Consequences of a pelvic fracture

It should be noted that every third patient admitted to the department with a pelvic fracture is in traumatic shock, which is often caused by massive bleeding and injuries. internal organs.

The pelvis is the support of the spine and skeleton. It is located at the base of the spine and connects the limbs to the trunk. In addition, the pelvic bones and the bone bed (or pelvic ring) is a receptacle for the internal pelvic organs.

The pelvic ring is formed by the pubic, ilium, ischium and sacrum. The pelvic cavity houses the bladder, rectum, uterus, and vagina in women and the prostate and seminal vesicles in men. Most often, fractures of the ischial and pubic bones occur.

Causes of pelvic fractures complicated by damage to internal organs

Most often, pelvic fractures occur due to car accidents, collisions with pedestrians, collapses of buildings or earth, etc.

Symptoms of pelvic fractures complicated by damage to internal organs

In men, pelvic fractures often damage the urethra, less often the bladder. In this case, complete and incomplete ruptures occur, accompanied by complete or partial urinary retention. Often a drop of blood appears on the outer edge of the urethra. In the event that a complete rupture of the bladder has occurred, it is not possible to pass a catheter into it. The appearance of blood from the catheter is also a consequence of complete damage to the urethra. If bloody urine appears first, and then clean, then partial damage to the urethra is diagnosed.

Complications arising from pelvic fractures

In order to prevent some complications, mummy is used for fractures. All complications that arise due to fractures of the pelvic bones are divided into 3 main groups by specialists, and this depends on the time of their occurrence:

1. Direct consequences, i.e. those that occur directly at the time of the fracture.
2. Early consequences (a few days after the fracture).
3. Late consequences (long time after the fracture).

A systemic complication of a fracture can be hypovolemic shock, aseptic traumatic infection, with an open fracture - sepsis, a delay in fusion or incorrect fusion of bones, as well as nonunion.

Local complications are damage to the main blood vessels, muscles and tendons, traumatic compression syndrome and damage to internal organs, as well as local infection, osteomyelitis and osteoarthritis.

Very often, due to a fracture of the pelvic ring, a rupture of the bladder or urethra occurs. In this case, the patient needs urgent surgery.

The developed syndrome of traumatic compression can cause limb amputation.

With fractures of the posterior half ring, retroperitoneal hematomas occur, which are characterized by clinical picture acute abdomen. In this case, intrapelvic anesthesia is done to reduce the pseudo-abdominal syndrome.

As a rule, with adequate treatment, pelvic fractures heal well. However, if adjacent tissues were damaged during the fracture, the patient may limp for a long time due to the slow recovery of muscles and ligaments. Damage to the nervous tissue leads to chronic pain, as well as damage to some joints and sexual dysfunction. To prevent many problems, proper nutrition is required when bones are fractured.

Degrees of dysfunction of the body

I degree. there is no shortening of the limbs and atrophy of the gluteal muscles. In this case, there are no restrictions on the patient's life.

II degree. It is characterized by contracture hip joint. Pain syndrome, hypotrophy of the gluteal muscles and moderate restriction of movement are noted.

III degree. The function of the hip joint is very limited, the gluteal and thigh muscles are atrophied, the patient has a duck gait.

Treatment of a clavicle fracture in children

Fracture of the collarbone is one of the most common injuries in children 2 - 4 years of age. It occupies a leading position in the ranking of fractures after the forearm and shoulder. A direct fracture of the clavicle occurs as a result of its direct impact, however, such a condition in life is quite rare. Much more often, an indirect fracture of the clavicle occurs when it breaks due to a blow from the shoulder, a fall on the elbow or outstretched arm, and also with simultaneous strong and sharp compression of the shoulder joints.

Injuries incompatible with life

Emergency physicians and emergency medicine centers deal daily with victims of injuries of varying severity. Patients with mild to moderate injuries may be treated on an outpatient basis or in specialized department hospital. Victims with severe injuries are in intensive care units, and sometimes they do not even have time to get to the hospital.

Damage to the hip joint and pelvic bones is a dangerous injury associated with loss of mobility and severe limitation in movement. It can lead to complete paralysis of the lower extremities, its consequences can cause disability. The pelvis has a complex structure. One of its main components is the pubic (or pubic) bone, consisting of 3 parts - the main body and located on both sides of the branches. There are injuries, depending on the presence or absence of the integrity of the pelvic ring.

A fracture of the pubic bone of the pelvis refers to the type of damage that does not violate the integrity of the pelvis itself, the injury is the result of a blow of great force, directed directly to the center of the main bone or with increased indentation. At the same time, the bones are not subject to displacement, and the severity of the injury is determined by the location and size of the damage. Athletes and elderly people with serious diseases associated with a violation of the structure of bone tissue (osteoporosis) are often susceptible to a fracture of the pubic bone. Injury occurs when the muscles around the bone contract violently.

