes to eliminate the possibility.

Upon the arrival of the ambulance, medical workers carefully transfer the patient to a stretcher with a rigid base. Similarly, a fabric roller is placed under the knees. In some cases, there is a fracture of the legs at the same time. different kind. Then you need to place them on the stair rails.

- the introduction of painkillers. If a shock clinic is observed, anti-shock actions are carried out. In particular, this is the replenishment of blood volume and the correction of hemodynamics.

In the first days, the patient should be in the hospital of the trauma department, where he will receive appropriate care and prompt assistance in unforeseen situations. Also, the doctor in the emergency room says to lie down, because such a thing as sitting and walking in the first stages is very dangerous.

Diagnostics

Diagnosis of a fracture of the ischium without displacement is carried out by the following methods:

Anamnesis.
Questioning the patient.
Palpation.
X-ray.
Tomography of computer-resonance or computer type.

The doctor conducts digital examination rectum, in women, the vagina is additionally examined, in men - prostate. This is done in order to check the presence or absence of a gap. The function of urination is also examined, bladder catheterization is performed

Severe injuries oblige the specialist to conduct additional diagnostic methods among which the most common are:

Rectal examination.
Method of comparative measurements.
Retrograde cystography.
Angiography.
Laparocentesis.
Laparotomy.
Urological research. They are carried out after stabilization of the condition of the victim.

Treatment

Treatment of a fracture of the ischium should be carried out exclusively in a hospital, the patient should be constantly monitored by medical personnel. The victim is placed in a “frog position” on a special orthopedic bed. At the same time, the knees are bent and spread apart, under knee joints lay pillows or small rollers. The patient is fixed in this position.

Analgesic therapy is constantly carried out, as there is a pronounced pain syndrome and a strong muscle contraction. In the most severe cases bleeding is stopped. The next step- replenishment of blood loss, for which infusion solutions are used. After urgent action the doctor prescribes conservative or surgical treatment, depending on the severity of the fracture and associated symptoms.

If the injury is not displaced, it is treated conservative ways. For about a month, the victim must comply with bed rest. If the fracture is isolated or marginal, Beler tires are used and the patient is fixed in a special hammock. Healing is carried out for 2-2.5 months.

Affected people are often interested in whether it is possible to sit with an injury such as a fracture of the ischium. The answer of experts to this question is that you can’t sit, at least in the first days. Further recommendations depend on the severity of the damage and the course of the rehabilitation process.

Surgical treatment

Sometimes a fracture of the ischium requires surgical treatment. Required to be carried out additionally antibiotic therapy. Often, a fracture with a displacement to the right or left is accompanied by bleeding. As a result, its elimination, suturing of damaged organs is required.

Next, the fragments are repositioned and osteosynthesis is carried out. To do this, use knitting needles or metal plates. The final stage surgical treatment– round-the-clock supervision of a doctor in order to control normal healing.

Rehabilitation

Rehabilitation for a fracture of the ischium occurs in accordance with the recommendations of a specialist. It often includes the following:

Physiotherapy.
Therapeutic gymnastics with an experienced specialist.
Treatment in a specialized institution of a resort or sanatorium.
Massage.

Complications and consequences

Fracture of the ischium may have serious complications and consequences. Among them, the most common are:

lameness;
problems with bone fusion;
complications of an infectious type;
osteoarthritis;
amputation of the uterus and vagina in women;
reduction in the length of one or both legs;
contracture of the pelvic joint;
problems with holding urine or feces;
leg muscle atrophy;
osteomyelitis;
muscle hypotrophy lower extremities.

Often, the consequences of a fracture of the ischium are observed in the absence of proper medical supervision, in case of non-compliance with the recommendations of a specialist, and also when the injuries were serious.

Dear readers of the 1MedHelp website, if you have any questions on this topic, we will be happy to answer them. Leave your feedback, comments, share stories of how you survived a similar trauma and successfully coped with the consequences! Your life experience may be useful to other readers.

The pelvis is a complex anatomical structure that provides stability to the torso and lower extremities of a person. It is made up of three distinct bony structures: ischial, pubic, and iliac. Knowledge of the ischial bone structure allows timely detection of diseases, as well as the development of methods for their prevention.

