The recovery process in case of a fracture of the pelvic bones. Pelvic fracture rehabilitation period Pelvic fracture treatment consequences surgery

The pelvis is not one bone, as many might think. It consists of three parts, firmly connected to each other. The structure of the pelvis is taken into account when making a diagnosis and determining the type of fracture, because often only one bone is damaged.

The pelvic ring consists of three paired bones:

• pubic;
• ileal;
• ischial.

​damage to internal organs;​

​Fracture immobilization - the type of immobilization and its duration depend on the location of the fracture and its type. For stable fractures, it is possible to place the patient on a backboard, with a bolster placed under his knees or Beller splints used. Unstable fractures are a direct indication for the use of skeletal traction.​

Pelvic structure

The pelvis is a system of several bones connected in a ring, which are located at the base of the spinal column, and connects the legs and body of a person. It also protects the organs located in it and is a support for most of the skeleton.

The pelvic ring consists of the following bones: the ilium, pubis, ischium and sacrum.

The pelvic bones are connected to each other by bone sutures, and they are motionless. The pubic symphysis is formed from the pubic bones closed in front, and the iliac bones are attached posteriorly to the sacrum.

On the outer side, all pelvic bones take part in the formation of one of the parts hip joint, namely the acetabulum.

Causes

Damage to the pelvic bones is quite diverse. But the common point in their development is the application of significant external force. The mechanism of such injury can be direct or indirect:

• A blow to the pelvic area.
• Falling onto a hard surface.
• Compression of the pelvis in the longitudinal or lateral plane.
• Jumping to your feet from a height.
• Sudden muscle contraction.

​Damage to the walls of the bladder may be accompanied by the presence of blood in the urine (hematuria), while the contours of the bladder itself are not determined by palpation and percussion.​

• ​The intensity of the pain increases with pressure on the lower part of the sacrum.​
• ​The last group includes fracture-dislocations - a fracture of the pelvic bones is accompanied by a dislocation of the pubic or sacroiliac joint.​
• ​An X-ray confirms the diagnosis.​
• ​Reduce vascular permeability​
• ​Prevention of fractures​
• ​12 folk methods for home treatment​
• ​ultrasound diagnostics;​

​Patients diagnosed with a pelvic fracture may face various complications:​

Clinical manifestations

Despite some differences in the clinical picture, there are common signs of a pelvic fracture. These symptoms indicate the presence of damage and the need for emergency assistance.

​The doctor prescribes the necessary medications, a diet rich in protein and calcium, and bed rest for up to one month.​

​Pelvic bone fractures account for about 10% of all bone fractures, most often they occur in men aged 25 to 50 years.​

​The risk group includes professional athletes, since injury can occur with sudden and strong muscle contraction, and elderly people or patients with osteoporosis, since their bone tissue is thinned and demineralized, which means it becomes fragile.​

Giving help

A fracture of the pubic and ischial bones is accompanied by severe pain, so it is necessary to give the victim an anesthetic and call " Ambulance».

Important! The arriving doctor must be told which drug the victim received and in what dosage.

An ice compress can also help relieve pain. You should not apply it directly to the skin; there should be a layer of fabric. It is not recommended to leave such a compress on long time, 15-20 minutes is enough.

It is extremely undesirable to transport a person with a pelvic fracture to the hospital on your own. If transported incorrectly, a fracture of the ischium without displacement can turn into a fracture with displacement, which will significantly complicate the process of treatment and fusion of bone tissue.

Only doctors in an ambulance can transport a person with a fracture of the ischium or pubis. To do this, he is placed on his back on a hard straight stretcher and helped to assume the “frog pose”:

1. Legs bend in knee joints.
2. A cushion made of clothing or other handy materials is placed under the feet.
3. The feet are connected.

In this position, they are taken to the trauma department of the hospital.

Since pelvic trauma is very dangerous, and if the fractures are complicated, then the most the right decision will urgently transport the victim to the hospital.

Transportation should only be carried out by an ambulance team, but if for a number of reasons this is not possible, then first aid should be provided to the patient before independently delivering him to the emergency room.

1. It is necessary to relieve pain to avoid traumatic shock. To do this, you should use painkillers that are available.
2. If an open fracture occurs, the next steps are to stop the bleeding by applying a tourniquet, below the injury and disinfecting the wound antibacterial agents.
3. The patient must be transported lying on his back. To do this, place him on a hard surface, and place a pillow or bolster under his knees, giving him a “frog” pose. After this, the victim is secured with a rope.
4. And only then the patient must be taken to a nearby hospital, where he will be provided with medical care, diagnosed and treated for a pelvic fracture.

The victim must be transported as carefully as possible. This is due to the fact that it is impossible to immobilize the patient with sufficient quality outside of a medical facility.

Timely and correctly provided first aid in case of damage to the pelvic bones, it greatly reduces the risk of complications and death.

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

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

First aid involves adequate pain relief, the administration of intravenous solutions, and timely hospitalization in a hospital.

General information

The pelvic ring is an important component skeletal system. It serves as a support for the torso, connecting it to the lower limbs, and provides protection for the internal organs located in the immediate vicinity.

This structure is formed by the connection of the sacrum and both pelvic bones, and the latter, in turn, consist of the ilium, pubis and ischium. It is the back of the ring that experiences the greatest load in everyday life, supporting the weight of the body.

The stability of the pelvis is ensured not only by the osteochondral joints, but also by the ligaments running from the sacrum to the iliac bones and the ischial and pubic tuberosities. They protect the ring structures from excessive rotation and displacement. In addition, the muscles and fascia of the pelvic floor play an important role in maintaining the normal alignment of bones.

Trauma therapy

Patients who have broken their pelvis and their loved ones are wondering what treatment is used for a fracture of the hip joint; they are also concerned about the question of how long it takes for a pelvic fracture to heal.

After the victim is taken to the hospital, first of all he is given the following treatment measures - anti-shock therapy, replacement of lost blood and fixation of the fracture area. All these actions belong to the main tactics in the treatment of pelvic fractures.

Pain relief

To relieve pain from a fracture, doctors can use narcotic drugs and novocaine blockades. An injection of a local anesthetic can cause a decrease in blood pressure, so in such complicated situations it is allowed to be administered only after replacing lost blood.

To treat a pelvic fracture with Malgen's sign, the patient is placed under therapeutic anesthesia.

Replenishment of lost blood

In case of large blood loss, severe shock and combined injuries, the replacement of lost blood is carried out for the first time hours. To do this, a large volume of blood is transfused to the patient.

In case of isolated injuries of the pelvic bones, fractional blood transfusions are performed over several days to compensate for blood loss. Intravenous infusions are alternated with the introduction of glucose, blood substitutes and blood plasma.

Immobilization

The duration and type of immobilization or fastening in the treatment of a pelvic fracture is determined by the location of the injury and the integrity of the pelvic ring. If the injury is isolated or a marginal fracture, then the patient is fixed in a hammock or on a backboard.

In rare cases, knee and popliteal rollers and Beller splints are used for immobilization. If there is a violation of the integrity of the pelvic ring, then skeletal traction is prescribed.

Conservative therapy

In case of stable injuries, healing of the pelvic bones occurs only when the patient is immobilized and does not require surgical intervention. Additionally, the patient is prescribed medication therapy:

• Painkillers.
• Medicines containing calcium and multivitamin complexes.
• If the fracture is open, then it must be treated with antibiotics.

After the bones have healed, an individual rehabilitation program is drawn up for the patient, including physical therapy, massage, physiotherapy.

Surgery

Surgical intervention is prescribed for complicated injuries of the pelvic bones and is recommended in the following cases:

• Injuries of the pelvic organs.
• Divergence of the pubic bones due to rupture of the symphysis.
• The resulting deformation of the pelvis significantly displaces bone fragments, and the therapy provided did not give a positive result.

In order for bone fragments to heal correctly, osteosynthesis is performed using knitting needles, screws or metal plates using an external fixator. This operation is carried out under general anesthesia.

