Diagnosis and treatment of pelvic fracture

A pelvic fracture is one of the most serious injuries. Damage to the pelvic bones is common, especially in the elderly. Difficulties in the field of diagnosis are caused by a large number of soft tissues, under which the human skeleton is hidden.

What are the features of a fracture of the pelvic bones, symptoms and diagnosis from our specialists.

Anatomical features

Pelvic fracture in 6% of cases is fatal. Such terrible statistics are explained by the age of the victims. Basically, the pelvic bones are broken by people over 65 years of age who have age-related changes in bone tissue. There are several reasons for a fracture of the pelvic bones:

A simple fall of a healthy person will not cause a pelvic fracture, as the bones are securely hidden under the soft tissues, which serve as a natural shock absorber. Elderly people do not absorb calcium well, bones become brittle and failure to land when dropped can cause a fracture.

If the fracture is caused by an accident, then this is usually multiple damage. And with a serious injury, mortality rises, and 4 out of 10 people die.

The pelvic part of the skeleton consists of a pelvic ring. The following parts form the bone ring:

The pelvic bones connect to the lower extremities and serve as protection for vital internal organs. The pelvic ring is divided into two groups of half rings according to a special acetabulum:

The front half-ring combines the branches of the pubic part and the symphysis. The posterior half ring consists of the sacrum, iliac bone, ligaments and joints. Through the back half-ring, the main load from the body moves to the person’s legs. The stability of the half rings is provided by the ligaments and muscles that connect the bones into a single apparatus.

Injury to both rings is accompanied by severe internal bleeding from the cancellous bone. Up to three liters of blood can accumulate inside the soft tissues. There are practically no open pelvic fractures, as they cause severe bleeding, which leads to the death of the victim.

Pelvic ring injury classification

Fracture of the pelvic bones is divided into groups depending on the strength of the mechanical impact and the complexity of the damage. There are three types of injuries:

  • And – the easiest type of injury, the ring is not broken and its integrity is preserved;
  • B – fracture of the anterior part of the ring, the posterior half-ring maintains integrity, ligaments, and vessels are not damaged, there is no vertical displacement;
  • C – both half rings are damaged, may be accompanied by rupture of muscles and blood vessels.

Each of the types is subdivided into subclasses, depending on the type of fracture and its location in the semicircle.

Shishkevich Vladimir, orthopedic and traumatologistShishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.

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Type A

This simplest type of injury is divided into two groups:

  • A1 – the whole ring, there is a slight crack of the pubic bone;
  • A2 – The pubic bone is damaged on two or one side. But with bilateral damage, the ring retains its integrity due to the sciatic part of the skeleton.

Type B

In a type B fracture, the anterior part of the pubic bone, ischium, or symphysis are injured. Injury may be accompanied by damage in the front half ring or be independent. After damage, consequences develop in the form of blockade in the ileal joint of the sacral region.

There are two subspecies of type B fracture:

  • B1 “Open Book” – Occurs when a mechanical effect is directed from the front of the pelvis to the back of it. The hip part is squeezed and damaged by the impact force, and the pubic symphysis is damaged. Bones unfold like a book. If the bones have spread to the plant no more than 2 cm, then this indicates the integrity of the joint. With a greater opening, a rupture of the sacroiliac ligament is diagnosed;
  • B2 “closed book” – Unlike the first case, the hip half-ring is squeezed to the s >

Type C

With type C, both half rings break and such an injury bears the name of the traumatologist who discovered it – Malgenya. Due to the peculiarities of the anatomical structure of the human skeleton, the damaged part of the pelvis is shifted to the upper part.

Acetabulum injury

When the hip part is fractured, the acetabulum is often injured. There are three types of injury to this bone:

  1. The extreme part of the bone is broken off, while the thigh is dislocated back and to the upper part;
  2. Fracture of the bottom of the basin without displacement;
  3. Fracture of the bottom of the cavity with a displacement of the hip to the inner part of the pelvis.

In case of a fracture of the acetabulum, the patient should not be touched, transportation is allowed only in a special reanimobile. Surgery and subsequent therapy require a lot of time and are carried out only in a hospital.

Diagnosis and first aid to the patient

It is difficult to provide first aid to a patient with a hip fracture. It is better not to disturb the injured person, and moving from place is possible only with the help of a hard stretcher or shield. Previously, the patient is injected with an anesthetic drug. A special dressing and splint are put on the pelvic part. After an injury, you must immediately call an ambulance.

During a visual examination, the doctor should assess what asymmetry is in the pelvic section, how the hips of the victim are located. Attention is drawn to the presence of hematomas. With a hip fracture, bruising is formed on the sides and front of the body. The specialist should try to slowly reduce and dilute the bone tissue of the pelvis. This action will help to evaluate how much the symphysis has diverged.