Many people ask where is the ischium located? This is a bone formation that is part of the pelvis. AT childhood, the pelvic bones are located separately and separated from each other by layers cartilage tissue. In an adult, the pelvic bones form a single structure.

The ischium is anatomically divided into two separate parts:

directly the body that forms the posterior part of the acetabulum;
a branch that ensures the formation of the pelvic ring by connecting with its other parts.

Attention! When the ischial bones hurt, such pain should be distinguished from the sensations that occur when other bone structures in the pelvic area are affected, including, femur. In no case should you self-medicate, since the pain syndrome may indicate the development of severe pathology: coxarthrosis, fractures, etc.

When examining a patient and studying radiographs, it is important for specialists to understand where the ischial tuberosity is located. This is a small bony protrusion located on the body of the bone. It has the appearance of a bony thickening and is the site of attachment of muscle tendons. In addition to the tubercle, the posterior obturator tubercle is isolated, located on the bone branch. It is also necessary for fixing tendons and ligaments.

The branch of the ischium is fused with pubis pelvis. This connection up to 20-22 years is represented by dense fibrous and cartilaginous tissue. Together, both bones form the obturator foramen through which large blood vessels and the nerve bundle pass.

There is a small and a large ischial notch, forming two anatomical openings. Through them, blood vessels and nerves enter the pelvis, providing blood supply and innervation. internal organs.

Ossification processes

Ossification takes place in four stages, which fall on different stages child development. The initial areas of bone tissue growth are already detected in newborns. When conducting x-ray examination, in a child after birth it is possible to identify three individual bones, which are separated from each other by a significant layer of connective and cartilaginous tissue. On the this stage development, the structure of the pelvis is not yet formed, and the branch of the ischium and pubis are not connected.

The second stage of ossification falls on 7-8 years. On radiographs, the connection with each other of the branches is revealed, which indicates the beginning of the formation of an integral pelvic ring.

The third stage occurs at 14-15 years of age and is associated with an increase in the amount of sex hormones and growth hormone in the blood.. It is manifested by the formation of the acetabulum, which is involved in the formation of the hip joint, together with the head of the femur.

In addition to large areas of ossification, so-called intercalary or additional bones are observed. These are small fragments of bone tissue that gradually merge with each other, forming an integral structure. In case of violation of their fusion in childhood, the formation of long-existing sections of the cartilaginous layer is possible.

At the age of 10 to 20 years, active ossification of tubercles on the surface of the bone begins. This is due to an increase in the load on the ligaments and tendons of the muscles attached to them. The final stage of ossification occurs at 20-25 years of age. At this time, the pelvic bones finally merge with each other, forming a monolithic structure. From now on, anatomical structure the ischium does not change.

In older people, the ischial bone gradually begins to develop dystrophic processes . Their main manifestation is osteoporosis, characterized by a slight decrease in density. bone mass. It usually does not lead to pathological fractures with absence comorbidities. However, when increased load, diseases endocrine system and other diseases, the elderly are at increased risk traumatic injuries pelvis.

Attention! Influences that violate ossification ( inflammatory processes, degenerative changes etc.) can lead to grave consequences associated with underdevelopment of bone tissue. In this regard, a person may develop hip dysplasia and other undesirable phenomena.

Differences in women and men

The pelvic bones differ in structure depending on the gender of the person. Such a difference is due childbearing function women. In connection with the passage of the child through birth canal, the pelvis must have a certain plasticity, this ensures its expansion during childbirth.

In the first 20 years of a person's life, the difference between male and female pelvis no. It has a similar elongated shape, which is detected even in childhood. After puberty, its structure begins to change. In women, there is a reversal of the ridge ilium outward, which causes the expansion of the upper sections of the pelvic ring. At the same time, the ischium maintains a plastic connection with the pubic bone, which allows the pelvis to expand during childbirth.

Reference! Fracture of the ischium - serious pathology accompanied by severe pain and impaired pelvic stability. It can cause damage to internal organs, blood vessels and nerve bundles.

Conclusion

Diseases of the musculoskeletal system, including the pelvis, are common in humans different ages. Knowledge of the structures that form the pelvic ring, including the anatomy of the ischium, allows you to timely determine the presence of pathology and consult a doctor. In these cases, the prognosis for the patient is favorable, since the diseases are best treated on initial stages of its development.

fractures pelvic bones account for approximately 5-6% of all fractures of the bones of the musculoskeletal system. Their main cause is car accidents, as a result of which a person has a strong compression of the bones in the sagittal and frontal planes. Also, often such injuries occur as a result of a fall on the buttocks with high altitude, collision with a car, collapse of a building or soil, etc.