During it, the surgeon always carefully checks the internal organs, nerves and blood vessels. If necessary, repairs identified damage.

After the reposition is completed, the patient is prescribed drug treatment, and after bone fusion, a rehabilitation course.

Rehabilitation

Since the patient is forced to lie for a long time in an almost immobilized position, it is necessary to restore the tone and ability of the muscles and ligaments to function normally. To do this, they regularly perform a complex consisting of gymnastic exercises selected and prescribed by a doctor.

The load should be minimal at first and increase gradually. Performing exercises should not cause discomfort, much less pain.

Rehabilitation after a pelvic fracture includes:

• physiotherapy;
• massage;
• taking calcium and magnesium supplements.

Patients who have completed treatment for a pelvic fracture must undergo a rehabilitation course. This is a prerequisite for returning the victim to a normal lifestyle and preventing disability, since gluteal bone damage is characterized as the most dangerous injury to the musculoskeletal system.

Restorative measures for this category of patients must be carried out under the supervision of a highly qualified specialist.

For each patient we develop individual program, which includes the following activities:

• Physiotherapy.
• Taking medications aimed at strengthening bone tissue.
• The use of special ointments, creams, gels.
• Massotherapy.
• Physiotherapy procedures.
• Therapeutic traction.
• Cryomassage.

During special physical education classes, patients must perform special exercises aimed at preventing the development of ankylosis and contractures. Daily implementation of the complex will help strengthen muscles and prevent their atrophy. Hiking is also very beneficial. fresh air, the duration should be increased gradually without overloading the body.

Patients undergoing recovery from fractures benefit greatly from special medications. They help to reanimate the functions of the musculoskeletal system.

After reduction and healing of the fracture, patients need rehabilitation measures. They allow you to restore motor function and normalize the condition of the pelvic organs. For this, the following treatment methods are used:

• Physiotherapy.
• Gymnastics.
• Massage.

Thanks to additional therapeutic measures, rehabilitation after a pelvic fracture is faster, and the patient will be able to return to active life sooner. But full recovery You will still have to expect from 1 to 3–4 months to be able to work.

But these signs are not reliable in terms of diagnosis and therefore the patient needs to undergo instrumental research methods. Transport in the “frog position”.

How to make a diagnosis?

The main diagnostic method is x-ray in two or three projections. Using this study, you can find out about the number of fractures, their location, the integrity of the pelvic ring, and the presence of fragments.

If necessary Additional Information about the condition of ligaments, joints, the presence of small cracks, modern methods are used: computer or magnetic resonance imaging.

An ultrasound examination of the abdominal and pelvic organs is mandatory. They are alarming free liquid in the abdominal cavity, blurred, distorted contours of organs.

If internal bleeding, rupture of the spleen or bladder is suspected, diagnostic laparoscopy is necessary. The surgeon uses a special device through the anterior incisions abdominal wall examines the condition of internal organs.

If damage is detected, non-viable tissue is removed, bleeding is stopped, and ruptures are sutured. Thus, laparoscopy is used both diagnostically and therapeutic purpose.

Additionally, special symptoms are used, which consist of the application of an axial load that causes pain. However, such symptoms are checked carefully so as not to aggravate the fracture or cause injury to organs.

First aid

If you suspect a pearl of the pelvic bones, the following measures must be taken:

1. Take the victim to a safe place.
2. Call an ambulance.
3. To combat traumatic shock, give the patient to take painkillers: Analgin with Diphenhydramine, Ketorol, Ibufen, etc. It is better to wash down the tablets with strong, warm sweet tea or coffee. If possible, you can do intramuscular injection analgesic. They can supplement the effect of painkillers and calm the victim. sedatives: tincture of valerian, Valocordin, Corvalol, etc.
4. In the presence of open wounds process them antiseptic solution and cover with a sterile bandage, securing it with an adhesive plaster.
5. Place the patient in the frog position on a flat, hard surface (a wooden panel or a removed door), covered with a not very soft mattress. Subsequently, it can be transported to a medical facility on the same surface. Place a 60 cm high cushion made from improvised materials or a pillow under your bent knees. Raise your head. Cover the victim.
6. Explain to the patient that he cannot move his legs.

Correctly provided first aid for fractures of the pelvic bones greatly reduces the risk of complications and deaths. It is necessary to transport the patient as gently as possible, since it is impossible to perform sufficient immobilization for such injuries outside of a medical facility.

The doctor should place the patient so that his knee joints have a flexion angle of 140 degrees, and the heels of both legs are connected. In this position, the patient’s knees are spread apart, creating a “frog pose.” Rupture in the area of ​​the symphysis pubis. With this type of fracture, the victim’s legs should be on a bolster, they should be straightened and lie parallel.

Consequences and complications of injury

​development of post-traumatic infection;​

• ​Fractures in which the pelvic ring is disrupted (unstable)​
• ​nasty thing​
• ​development of an infectious inflammatory process;​
• ​Local symptoms of pelvic bone injuries​
• ​Pelvic bone fractures can result from:​
• The symphysis is strengthened by a ligamentous apparatus; in the middle there is a cartilaginous plate.
• ​Palpation is another important technique to confirm a fracture. It is carried out carefully, but carefully. As a result, it is possible to establish the exact location of the fracture, the asymmetry of the bone protrusions and the displacement (crepitus) of fragments.​

Recovery stages

How long it will take for a pelvic fracture to heal depends not only on the type of injury, but also on the implementation of all the doctor’s recommendations and the patient’s diligence in implementing them. Rehabilitation for fractures is carried out only under the supervision of a specialist.

Standing up on your own, making sudden movements, or exercising is prohibited! The bones may not have fused together at the time of such “amateur activity,” which will lead to complications.

1. Physical therapy is the main method of preventing muscle atrophy (weakness) and stiffness in joints. Recovery begins immediately after stabilization or surgery. The early recovery period should begin with breathing exercises, contracting individual muscle groups and holding them in this position for several minutes. When the bones begin to heal and the doctor allows light warm-up, physical activity must be increased. At first, the exercises are performed in a supine position, and closer to recovery - in a standing position. Rehabilitation after a pelvic fracture is aimed at restoring muscle strength and the full range of active movements.
2. Swimming or simply walking in the water is shown.
3. Massage improves blood circulation in the damaged area, removes stagnation of lymph and venous blood. Lungs massage movements lead to an increase in muscle tone.
4. With food, building material for bone tissue restoration enters the body. It is necessary to eat foods rich in calcium: green vegetables, cabbage, parsley, cottage cheese, cheese, nuts, sea fish, legumes.
5. If nutrition alone is not enough, the doctor prescribes special calcium supplements.
6. Chondroprotectors and collagen are necessary to prevent bone destruction and restore cartilage tissue.
7. Rehabilitation for fractures includes physiotherapeutic procedures. There is a large selection of them, which is determined by the attending physician.
8. Patients are recommended to wear a bandage, corsets, crutches, and walkers for a long time in order to reduce the load on the pelvis.

It is impossible to predict how long rehabilitation will take. It all depends on the efforts made, the body’s internal reserves, and the severity of the damage received. As a rule, healing of pelvic fractures takes from 5-6 months to a year.

The pelvis is a circular structure of the lower part of the spine. Both sides of the pelvis are actually made up of three bones (iliac, ischial and pubic). Strong ligaments attach a small triangular bone called the sacrum to the pelvis. The whole structure is cup-shaped with two cavities called acetabulums, which are the sockets for the hip joints.

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

Pelvic fractures most often occur in adolescents involved in sports and older people suffering from osteoporosis.

There are very frequent cases when, while playing sports, a teenager thinks that he has pulled a muscle, but meanwhile he has suffered a pelvic fracture, like a fissure. Such fractures occur from sudden muscle contraction. Since muscles back surface the hips are very strong (in athletes, especially) their contraction can pull the ischium so much that a crack occurs there or even breaks away from it small piece. Typically, with such fractures, the pelvis remains stable and internal organs are not damaged.