If the patient is obese, then the hematoma can rise above the pelvis, to the stomach. Swelling and bruising will cause a symptom of “acute abdomen.”

With torn anteroposterior and anteroposterior axes, the patient develops individual symptoms. When injuring the anterior upper part, the patient manifests symptoms:

  • Sharp pain in the lower abdomen;
  • Swelling occurs at the site of damage;
  • The leg becomes shorter on the damaged side of the pelvis.

Damaged anterior lower part causes symptoms:

  • Acute pain in the groin;
  • When the hip is bent, the pain intensifies;
  • The patient loses the ability to move on his feet.

After a visual examination and stabilization of the patient, he is sent to an x-ray.

During the x-ray, the patient should be lying. Identify a fracture of the back of the pelvis: the coccyx and sacrum will help the projection from the side of the body. Acetabular injuries are diagnosed using an oblique image.

If the image does not make it possible to clearly diagnose the condition of the bones, blood vessels and ligaments, then the patient is sent for computed tomography. The procedure makes it possible to clearly present the fracture lines, to detect fragments.

Therapeutic effects

Treatment should begin with the removal of a person from a shock state. Further, with the help of drip administration, the lost volumes of blood are filled. Blockade helps to relieve the pelvic part. A solution of the pain medication is injected into the soft tissues, this helps relieve acute pain and stop blood loss.

The simplest anesthetic Novocaine is introduced in a volume of 300 ml. Recovery of blood volume is carried out by different drugs, which are selected taking into account the overall clinical picture of the patient. In complex cases, transfusion of donated blood is required.

The immobilization of broken parts is carried out by various methods:

  1. With the help of exposure to patients a certain position of the body;
  2. A skeleton hood using special weights;
  3. Using a rod device.

Exposure to a certain position of the body will require at least one month of time. The injured month lies with hips apart and legs bent. A special roller is placed under the knee. The pose is called the frog.

The second method of treatment by lying relatively new is the fusion of the pelvic bones in a hammock. Bones are connected under the influence of body gravity and gradually grow together. You will have to lie in a hammock for at least 1,5 months.

The most effective treatment method is to stabilize the skeleton with metal rods and plates. They are installed in an open operation, when the patient’s soft tissues are dissected, the bones are put in place. Recovery using knitting needles and platinum will require 1 month, and another 6 weeks will be spent on rehabilitation.

Post-injury rehabilitation

The rehabilitation period will require patience and endurance from the patient. The first days after prolonged lying down, the hip joint will cause pain with any attempt to move. Properly selected exercise therapy will help to develop joints. Exercises are selected individually for each patient, taking into account the characteristics of the injury, the physical capabilities of the patient.

The first two weeks the patient has instability on the legs and a pain symptom with each movement. But exercises must be done every day. The complex becomes more complex gradually, and new loads accelerate recovery. Exercise therapy is performed strictly under the supervision of a specialist.

Additionally, massage and electrophoresis are included in the rehabilitation period. The procedures will help restore blood circulation in the pelvic area and bring the muscles to tone.

How long rehabilitation takes depends on the patient’s persistence and his individual characteristics of the body. Children recover faster than adults and begin to walk on their own for 2-3 weeks. People after 45 will need at least 3 months to recover.

Possible complications

Hip injury causes various complications that can occur even at the stage of damage and will be caused by a fracture. These include:

  1. Heavy blood loss;
  2. Shock after an injury;
  3. Damage to the genitourinary system;
  4. Damage to the digestive tract.

Pathologies caused by trauma have pronounced symptoms and are stopped by the ambulance team that arrived at the scene. Damage to internal organs is repaired operatively in the surgical department.

After recovery, the patient may develop long-term complications:

  • Pain when walking in the groin or pelvis;
  • Violation of movements, shakiness when walking;
  • During childbirth, a woman may relapse;
  • Hip arthrosis.

Preventing injury is almost impossible. People need to observe industrial safety precautions, be more careful when driving personal vehicles, beware when crossing the road. The elderly should refrain from long trips, walking up the stairs and avoid whipping on chairs, tables, ladders.

A fracture of the pelvic bones is one of the most serious injuries, but it rarely happens in a healthy person.

By maintaining your body in good shape and not gaining excess weight, you will prevent dangerous damage. But if an accident has already occurred, then it is better to follow the advice of a doctor and bring the rehabilitation course to a complete recovery of the body.

Shishkevich Vladimir

Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews. It specializes in the treatment of diseases in orthopedic, traumatological, vertebrological profiles