Ischial fracture is one of the most frequent fractures pelvis. And this is primarily due to the anatomical features of its structure.

The ischium is quite thin and consists of two parts - branches bending at an angle and the body itself, which forms the posterior and partly lower divisions acetabulum and quite smoothly passes into upper part branches of the ischium.

As for the branch of the ischium, it has a slight rough thickening (the so-called ischial tuberosity) and bottom in the anterior sections it is connected to the lower branch of the pubic bone.

In the vast majority of cases, a fracture of the ischium occurs as a result of an unsuccessful landing on the buttocks after a fall or due to strong compression of the pelvic bones. He represents a very serious injury, since it is associated with the possibility of severe damage to internal organs (in particular, pelvic organs related to the urogenital system), with significant blood loss, as well as with the likelihood of developing a shock state against the background of pain and blood loss. The most frequent such fractures in the stronger sex, especially at the age of 25 to 50 years.

Ischial fractures can be either stable or unstable. characteristic feature unstable is that fragments of the pelvic bones formed as a result of an injury can at any time be able to move even under the influence of a slight load (for example, when trying to move the foot, tilting or turning the body, and even with muscle tension abdominals). With unstable fractures, there is a violation of the integrity of the pelvic ring - the bone structure formed by the bodies of the ilium, pubic and ischial bones, as well as the sacrum.

An unstable fracture, in turn, can be rotationally unstable or vertically unstable. As for stable fractures, their distinguishing feature, on the contrary, is the absence of violations of the integrity of the pelvic ring in the patient.

Symptoms of a hip fracture

A fracture of the ischium is accompanied by both common symptoms for all fractures, and has a number of specific features arising depending on the characteristics of each particular fracture.

In cases where the patient has an isolated fracture of one of the branches of the ischium (not involved in the formation of the pelvic ring), characteristic clinical manifestations are considered:

local soreness;
Swelling at the site of injury;
Symptom of "stuck heel" (Gorinevsky - a symptom that consists in the impossibility for the patient, who is in the supine position, to raise the straight leg).

Damage to the bones of the pelvic ring without disturbing its continuity, in particular, a unilateral or bilateral fracture of the same branch of the ischium, as well as fractures of the ischial branch on the one hand and the pubic branch on the other, are accompanied by:

Local soreness, which increases when trying to roll over on its side;
A positive symptom of "stuck heel".

Symptoms of a fracture of the ischium, which belongs to the category of fractures of the pelvic ring bones with a violation of its continuity and is characterized by ruptures of the joints, are:

Soreness in the symphysis and perineum;
The need to be in forced position frogs (when the knees are bent and laid aside);
Positive symptom of "stuck heel".

To the group common features that accompany all pelvic fractures include:

Traumatic shock. It develops in every third person with a pelvic fracture. And in those cases when it is accompanied by multiple and combined injuries, this symptom is noted in 100% of the victims. This condition is characterized by increased pallor skin, the formation of sticky cold sweat, a drop in performance blood pressure, increased heart rate and in some cases loss of consciousness;
Bleeding from the urethra (if the urethra was damaged as a result of a fracture of the ischium);
Urinary retention and dysfunction of urination;
Bruising in the perineum;
Violation of the configuration of the pelvis;
Swelling at the site of injury;
Sharply expressed soreness when trying to move the legs;
Impossibility of support on the legs;
Bleeding out anus(if the rectum is damaged).

Treatment of a fracture of the ischium

In cases where the patient is admitted in a severe state of shock, first of all, he is given a series of anti-shock procedures. With significant blood loss resort to the introduction of blood substitutes, plasma or blood.

next necessary measure treatment of a fracture of the ischium is the anesthesia of the injured area. For this purpose, an intrapelvic blockade can be prescribed according to the Shkolnikov-Selivanov method. After anesthesia, the patient's body is fixed on an orthopedic bed in the frog position, in which the legs are slightly bent at the hips and knees, the latter are spread apart, the feet are located close to each other, and the hips are deployed in outside. Rollers are placed under the knees and hips.