Because many older people have osteoporosis, they may experience pelvic fractures even when they are standing, getting out of the bath, or walking down stairs. As a rule, with such fractures, although one of the pelvic bones is broken, its structural integrity is not compromised.

But most pelvic bone fractures occur in accidents and falls from heights. Depending on the direction and severity, these injuries can be life-threatening and require treatment. surgical intervention.

Symptoms of a pelvic fracture

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

Usually, when a pelvic injury occurs, a person tries to force himself into a forced position in which his hips and knees are bent, and thus reduce pain. If the fracture occurred during an accident, or during a fall from a height, the victims, in addition to problems with the bones of the pelvis, abdomen, etc. In addition, serious bleeding is added, which can cause a state of shock in the victim. Therefore, if a pelvic fracture is suspected, the best thing those around you can do is to stabilize the pelvis and quickly transport the person to the hospital.

Diagnosis of pelvic bone fracture

If a pelvic fracture is suspected, the following must be prescribed:

1. X-ray examination of the victim's pelvis;
2. Computed tomography (to determine the severity of pelvic trauma and other associated injuries blood vessels and nerves, if any).

Treatment

Non-surgical treatment

Stable fractures, such as those that tear off a small piece of the pelvic bone when athletes collide with each other, usually heal without surgery. The victim is asked to use crutches or a walker to reduce the pressure of body weight on the pelvis and legs. Typically, a person will have to walk like this for three months or until the fracture heals. Medications include painkillers and drugs that reduce blood clotting, such as aspirin.

Surgery

Pelvic fractures that occur as a result of car accidents and falls from heights are considered very dangerous, as they can cause extensive internal bleeding, which is why such victims undergo surgery.

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

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

Forecast

Stable pelvic fractures most often heal without problems.

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

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

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

There is a certain classification of fractures.

Pelvic fractures can be divided into several types:

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

Let's look at some of the groups of fractures. Their classification:

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

As we have already said, with a type B fracture, the anterior semi-ring is damaged (fracture of the pubis, ischium, symphysis), and the posterior semi-ring can also be damaged. The consequences of such damage are blockade in the sacroiliac joint.

Main Causes of Injury

Damage to the pelvic bones is quite diverse. But the common point in their development is the application of significant external force. The mechanism of such injury can be direct or indirect:

• A blow to the pelvic area.
• Falling onto a hard surface.
• Compression of the pelvis in the longitudinal or lateral plane.
• Jumping to your feet from a height.
• Sudden muscle contraction.

​In case of fractures, it is the diet that helps to enrich the patient’s body with useful substances.​

Causes of pelvic fracture

​Doctors apply compression to damaged pelvic bones.​

The main types of fracture are:

• ​In the photo there is a fracture of the pubic pelvic bone
• ​A pelvic fracture can lead to serious consequences, including lifelong disability.​

​If a patient has a fracture of the pelvic bones, first aid is necessary from the first moments after the injury. First aid for a pelvic fracture consists of relieving the shock symptom and reducing pain by administering analgesics and fixing the body in a special gentle position. If there are open wounds, they need to be treated, and pressure bandages should be applied to the vessels that are bleeding. In principle, all these measures should be taken by ambulance specialists. Until the doctors arrive, you can only provide peace to the victim, since pain relief requires professional intervention. The patient is transported on his back on a stretcher, placing a bolster under his knees. You need to be especially careful if the patient has a displaced pelvic fracture, since broken bones can cause additional damage and unbearable pain. It is very difficult to immediately diagnose a pelvic fracture, because the victim is in a very serious condition and cannot immediately determine what it still has damage. A slight fracture of the pelvic bone often does not require surgical intervention, so treatment is carried out in a conservative style. During the entire period, the victim walks in a special device that fixes the leg in one position.

​At the end, I would like to show you a video about how the pelvic bones are aligned during a fracture and how the rehabilitation then proceeds. Enjoy watching

A pelvic fracture is a fairly common and dangerous injury, because there are quite a few important organs in the pelvic area. As a rule, a fracture of the pelvic bones occurs most often in professional athletes; the injury occurs during a strong and sudden muscle contraction. Fractures also often occur in older people who suffer from osteoporosis. In them, a fracture can occur even with a minor injury, which a young and healthy man I might not even notice.​

First aid and treatment for pelvic fracture

A person’s ability to work returns after 3–5 months. Much depends on the age of the patient, the severity of the injury and the number of fractures.​

​: fermented milk products;​

​Bones can develop and become stronger thanks to minerals such as magnesium, phosphorus, potassium and manganese.​

​For this, a fixative is used, which reduces bleeding and does not interfere with the operation (if necessary).​

​When strong impact or compression can seriously damage all the pelvic bones.​

​Injury is accompanied by loss of blood, damage to internal organs and severe pain, traumatic shock, and sometimes leads to death.​

Rehabilitation procedures

​Pelvic bone fracture treatment can be divided into three main stages: adequate pain relief, after which possible blood loss is compensated and the fracture is immobilized.​

This is why transport immobilization is necessary, which will help prevent additional displacement of fragments. A person with such a diagnosis should be immediately hospitalized.​

Classification

Given the complexity of the structure of the pelvic region and the variety of mechanisms of injury, bone fractures are different. Their classification is based on the location and nature of the damage, and the involvement of nearby organs in the process. Thus, among pelvic fractures there are several clinical groups:

• 1 – Marginal injuries (iliac wings, ischial tuberosities, coccyx).
• 2 – Without breaking the continuity of the bone ring (one branch of the ischium or pubis).
• 3 – With a violation of the continuity of the ring (in the anterior, posterior or both sections).
• 4 – Fractures of the acetabulum (roof, floor or central dislocation).
• 5 – Fractures with damage to internal organs.

Half of all pelvic injuries are group 3 fractures that violate the integrity of the bone ring. In its anterior section, both pubic and sciatic branches can be injured, and divergence of the pubic symphysis also occurs.

Injuries to the posterior section are characterized by fractures of the sacrum or ruptures of its articulations with the iliac bones. And the most severe in this group are considered to be fractures of the anterior and posterior semi-rings: unilateral, bilateral, diagonal.

The classification also takes into account other characteristics: the presence of displacement of bone fragments, damage to blood vessels, nerves, skin (open and closed fractures). This becomes the basis for a full clinical diagnosis.

Clinical classification fractures of the pelvic region takes into account the type and location of damage to bone structures, as well as injury to internal organs.

1. Fractures with dislocation;
2. Fractures of joints in which the structure of bones and ligaments is not affected. This is called a stable pelvis. Stability is determined by the inviolability of the pelvic diaphragm and the ability to withstand standard physical activity no offsets;
3. Fractures in which there is incomplete separation of the pelvic half-ring from behind. This situation is called partially stable;
4. This type of fracture involves a complete disruption of the posterior semiring with disruption of the integrity of its bone and ligamentous elements. This is an unstable position with complete deprivation of the integrity of the bones and ligaments;
5. Depending on the behavior of the fragments:
   • With displacement of fragments;
   • No displacement of fragments.