To determine the methodology and mechanisms of treatment, it is important for a doctor to know the cause and nature of the damage received. Common causes of injury:

• accidents and collisions with pedestrians;
• direct blows;
• landslides of rocks and soil rocks;
• falling from height;
• getting into squeezing conditions (between cars, wagons, etc.).

A fracture of the pubic bone can be either spontaneous or with complications combined with cracks and violations of the structure and integrity of other pelvic bones. It can, in some cases, cause ruptures in the internal organs located in the pelvis (female genitals, bladder, rectum).

Symptoms

Signs of injury to the pubic joint are:

• acute pain in the injured area with minimal movements, it is characteristic of almost all pelvic injuries;
• subcutaneous hemorrhages;
• puffiness;
• numbness of the place, observed in violation of the integrity of the nerve trunks;
• limited movement, inability to raise the leg (the effect of a stuck heel);
• hematoma and induration, hardening of the impact site.

Diagnostics

When diagnosing an injury, it is important for a doctor to:

• medical history indicating the nature of the injury;
• patient complaints;
• examination indications;
• additional diagnostic tools (if necessary).

The most commonly used diagnostic method is radiography. In this case, an overview image is taken, as well as, for accurate diagnosis and correct diagnosis, an aiming photo of the pubic (pubic) bone.

First aid

In case of a fracture of the branches of the pubic bone, the speed and quality of emergency care are important, which can subsequently become a good factor and indicator for further treatment and complete recovery of the patient. Before starting its implementation, it is necessary to call a doctor and, while waiting for his arrival, provide assistance to the victim.

In this case, immobilization of the injured person is important so that the resulting fragments do not move and this does not lead to damage to their edges of soft tissues or internal organs. For this, the patient is laid on his back and a roller or an object replacing it is placed under his knees.

The patient needs pain relief, for this, drugs with a strong effect, both general and local, are used. Serious attention is paid to the elimination of pain shock, from which the patient may lose consciousness, therefore, before the arrival of doctors, it is necessary to pay attention to the general condition of the injured person - to his pulse and heart rate.

In severe open injury, with wounds and soft tissue damage, it is necessary to use disinfectants process them and cover with a cloth, protecting them from bacteria and infections. With abundant blood loss, it is necessary, if possible, to apply a tourniquet or tightly close the place of rupture of blood vessels.

Treatment

Then the patient must be placed in a hospital where the necessary treatment is carried out. Correct diagnosis is important, which will determine the severity and specific location of the lesion. This will reveal the facts of damage or their absence in the internal organs. In case of large blood loss from soft tissue injuries or ruptures in the internal organs, a transfusion of donor blood or plasma may be recommended to the patient.

Damage to the pubic bone or fracture of its upper branch, depending on the severity, requires conservative treatment or surgical intervention. The operation is necessary for a patient who has a large number of small fragments of bone tissue that cannot be compared into a dense structure. Through the incision made, they are removed.

The patient may need surgery when diagnosing damage to the internal organs of the small pelvis, which are manifested by the following symptoms:

• urination with blood fragments;
• urinary incontinence;
• bowel problems, etc.

Their detection is possible with the help of ultrasound, MRI and other diagnostic procedures and methods.

Rehabilitation

Complicated fractures are quite difficult. They are multiple and are accompanied by damage to the joints and bones of the pelvic ring, blood vessels, nerve endings and internal organs. Their most common localization is the anterior pelvis. Depending on the severity of the injury, there are three stages in the restoration of the functions of the pelvic bones. The appointment of a complex of recreational activities and therapeutic exercises is carried out by a rehabilitation doctor.

At the first stage, the specialist faces the following tasks:

• restore the work of internal organs;
• prevent muscle atrophy;
• promote relaxation of muscle tone;
• gradually restore the functions and work of the lower extremities.

At the second stage, supplemented by small physical activity, the patient is prepared for standing and the first steps, in connection with this, muscles and joints are developed. At this stage, the sitting position does not apply.

The third stage is marked by gradual loads and exercises that promote rotation of the torso, bending of the legs; in case of injury to the pubic joint, squats with the bent legs apart are included in the complex.

With complex fractures, from the first to the last stage, all loads are assigned and performed under the close supervision of a specialist.

Massage promotes recovery at all stages. It allows you to normalize the work of impaired blood circulation and prevent muscle atrophy of a bedridden patient.

Consequences

Untimely access to a medical facility in case of pelvic injury can lead to unpleasant consequences and complications:

• damage to the pelvic muscles, nerve trunks;
• formation of prerequisites for the appearance of osteomyelitis, osteoarthritis;
• traumatic blood loss;
• disruption of the pelvic organs;
• the formation of infectious and inflammatory processes (internal and external);
• incorrect fusion of bone tissue;
• the appearance of growths;
• thinning of muscle fibers that limit motor activity;
• lameness, etc.

In some episodes, patients notice a decrease in the length of one limb, which leads to a violation of the proportions of the human body, there is a suspension of bone fusion, partial or complete loss of mobility.

Pelvic injury and its consequences are serious and dangerous injuries. musculoskeletal system person. You need to take its treatment seriously and remember that the quality of your future life depends on it.