Duration bed rest depends on the complexity of the fracture, usually it is about one month. Physical exercise permitted only after seven weeks from the date of injury.

The rehabilitation period after the end of bed rest includes:

Therapeutic exercise;
electrotherapy;
Heat treatment;
Massotherapy;
Application of various medicines in the form of ointments and gels;
Balneotherapy, etc.

In addition, the treatment of a fracture of the ischium must be supplemented with the use of drugs containing collagen.

The consequences of a fracture of the ischium

The consequences of a fracture of the ischium and pelvic bones in general can be very serious, especially if the fracture was accompanied by multiple injuries due to the collapse of buildings, traffic accidents, natural disasters, etc. The damage provoked by such phenomena is often accompanied by internal bleeding, ruptures of organs and other unpleasant phenomena.

In addition, the consequences of a fracture of the ischium can be:

Delayed fusion of bone tissue, improper fusion or non-union of bones;
Post-traumatic infection;
The development of paresthesia (a type of sensitivity disorder);
Osteoarthritis;
Osteomyelitis;
Damage to muscles, blood vessels, nerves and tendons;
Shortening of the limbs;
Hypotrophy and atrophy of the gluteal muscles;
Contracture of the hip joints.

AT human body there are more than 200 bones with a variety of structures. Each of them performs a specific role and provides normal work the whole organism. The pelvis contains the ischium, which is responsible for protecting and supporting the organs located in the lower part. abdominal cavity. It is also designed to firmly attach the legs to the body. If you experience pain or injury to the ischium, you should immediately contact the emergency room, since some injuries are life-threatening.

The ischium consists of a body and a branch bent at an angle.

Anatomical structure:

From below and behind it is a limiter of the obturator opening.
The body of corpus ossis ischii is placed posterior to the obturator foramen.
The branch merges anteriorly with the inferior branch of the pubis.
A tubercle is located at the lower edge of the lesser sciatic notch.
The axis is located between the lesser and greater ischial notch.

Ossification

If you take a picture on an X-ray machine infant, then you can consider the gaps in the pelvic bones. Between them is cartilage, which remains invisible on the x-ray. In the region of the acetabulum, the lumen between the pubis and ischium missing, because they are on top of each other and look like a single whole. In its form, the bone connection is similar to a claw. The hole in the pelvic bone (foramen obturatum) is not closed.

When a person reaches the age of eight, the branches of the ischium and pubis become one. And by the age of 16, the acetabulum connects with ilium and the pelvis is formed. In almost all areas of attachment of ligaments and muscles, additional ossification points appear (this process continues until the age of 19). A complete fusion occurs by the age of 25.

Please note that it is by the second ten years of life that a specialist can find out the sex of a person from the pelvic bone. Additional bone formations are involved in synostosis in the region of the acetabulum. If they are stored in long time, then they are assigned to ossa acetabuli. On x-ray, they can be confused with fragments.

Pain

Cause pain can become an injury, inflammatory or infectious disease.

Pain occurs:

With intense training and hard physical work.
If a person is actively engaged in cycling, then there is a risk of developing inflammation of the ischial bursa (bursitis).
Oncological neoplasms. Pain may radiate to surrounding tissues. It is observed during fibrosarcoma or histiocytoma.
With a fracture, crack or puncture. Occurs when squeezing the pelvis or an unsuccessful fall on the buttocks.
As a result of acute or chronic diseases from the circulatory system.
During infection with specific microorganisms, osteomyelitis or tuberculosis is diagnosed.
For metabolic diseases skeletal system. As a result of lack useful substances in the human diet, there are violations of resorption or tissue formation.

The disease can be diagnosed with an x-ray.

fracture

Violation of the integrity of the ischium is classified as dangerous and severe injuries support system. Since there is always a risk of complications with damage.

General symptoms:

Swelling of the injured area.
The patient lying on his back is unable to raise his straight leg. This condition is also called the "stuck heel" syndrome.
The pain becomes more intense when you try to turn to the side.

Additional signs of damage to the pelvic bone:

Severe pain when moving the lower limbs.
Paleness of the skin.
Hypotension.
Arrhythmia.
Loss of consciousness.
Problems with urination.
In the case of a piercing fragment of the rectum or urethra, bleeding may begin from the anus or urethra.