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

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

​Complications after injury:​

​: nuts, cheese, sturgeon caviar.​

​These useful material will help to absorb protein and calcium, the building blocks from which new bone tissue will be built.​

​Immobilization of a fracture is carried out so that bone fragments do not move and do not injure organs, muscles, nerves and blood vessels.​

​As a rule, the urethra is torn away from prostate gland and blood is released from the urinary organs. Bladder injury is indicated by the presence of blood in the urine and difficulty urinating.​

​Since injury can occur due to sudden muscle contraction. Older people and those suffering from osteoporosis are also at risk.​

​2. If a patient has an isolated pelvic fracture, he is given a split blood transfusion within two or three days after the incident. When severe pelvic injury is noted, in combination with severe shock, a large volume of blood is transfused to the patient to compensate for blood loss during the first hours after the injury.​

Signs and symptoms

A fracture of the pubic bone of the pelvis manifests itself in the following signs and symptoms:

• Severe pain syndrome. The pain becomes stronger when trying to move the damaged area;
• Swelling at the site of injury;
• Symptom of “Stuck heel”: when lying down, the patient is unable to lift his leg from the surface on which he lies;
• In a passive lying position, affected people experience an outward turn of the legs while simultaneously spreading the legs (toad position - Volkovich);
• Larrey's symptom: pain increases when trying to spread the legs;
• The ability to feel the cracking of fragments and bones during palpation;
• In some cases, hemorrhage at the fracture sites is obvious;
• Sometimes a “pseudo-abdominal syndrome” is present, caused by the presence of a retroperitoneal hematoma;
• Any touch to the damaged area causes unbearable pain.
• Gabai's positive symptom: while turning onto the stomach, or from the stomach to the back, the patient supports the injured leg with a healthy one.
• Manifestation of dysuric disorders: blockage of the wall of the urinary sac, or hemorrhage.
• General signs worsened condition: increased temperature; increased sweating; in severe pain syndromes - signs of impaired consciousness; Falling blood pressure and increased heart rate; Rapid breathing.

Symptoms

First, you should consider the symptoms inherent in the fractures themselves, and then move on to the consequences of pelvic trauma. The least difficult to diagnose are injuries without displacement of bone structures, those included in the first 3 groups according to the classification.

Such patients are bothered by pain in the pelvic area, which often becomes an obstacle to independent movement.

Upon examination, signs of mechanical injury are visible: abrasions, bruises, swelling, hematoma. Palpation at the site of injury is painful, and with comminuted fractures, crepitus of bone fragments can be heard.

The deformation of the pelvis is clearly visible, which is determined by measuring the distances between the anatomical structures: the xiphoid process (symphysis pubis) and the iliac spines.

Characteristic signs of individual pelvic fractures are:

• “Frog Pose” (Volkovich) – lying on your back with your legs spread to the sides and your knees bent.
• A symptom of backward or lateral walking - it is easier for the patient to walk backwards.
• A symptom of a “stuck heel” is the inability to lift your straight leg off the bed.
• A positive symptom of axial loading is pain at the fracture site when the pelvis is compressed.

In patients with group 3 fractures, the symptoms of damage become much more pronounced due to the displacement of bone structures. The deformation is more pronounced and visible to the naked eye.

Due to the upward dislocation of one half, shortening of the limb of the same name is noted. With ruptures of the symphysis pubis, a defect is palpated in this area - an increased distance between the bones.

But in addition to the violation of the integrity of the pelvic ring, in such cases there are signs of traumatic shock and internal bleeding, which may represent real threat for life.

Acetabular fractures are characterized by pain in the hip joint and limited mobility in it. Shortening of the limb compared to the uninjured side is revealed. Pain increases with axial loading and tapping on the greater trochanter of the femur.

The clinical picture of injuries to the pelvic region, taking into account their type, consists of the symptoms of the fracture itself and signs characteristic of damage to internal organs, vascular and nervous structures.

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

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

Local symptoms

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

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

In some cases, the fragments are mobile and when palpated, you can hear them crunching - crepitus.

Pelvic ring injury

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

If the injury is accompanied by a violation of the integrity of the anterior pelvic semi-ring, then when the legs move or when the pelvis is compressed in the anteroposterior or lateral direction, the pain intensifies.

In case of fractures near the symphysis, the victim is forced to move his bent legs, and an attempt to separate them provokes severe pain. In case of fractures of the upper branch of the pubis or ischium, the victim takes the “frog” pose - lies on his back and spreads his bent legs to the sides.

And with fractures of the posterior half-ring, the patient lies on the side opposite to the injury and his leg movements on the side of the fracture are sharply difficult.

Pubic bone injury

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

Trauma to internal organs and the formation of a hematoma in the anterior abdominal wall causes the appearance of symptoms " acute abdomen».

Anterior superior spine injury

With such fractures, the fragments move downward and outward. In this case, the displacement causes the leg to shorten.

The victim tries to walk backwards - in this position the pain syndrome becomes less intense, because the leg moves not forward, but backward.

This symptom is called the “Lozinsky symptom.”

Injury to the sacrum and coccyx

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

Trauma to the ilium and superior acetabulum

With such fractures, the pain is localized in the area of ​​the iliac wing. The victim's hip joint functions are impaired.

Malgenya fracture

Experts identify the following signs of a bone fracture in the pelvic area:

• Are common. Damage to the pelvic bone is accompanied by tachycardia, pallor of the skin, and arterial hypotension.
• Local. They are expressed by intense sharp pain, swelling, hematoma and deformation of the pelvic bones. A distinct crunching sound may be present upon palpation.

Diagnostics

Despite the rather characteristic clinical signs, a pelvic fracture can only be confirmed by instrumental means. The diagnostic program for such injuries should include:

• X-ray.
• Computed tomography.
• Magnetic resonance imaging.

However, it is not always possible to conduct a full examination due to the patient’s serious condition and the need for urgent intensive care.

Then the diagnosis is established only on the basis of the clinical picture of the fracture. If there is a suspicion of damage to internal organs, then the diagnostic program is expanded - ultrasound and retrograde urography are performed.

Diagnosis of injuries to the pelvic area consists of clinical and additional methods that confirm the doctor’s assumption.

An X-ray examination can confirm the diagnosis of a fracture.

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

If symptoms of an “acute abdomen” are detected, laparoscopy, laparocentesis or diagnostic laparotomy may be performed. If there is a suspicion of injury to the urinary organs, then ultrasound of the bladder and urethrography are performed.

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

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

In severe cases, consultation with a urologist, resuscitator, proctologist or gynecologist is necessary. The patient's condition is always serious, so hospitalization cannot be avoided.

The examination includes palpation of the pelvic bones and radiography. X-rays can detect cracks and displacements of bone fragments.

If internal bleeding is suspected, laparoscopy is prescribed.

Diagnosis of suspected pelvic fracture includes palpation and radiography.

Treatment

Treatment measures for pelvic bone fractures are based on the nature of the injury and the clinical picture of the injury. Each case must be considered individually, since there are various nuances in approaches to treatment for this category of patients.

But there are also general principles of treatment at various stages.

Prehospital care

Immediately after an injury, the victim must be given first aid. The patient's condition may be severe due to internal bleeding or shock. Therefore, transportation to a medical facility should be carried out after or against the background of primary measures:

• Immobilization of the pelvis using splints or special suits.
• Position the patient lying on a rigid board.
• Maximum restriction of movement.
• Infusion of blood substitutes and painkillers.

This will avoid the risk of complications and minimize the extent of damage. Further assistance will be provided at the hospital stage by qualified personnel.

Medicines

Given the severity of the injury, it is necessary to begin treatment in a hospital with intensive drug therapy. And only after the patient has been brought out of shock, blood loss has been compensated and pain has been eliminated, one can move on to the next stage. It is recommended to administer the following drugs:

• Saline solutions(Trisol).
• Blood substitutes (Gelofusin, Refortan).
• Analgesics (Omnopon, Ketanov).

Intrapelvic blockades with local anesthetic Novocaine are widely used. This is a very effective way to prevent and eliminate shock in case of damage to the pelvis and surrounding organs.

Drug therapy should begin as early as possible. The list of drugs used and dosage are determined by the doctor.

Reposition

For displaced fractures, it is necessary to achieve early and effective reduction of the pelvic bones. The methods used for this purpose depend on the type of fracture. But each of them involves immobilizing the patient in a certain position for a period of 3 weeks to 2 months until the bone defect heals. The most common methods are:

• Lying position on a backboard.
• Rollers under the knees and lower back.
• Orthopedic pillows.
• Belair tires.
• Hanging in a hammock.
• Skeletal traction.
• Special belts, bandages.

If the effect of conservative reposition is not observed within several days, then you need to move on to surgical methods of restoring the integrity of the pelvic bones, since after 1.5–2 weeks even surgery will become impossible.

This is done using manual alignment or osteosynthesis with metal plates.