Required urgent hospitalization sick. Only a traumatologist can prescribe effective treatment.

Structure (video)

Ischium, os ischii. Limits the obturator opening behind and below. Rice. A, B.
The body of the ischium, corpus ossis ischii. Part of the bone located posterior to the obturator foramen. Rice. A, B.
Branch of the ischium, ramus ossis ischii. The part of the bone located downward from the obturator foramen. Anteriorly, it merges with the inferior ramus of the pubis. Rice. A, B.
Ischial tubercle, tuber ischiadi (ischiale). It is located at the lower edge of the lesser sciatic notch. Rice. A, B.
Ischial spine, spina ischiadica (ischialis). It is located between the large and small ischial notches. Rice. B.
Greater ischial notch, incisura ischiadica (ischialis) major. It is located between the inferior posterior iliac and ischial spines. Rice. B.
Small ischial notch, incisura ischiadica (ischialis) minor. located between ischial spine and mound. Rice. B.
Pubic bone, os pubis. Forms the anterior and inferior edges of the obturator foramen. Rice. A, B.
The body of the pubic bone, corpus ossis pubis. Rice. A, B.
Pubic tubercle, tuberculum. Located laterally from pubic symphysis. Rice. A, B.
Symphysial surface, fades symphysialis. Turned towards the opposite bone. Rice. B.
Pubic crest, crista pubica. Directed medially from the pubic tubercle to the symphysis. Attachment site of the rectus abdominis muscle. Rice. A, B.
Superior branch of the pubic bone, ramus superior ossis pubis. Limits the obturator opening from above. Rice. A, B.
Iliopubic eminence, eminentia iliopubica. It is located along the line of fusion of the pubic bone with the ilium in front of the acetabulum. Rice. A, B.
Crest of the pubic bone, pecten ossis pubis. It is a continuation of the arcuate line and goes to the pubic tubercle. Origin of the pectineus muscle. Rice. A, B.
Obturator ridge, crista obturatoria. Located between the pubic tubercle and the acetabulum. Attachment site of the pubofemoral ligament. Rice. BUT.
Obturator sulcus, sulcus obturatorius. Located at top edge hole of the same name. Rice. A, B.
Anterior obturator tubercle, tuberculum obturatorium anterius. A slight elevation, in front of the obturator sulcus. Rice. A, B.
Posterior obturator tubercle, . Occurs behind the obturator sulcus. Rice. A, B.
The lower branch of the pubic bone, ramus inferior ossis pubis. It is located in front of and below the obturator foramen between the suture connecting the branches of the pubic and ischial bones on one side and the pubic symphysis on the other. Rice. A, B.
Taz, pelvis. It consists of the sacrum and two pelvic bones. Rice. C, D, D, E.
21a. Pelvic cavity, cavitas pelvis (pelvica).
Pubic arch, arcus pubis. It is located below the symphysis and is formed by the right and left pubic bones. Rice. G.
Subpubic angle, angulus subpubicus. Educated right and left lower branches pubic bones. (In men, approximately 75°, in women - 90° - 100°). Rice. AT.
Large pelvis, pelvis major. The space between the two wings of the ilium, above the borderline.
Small pelvis, pelvis minor. The space below the border line.
Rice. B, G, D.
Upper aperture of the pelvis, apertura pelvis (pelvica) superior. Entrance to the small pelvis. It is located in the linea terminalis plane. Rice. G.
Lower aperture of the pelvis, apertura pelvis (pelvica) inferior. The exit hole from the small pelvis. Limited to the coccyx, pubic arch and sacrotuberous ligament. Rice. E.
Axis of the pelvis, axis pelvis. Passes through the centers of all straight lines connecting the pubic symphysis and the pelvic surface of the sacrum. Rice. E.
Conjugate, diameterconjugata. The distance between the promontory and the posterior surface of the pubic symphysis, approximately 11 cm. D, E.
Transverse diameter, diameter transversa. The largest size of the upper pelvic inlet, approximately 13 cm. D.
Oblique diameter, diameter oblique. The distance between the sacroiliac joint on one side and the iliopubic eminence on the opposite side is approximately 12.5 cm. D.
Tilt of the pelvis, inclinatio pelvis. The angle between the top aperture plane and the horizontal plane. Rice. E.