In hospital treatment, patients with fractures of the pubic bones are placed on a backboard, and their legs are placed on Beler splints so that those muscles that are attached to the damaged area relax. Preliminarily carried out local anesthesia novocaine solution. Duration of bed rest - 16-21 days.

During this time, the patient is given treatment and physical training complexes and massages. Lines of incapacity for work up to 45 days.

For pelvic fractures with displaced fragments along with anti-shock therapy, the patient is placed in the Volkovich position with cuffs on both legs. In case of pelvic fractures with ruptures of the pubic symphysis, a pelvic support belt should be made and only in it should the patient be placed on his feet.

After the victim is admitted to the hospital, the first step is anti-shock therapy, which consists of relieving pain, replacing lost blood and immobilizing the fracture area.

Pain relief

For pain relief, narcotic analgesics (morphine hydrochloride, promedol, etc.) can be used and novocaine blockades can be performed.

The administration of a local anesthetic can cause a decrease in blood pressure, so in such situations it can be administered only after blood loss has been compensated.

In cases of Malgen's fractures, the victim is placed under therapeutic anesthesia.

Replenishment of lost blood

In case of massive blood loss, severe shock and associated injuries, replacement of lost blood is performed in the first hours. To do this, large volumes of blood are transfused to the victim.

In case of isolated fractures of the pelvic bones, fractional blood transfusions are performed over 2-3 days to compensate for blood loss. Intravenous infusions are supplemented by the introduction of glucose solutions, blood substitutes and blood plasma.

Immobilization

The duration and type of immobilization for pelvic fractures is determined by the location of the injury and the integrity of the pelvic ring. In case of an isolated or marginal fracture, the victim is fixed in a hammock or on a backboard.

In more rare cases, knee and popliteal rollers and Beller splints are used for immobilization. If the integrity of the pelvic ring is compromised, skeletal traction is performed.

Conservative therapy

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

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

After the bones have fused, an individual rehabilitation program is drawn up for the patient, including physical therapy, massage and physiotherapy.

Surgery

Surgery for pelvic bone fractures is recommended in the following cases:

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

To compare bone fragments, osteosynthesis is performed using knitting needles, screws and metal plates. Typically, an external fixator is used to secure such devices.

Such interventions are performed under general anesthesia. During the operation, the surgeon always conducts a thorough inspection of the internal organs, nerves and blood vessels and, if necessary, eliminates the identified damage.

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

​3. Treatment of a pelvic fracture also involves immobilization, the duration and type of which will directly depend on the location of the injury and the presence of a violation of the integrity of the pelvic ring. For marginal and isolated fractures, fixation is performed in a hammock or on a shield, using rollers in the popliteal region and Beler splints. When a violation of the integrity of the pelvic ring is diagnosed, it is recommended to use skeletal traction technology.​

Pelvic fracture

All pelvic fractures are classified into three main groups:

During treatment, regardless of whether it is conservative or surgical, bed rest is required for at least a month. In this case, the damaged limb must be placed on special splints intended for this purpose.​​Name *​

​poor mobility of the hip joints;​​Rehabilitation after a pelvic fracture includes the following processes:​​magnesium​​When the pubic bone is fractured, internal organs (urethra, rectum, vagina) suffer and it is important for doctors to restore their functionality.​

​Since pelvic injuries are very dangerous, if a fracture occurs, the victim must be urgently taken to the hospital.​​Quite often, fractures occur in accidents: road accidents or a fall from a height.​​Damage to internal organs, as well as severe displacements, force the use of surgical intervention . The longest and most important period is rehabilitation after a pelvic fracture. To provide the pelvic bones with sufficient flow nutrients For normal recovery, the patient is prescribed medications containing collagen protein. Additionally, it is recommended to use ointments and special gels.​​B. Rotational unstable or partially stable C. Unstable fractures, which involve complete rupture of the sacroiliac joint, as well as rotational and vertical instability.​

First aid for a pelvic fracture

The duration of the treatment itself and the recovery period will depend on many factors, such as the severity of the injury, the degree of shock, the condition of the victim and, of course, the timeliness of seeking help from a medical facility.

On average, the course of treatment lasts 3-4 months, but if complications are possible, it will be increased. ​

Pelvic fracture treatment

​As a rule, it occurs due to strong compression of the pelvis or a direct and very strong blow. In such cases, bone displacement rarely occurs; the condition of the victim primarily depends on the severity and location of the damage.​

​change in the shape of the acetabulum and pelvic ring;​

​physiotherapy;​

​: nuts, bananas, leafy vegetables, wholemeal bread, herring, shrimp, sea bass, flounder;​

​If the victim has a rupture of the symphysis pubis, then urgent surgical intervention is necessary.​

To treat a pelvic fracture, two main methods are used - traction and osteosynthesis. It is not recommended to carry the victim yourself after an injury. It is necessary to use a rigid stretcher to prevent the formation of displacements.

Treatment of pelvic bone fractures includes measures such as anesthesia and immobilization of the bone structure. The doctor prescribes a procedure to replace blood volume.

With single injuries, you can lose up to 1 liter of blood. Mortality is 6% of cases.

Correction is carried out using saline solution. If we are talking about severe fractures of the pelvic bone with displacement of fragments, then the loss of a large amount of blood (up to 3 liters) is possible.

At the same time, the mortality rate is quite high.

First aid

First aid for prehospital treatment is represented by the following steps:

If you suspect a pearl of the pelvic bones, the following measures must be taken:

1. Take the victim to a safe place.
2. Call an ambulance.
3. To combat traumatic shock, give the patient to take painkillers: Analgin with Diphenhydramine, Ketorol, Ibufen, etc. It is better to wash down the tablets with strong, warm sweet tea or coffee. If possible, an intramuscular injection of an analgesic can be given. Sedatives can supplement the effect of painkillers and calm the victim: valerian tincture, Valocordin, Corvalol, etc.
4. If there are open wounds, treat them with an antiseptic solution and cover with a sterile bandage, securing it with an adhesive plaster.
5. Place the patient in the frog position on a flat, hard surface (a wooden panel or a removed door), covered with a not very soft mattress. Subsequently, it can be transported to a medical facility on the same surface. Place a 60 cm high cushion made from improvised materials or a pillow under your bent knees. Raise your head. Cover the victim.
6. Explain to the patient that he cannot move his legs.

Correctly provided first aid for fractures of the pelvic bones greatly reduces the risk of complications and deaths. The patient must be transported as gently as possible, because It is impossible to perform sufficient immobilization for such injuries outside of a medical facility.

Since pelvic injuries are very dangerous, if a fracture occurs, the victim must be urgently taken to the hospital.

The patient should be transported lying on his back, with a bolster placed under his knees.

If necessary, give the victim pain relief.

​As a rule, athletes are susceptible to fractures of the pelvis, including the pubic bone.​

​1. Anesthesia of the fracture site is performed using intraosseous or intrapelvic anesthesia. The drug novocaine has a hypotensive effect on the body; therefore, in case of painful shock, it is administered after compensation of the volume of circulating blood. In case of a Malgenya fracture, the victim is given therapeutic anesthesia.​

A pelvic fracture is the most severe injury of the musculoskeletal system. A fracture of the pelvic bones threatens not only to make a person disabled, but also to deprive him of his life if he is not helped in time.

First aid for a pelvic fracture should be provided as quickly as possible, you will learn about it in this article. A pelvic fracture requires professional treatment, so do not try to treat it yourself, as the consequences can be life-threatening.

Rehabilitation after a pelvic fracture is also important, which can be done independently. ​

When traumatic shock develops, a blood transfusion is used, as well as a procedure for complete immobilization of the injured bone. In the case of a closed and marginal fracture, fixation is often performed on a backboard or in a hammock.

Immobilization can also be performed using Beler splints or rollers in the popliteal area. If the injury leads to consequences in the form of cracks or fractures of the pelvic ring, skeletal traction is mandatory.

​​We wish you good luck and don’t get sick. ​​fracture without displacement;​.

First aid for a pelvic fracture should:

• Take measures to stop bleeding and, if necessary, replace blood loss.
• Pain relief with intramuscular analgesics.
• Perform immobilization for a fracture in the pelvic area.

The damaged part of the body is fixed with a blanket, which should be rolled up and placed under the knees. The upper body needs to be raised. Please note that this measure will improve your overall well-being by reducing pain.

Traditional medicine to help

There are several simple methods that help the patient recover after a serious injury:

Consequences of fractures

If the patient was provided with timely and competent first aid, if he was brought to the hospital on time and treatment measures began, then the consequences can be forgotten, and the prognosis, according to doctors, is favorable.

The degree of consequences depends on the severity of the initial condition of the patient with a fracture of the pubic bone.

Due to their high strength and structural features, fractures of the pelvic bones occur under strong impacts:

• car accidents;
• collisions with pedestrians;
• falling from a great height;
• compression of the pelvis during building collapses;
• due to strong muscle contraction during sports.

This most often happens in active middle-aged people. But old people are also susceptible to fractures in this area. With osteoporosis, their bones are so fragile that the pelvis can be damaged even if it falls on the buttocks.

Pelvic fractures occur when falling from a height

1. Industrial injury (compression of the pelvis in the sagittal as well as in the frontal direction);
2. Car crashes;
3. Compression of the pelvis by transport wheels;
4. During landslides;
5. Damage to the symphysis pubis during childbirth;
6. When falling from a height;
7. In children, fractures of the pelvic bones can occur when sledding, rollerblading or skating.

The most common cause of hip fracture is car accident, in a collision with a car bumper.

In the elderly, a common cause of fractures is a fall, especially in icy winter conditions.

When falling from a height, a combined fracture of the femur and pelvis in the joint area usually occurs.

Types of pelvic fracture

Depending on the severity, such injuries can be open or closed, single or multiple. When several bones are broken, the victim loses a lot of blood - up to three liters. Damage to internal organs or nerve roots causes severe shock and is often fatal.

One of the most common injuries is rupture of the symphysis pubis

Most often, a classification is used for pelvic fractures based on the location and nature of the injury.

1. Injuries to individual bones are usually easy to treat and rarely cause complications. They are usually stable and do not cause damage to internal organs or excessive bleeding. These include the common fracture of the pubic bone, marginal fractures of the ilium or ischium.
2. When the pelvic ring is broken during a fracture, such fractures are considered unstable and dangerous. Depending on the direction in which the force is applied, the debris may move horizontally or vertically. Such injuries are accompanied by large bleeding and damage to internal organs.
3. Fracture-dislocations belong to a separate group. If the acetabulum is damaged, it usually affects the hip joint. Dislocation of the pubic or sacral joint may also occur.

1. Isolated fractures of the pelvic bones;
2. Fractures in the area of ​​the pelvic ring without breaking its continuity;
3. Fractures in the area of ​​the pelvic ring with disruption of its continuity;
4. Double vertical fracture of the pelvic bones (Malgenya fracture);
5. Fracture in the acetabulum;
6. Fractures of the pelvic bones, which are combined with injuries to the internal (pelvic) organs.

Signs of a pelvic fracture

When bones are damaged in the pelvic area, the main symptoms of all injuries are observed: pain, swelling, hematoma, bone deformation, and limited mobility. In case of severe injury, shock is possible, which is manifested by pallor, rapid heartbeat, decreased blood pressure, or loss of consciousness.

Depending on the location of the lesion, specific symptoms are also observed.

• Damage to the pubic bone can be suspected by the symptom of a “stuck heel,” when the victim cannot lift his leg. Pain also appears when spreading the legs, so the patient keeps them compressed.
• With vertical fractures, shortening of the limb is observed.
• Often, bilateral fractures lead to the victim being forced into a “frog” position.
• With injuries in the area of ​​the coccyx and sacrum, damage to the nerve roots often occurs. This may cause urinary incontinence, defecation retention and other neurological disorders.

Damage diagnostics

The diagnosis of the victim is made on the basis of an external examination, anamnesis of the circumstances of the injury and palpation. When pressing, the pain intensifies, and bone mobility and crepitus may occur.

But with severe injuries, pressing on the fracture site can be dangerous, so other diagnostic methods are used.

• Most often done X-ray pelvis in front. If there is a suspicion of a fracture of the coccyx, then also from the side. Lateral photographs also make it possible to determine whether there has been any displacement of the fragments.
• For a more detailed examination of the injury site, a computed tomography is performed.
• Angiography or MRI is prescribed as additional examination methods.
• Sometimes it is necessary to do an ultrasound of internal organs, laparoscopy, urethrography and rectal examination. This is very important for determining the condition of internal organs.

Effective treatments

In most cases, victims are taken to hospital in serious condition. Therefore, first they undergo anti-shock therapy, the administration of painkillers and compensation for blood loss.

To do this, morphine, plasma, and saline are administered intravenously. Further treatment depends on the nature and complexity of the injury.

This may be simple immobilization, surgical traction, or surgery.

Immobilization

This treatment is carried out if the injury is uncomplicated and there is no displacement of fragments. Most often, the patient is on a hard bed in the “frog” position using popliteal bolsters.

Belair tires or a special hammock can be used. Healing of even simple fractures in the pelvic area takes at least 3-4 months.

In some cases, a special hammock is used to immobilize a fractured pelvic bone.

Surgical traction

It is necessary if an x-ray examination reveals displacement of bone fragments. Most often, this occurs by passing a special needle through the bone and fixing it on a device with a suspended load.

Operation

It is necessary in case of a fracture, if internal organs are damaged, or in cases where ordinary traction cannot put bone fragments in place. Osteosynthesis is performed using screws, wires and special plates.

Taking medications

The most commonly prescribed medications are painkillers and blood thinners. Indeed, with prolonged immobility, venous stagnation is possible.

If soft tissue is damaged, antibiotics are needed to prevent infection from developing. Preparations containing collagen, chondroitin and glucosamine are also prescribed.

They strengthen bone tissue and contribute to its restoration.

Such injuries should be treated only in specialized hospitals. All femur fractures are treated by surgical comparison of the fragments.

Treatment of a fracture in old age is most difficult to tolerate, but it is not possible to properly heal the bone using a conservative method. Fractures of the femoral neck in older people require metal osteosynthesis - a metal rod is placed into the bone at the fracture site to connect the fragments.

In case of fractures of the diaphysis, the fragments are connected by the bone method - metal plates are applied to the surface of the bone, secured with bolts. With this method, bone fusion occurs faster, but a certain period of immobilization is still required.

In addition to surgery, patients require medication support. Drugs are prescribed to improve microcirculation in the area of ​​the fracture - chimes, pentoxifylline.

Painkillers and anti-inflammatory drugs are needed. Calcium supplements are prescribed for long-term use.

​ and...​ people Fracture of the​ neck of large human joints​ 10 kg, in​ and diaphysis of the bone,​ or an accidental blow.​ expressed: in a person​ traction, external fixation​ increases a person’s mobility.​ not every patient​ movements, walking increases .Sometimes, in order for fractures of the femoral neck, treatment requires limited movement and medications. Also on

First aid

1. Stop bleeding;
2. Treatment of traumatic shock;
3. Pain relief (narcotic and non-narcotic analgesics, ketorol);
4. Transport immobilization;
5. Transporting the victim to the hospital.

The scope of primary care for the victim depends on the severity of the condition and type of injury.

The doctor who arrived at the scene of the accident should assess:

1. The patient's level of consciousness;
2. Frequency and rhythm of the patient’s respiratory movements;
3. The presence of foreign bodies in the mouth or throat;
4. Measure blood pressure and heart rate;
5. Presence of open injuries and damage;
6. Color of the skin and mucous membranes;
7. Pulsation in peripheral vessels;
8. The presence of subcutaneous emphysema;
9. Presence of signs of external or internal bleeding;
10. Determination of bone fractures;
11. Presence of soft tissue damage.

The doctor should place the victim on a flat and hard surface. Transport in the “frog position”. To maintain this position, a cushion of clothing is placed under the victim’s knees.

A femur fracture is a serious injury that can even be fatal. Therefore, medical assistance should be provided at the scene of the incident.

If there is visible bleeding from damaged large vessels, it is necessary to apply a hemostatic tourniquet. It should be remembered that the tourniquet cannot be applied for more than two hours to prevent tissue necrosis.

During transportation, painkillers are administered and, if necessary, infusion therapy is performed to restore the volume of lost blood.

Femur fracture

Consequences of a fracture

Despite modern, more effective methods of providing medical care, about 15% of victims remain disabled for life. This happens due to multiple fractures, damage to internal organs, or improper bone healing.

After severe injuries, the victim suffers from pain for several years, and his posture and gait may be affected. People will not return to normal life soon, and professional athletes have to say goodbye to sports.

megan92 2 weeks ago

Tell me, how does anyone deal with joint pain? My knees hurt terribly ((I take painkillers, but I understand that I’m fighting the effect, not the cause... They don’t help at all!

Daria 2 weeks ago

I struggled with my painful joints for several years until I read this article by some Chinese doctor. And I forgot about “incurable” joints a long time ago. That's how things are

megan92 13 days ago

Daria 12 days ago

megan92, that’s what I wrote in my first comment) Well, I’ll duplicate it, it’s not difficult for me, catch it - link to professor's article.

Sonya 10 days ago

Isn't this a scam? Why do they sell on the Internet?

Yulek26 10 days ago

Sonya, what country do you live in?.. They sell it on the Internet because stores and pharmacies charge a brutal markup. In addition, payment is only after receipt, that is, they first looked, checked and only then paid. And now everything is sold on the Internet - from clothes to TVs, furniture and cars

Editor's response 10 days ago

Sonya, hello. This drug for the treatment of joints is indeed not sold through the pharmacy chain in order to avoid inflated prices. Currently you can only order from Official website. Be healthy!

Pelvic bones are a violation of the integrity of the bone structures that make up the pelvic ring. They refer to severe skeletal injuries and, in general, to severe injuries human body. The reason for this is severe blood loss and development, which, in turn, develops due to pain and blood loss.

Local signs of this pathology, in addition to pain, are deformation (curvature) of the pelvis, shortening of the lower limb, which is visible without measurement, and impaired leg movements. If a fracture of the sacrum is observed, then nerve branches may be damaged, which leads to urinary incontinence.

Treatment of the pathology is complex, rehabilitation can be lengthy, especially in cases of trauma to the nervous structures and pelvic organs.

Table of contents:

Total information

Fractures of the pelvic bones account for about 4-7% of total number all diagnosed fractures. the main problem Such injuries lie in the fact that they are often accompanied by trauma to internal organs - because of this, the victim’s condition becomes even more severe, and in some cases there is a danger to life.

The pelvis is a collection of bone structures connected by different joints that are located at the base of the spinal column. The bones “build” a figure similar to a ring, which is why the pelvis is defined in the clinical literature as a pelvic ring. It acts as a kind of support for the skeleton, serves as protection for the internal organs that are located in the lower abdomen, and is also a connecting link between the bone structures of the lower extremities and torso.

The pelvic ring includes three pairs of pelvic bones (pubic, iliac and ischial), as well as the sacrum, which forms the back of the pelvic ring. The pelvic bones are separated by bony sutures, which are thin, but nevertheless ensure the solidity of the pelvic ring. The pelvic bones are motionless one in relation to the other.

The following joints are distinguished in the pelvic ring:

• pubic symphysis - it is formed by articulating with each other, the pubic bones;
• sacroiliac joints - through them the iliac bones are attached to the sacrum.

The pelvic ring has another important relationship - namely with the acetabulum, which forms the basis of the hip joint and in the formation of which all three pelvic bones take part.

Causes and development of pathology

A fracture of the pelvic bones occurs when they are exposed to a traumatic force. The mechanisms of influence in this case can be completely different, but, as a rule, pelvic bone fractures occur under such circumstances as:

• falling from height;
• compression during car accidents;
• building collapses during natural or man-made disasters;
• industrial accidents (for example, in a mine);
• hitting a pedestrian.

There are many types of pelvic bone fractures - among the determining factors are the direction of injury (lateral, anteroposterior) and the degree of compression.

There are four groups of this type of injury - these are fractures:

• stable;
• unstable;
• fractures of the floor or edges of the acetabulum;
• fractures and dislocations of the pelvic bones.

Stable pelvic fractures are considered to be those in which the integrity of the pelvic ring is preserved. Such fractures, in turn, can be:

• isolated;
• marginal.

With unstable fractures of the pelvic bones, the integrity of the pelvic ring is compromised. Among such fractures, in turn, depending on the mechanism of injury, fractures are distinguished:

• vertically unstable;
• rotationally unstable.

With vertically unstable types of fractures, the integrity of the pelvic ring often suffers in two places at once - namely in the posterior and anterior sections. The resulting bone fragments are displaced in the vertical plane.

If rotationally unstable fractures with displacement occur, then such displacement of the resulting bone fragments occurs in the horizontal plane.

Fractures of the floor or edges of the acetabulum in some cases may be accompanied by hip dislocation.

Fracture-dislocations of the pelvic bones are considered to be those in which, simultaneously with a fracture of the bones of the pelvic ring, a dislocation occurs in the pubic or sacroiliac joint (or both at once).

With traumatic injury to the pelvic bones, blood loss is always observed. If marginal and isolated fractures occur, it is relatively small - 200-500 ml. Unstable vertical fractures are more dangerous in terms of bleeding and blood loss - with them, victims can lose 3 or more liters of blood. Such massive blood loss is caused by the fact that when the pelvic bones are traumatized, the integrity of the walls of large vessels is disrupted.

In addition to damage to blood vessels, severe fractures of the pelvic bones are often accompanied by damage to:

• urethra and bladder - more often;
• rectum and vagina - less often.

In some cases, combined damage to several organs is observed, which leads to a more severe condition of patients. This is often observed if, due to severe trauma, sharp fragments of the pelvic bones are formed that injure these organs.

When the contents of injured internal organs enter the pelvic cavity, pelvioperitonitis (pelvic) occurs - an inflammatory lesion of the peritoneal layers that line the pelvic cavity from the inside and cover the organs located in it. Pelvic peritonitis with fractures of the pelvic bones can be:

• aseptic – in case a bone fragment of any pelvic bone was injured bladder, and its uninfected contents spilled onto the sheets of the pelvic peritoneum;
• septic (infectious) - develops if the contents of a wounded rectum or a loop of the large/small intestine, which at that time had descended into the pelvic cavity, got onto the peritoneum.

Based on what has been described, in case of fractures of the pelvic bones, you need to be prepared for the fact that you will need the help of not only a traumatologist, but also a surgeon.

Often when individual fractures nerve structures of the pelvic ring are affected:

• roots;
• trunks of the lumbar plexus.

In this case they can be:

• squeezed;
• injured (up to complete destruction of their integrity).

This development of clinical events is accompanied by neurological disorders - sometimes quite serious, after which the victim becomes a patient of a neurologist for a long time.

Symptoms

Symptoms of pelvic bone fractures include:

• local;
• general.

Common local signs The pathologies described are:

• deformation in the pelvic area;
• pain;
• swelling of the soft tissues in the area of ​​the fracture;
• hematoma;
• crepitus.

Characteristics of pain:

• by location - in the area of ​​the fracture;
• by distribution - since the pain is often severe, the patient feels that “everything hurts”, but this is not irradiation of pain in the classical sense;
• by nature - harsh;
• in terms of intensity – strong, often unbearable;
• by occurrence - they arise at the time of injury and do not subside until relieved with potent analgesics.

note

Crepitus is a light crunching sound, sometimes not heard by the ear, but felt by the tips of the palpating fingers, which occurs due to the displacement and friction of bone fragments against each other.

If the anterosuperior iliac spine is torn off, then the following can be noted:

• shortening of the limb, which is determined visually, without measurements - it occurs due to the fact that bone fragments are displaced outward and downward;
• symptom of Lozinsky's reverse movement - it consists in the fact that when moving the lower limb on the affected side, the victim feels less pain, so he tries to move backwards.

For fractures of the ilium and upper sections acetabulum clinical picture next:

• decreased range of motion in the hip joint;
• pain in the area of ​​the iliac wing.

With fractures of the coccyx and sacrum, the following symptoms are observed:

• pain that intensifies when pressing on the lower part of the sacrum;
• difficulty in emptying stool;
• if the sacral nerves are damaged, there is a loss of sensitivity in the buttocks, and in some cases urinary incontinence is observed.

If a fracture of the pelvic ring occurs without violating its integrity, then the clinic is presented with a pain syndrome. Features of pain:

• with a fracture of the ischial bones, pain appears in the perineal area, with a fracture of the pubic bones - in the pubic region;
• increase when performing leg movements, as well as palpating and squeezing the pelvis in the lateral direction.

In case of fractures with a violation of the integrity of the anterior pelvic semi-ring, the following is characteristic:

• pain appears in the perineum and pelvis;
• the pain syndrome intensifies with lateral and anteroposterior compression of the pelvis, as well as when trying to move the legs.

note

In case of fractures of the ischial and superior branches of the pubic bone, the victim is in the frog position - lying on his back, legs bent and spread apart.

If fractures are observed near the symphysis or its rupture occurs, the victim slightly bends his legs to alleviate the condition, while bringing them together. Spreading the legs causes a sharp feeling of pain.

For fractures of the posterior half-ring, the symptoms are as follows:

• the victim lies on his healthy side;
• when moving the leg on the affected side, pain occurs, such movements are limited.

When the integrity of the posterior and anterior semi-rings is simultaneously violated (such damage is called a Malgenya fracture), the symptoms are as follows:

• pelvic asymmetry;
• pathological mobility with lateral compression;
• the formation of bruises in the perineum, and in men - in the scrotum area.

Symptoms of acetabular fractures are as follows:

• pain syndrome, which intensifies with tapping on the thigh and axial load (trying to lean on the leg on the affected side);
• dysfunction of the hip joint.

If a hip dislocation occurs simultaneously with a fracture of the pelvic bones, the following are observed:

• violation of the position of the greater trochanter;
• forced position of the limb.

General symptoms of pelvic bone fractures include signs of painful shock. It develops:

• with isolated traumatic bone fractures - in 30% of injured people;
• in case of combined and multiple injuries – in 100% of victims.

The immediate causes of traumatic shock in fractures of the pelvic bones are:

• severe blood loss;
• compression or damage to sensitive branches of the pelvic area.

The main features are as follows:

• pallor of the skin and visible mucous membranes appears and increases;
• the skin is covered with cold, sticky sweat;
• blood pressure is reduced;
• pulse rate increased;
• is possible .

Since fractures of the pelvic bones often damage internal organs, for this reason the clinic of pelvioperitonitis may develop - inflammation of the pelvic peritoneum.

It is also worth remembering about possible damage urethra. For him, the relevant signs are those that form the clinical triad:

• urinary retention;
• bleeding from the urethra;
• hematoma in the perineal area.

If bone fragments formed during a fracture of the pelvic bones damage the bladder, then the following symptoms are observed:

• urinary disturbance;
• (blood in urine).

Diagnostics

The diagnosis of a pelvic fracture is made on the basis of the victim’s complaints, pathological history (the fact of trauma with a characteristic mechanism), and the results of additional examination methods.

A physical examination reveals the following:

• upon examination - deformation of the pelvic area. The patient may take a forced position, which depends on the type of pelvic bone fracture. At traumatic shock characteristic is general form the patient is indifferent, the skin and visible mucous membranes are pale, the tongue is dry;
• upon palpation (palpation) - sharp pain is noted in the area of ​​the fracture. Palpation should be carried out with extreme caution so as not to provoke even greater pain in the victim. pain. With the development of peritonitis, the abdomen is tense, there is pronounced pain above the pubis and in both iliac regions, and positive symptoms of peritoneal irritation.

Instrumental research methods used in the diagnosis of pelvic fractures are as follows:

Laboratory methods used in the diagnosis of pelvic fractures are:

• – an increase in the number of leukocytes and ESR indicates an inflammatory process and may signal the development of pelvic peritonitis;
• bacterioscopic examination - if pathological contents are found in the pelvic cavity, it is examined under a microscope, the pathogen that could provoke septic inflammation of the pelvic peritoneum is identified;
• bacteriological examination - the punctate is sown on nutrient media, the type of pathogen is determined by the growth of colonies, which is important for subsequent therapy of pelvioperitonitis. The sensitivity of the pathogen to antibiotics is also determined.

Differential diagnosis

Differential (distinctive) diagnosis should be carried out between different types pelvic bone fractures.

Complications

The most common complications that accompany a fracture of the pelvic bones are:

• bleeding;
• violation of the integrity of organs located in the pelvic area;
• pelvioperitonitis - inflammatory damage to the pelvic peritoneum due to the ingress of infected contents of damaged pelvic organs;
• diffuse peritonitis - spread of the inflammatory process to the peritoneum of the abdominal cavity.

Treatment and emergency care for pelvic fracture

Treatment for a pelvic fracture consists of:

• restoration of the integrity and correct structure of the pelvic ring;
• anti-shock measures.

In this case the following is carried out:

• complete pain relief;
• rapid compensation of blood loss;
• immobilization.

Anesthesia (pain relief) can be:

• parenteral – injection of strong painkillers (often narcotics) into the buttock;
• anesthesia of the fracture site;
• intraosseous;
• intrapelvic.

note

Novocaine, which is used for anesthesia in cases of fracture of the pelvic bones, lowers blood pressure. Therefore, in case of traumatic shock, novocaine in large quantities administered only after blood loss has been compensated.

The basic rules for blood transfusion (blood transfusion) for pelvic fractures are as follows:

• victims who have been diagnosed with isolated pelvic fractures are given fractional blood transfusions within 2-3 days after the injury;
• if severe pelvic injuries or combined trauma are detected, as well as in the event of severe shock, large volumes of blood are transfused within the first hours after injury.

Immobilization is carried out immediately, its type and duration depend on:

• fracture location;
• violation of the integrity of the pelvic ring.

If isolated and marginal fractures are diagnosed, then the patient is fixed on a backboard or in a hammock; so-called Beler splints or rollers in the popliteal region can also be used.

If the integrity of the pelvic ring is compromised, skeletal traction is performed.

Surgical treatment of pelvic bone fractures is carried out in such cases as:

• damage to the pelvic organs;
• significant divergence of the pubic bones due to rupture of the symphysis;
• the impossibility of complete reposition of bone fragments if they are significantly displaced.

If symptoms occur that indicate the development of peritonitis, surgery is performed urgently. The following manipulations are performed:

IN postoperative period dressings are carried out with drainage rinsing.

After surgery, conservative therapy should also be carried out. It is based on the following purposes:

• breathing exercises. It is necessary for the prevention of congestion and the occurrence of congestion. Due to a fracture of the pelvic bones, the patient must be in a supine position, and there is no talk of early rise, which is practiced after surgical operations;
• dressings with washing of drainage tubes;
• – they are prescribed taking into account the previously identified sensitivity of microflora to antibiotics;
• painkillers.

Prevention

Prevention of pelvic bone fractures is:

• avoiding any situations that may threaten injury to the pelvic bones in particular and the entire body as a whole;
• in case of any risks - the use of protective equipment, in particular when moving in vehicle– use of seat belts.

Consequences of a pelvic fracture

The prognosis for a fracture of the pelvic bones is different, often difficult. With isolated and marginal fractures, recovery is easier. Fractures with a violation of the integrity of the pelvic ring require considerable effort to restore the patient.