The most severe injuries to the human body are pelvic injuries, they account for 18% of the total number of injuries. With this pathology, a person develops a shock of varying severity, which can be triggered by severe internal bleeding. Even in modern trauma clinics, the frequency of death from such injuries is 25%, which is associated with the limited capabilities of treatment methods for severe forms of pathology, as well as the need for resuscitation. After therapy, disability develops in 35% of victims.
Description and characteristics of pelvic injury
The pelvis is a part of the skeleton, which is located at the base of the spinal column, connects the trunk with the lower extremities, acts as a support for the skeleton, protects the internal organs. It consists of a fixed bone ring. The ring is formed by two pelvic bones, each of which consists of the pubic, sciatic and iliac bones. They are separated by thin bone sutures. The bones are motionless relative to each other. All three bones are connected to the hip joint. When bones are damaged, pelvic injuries often occur. In men, the rectum, bladder, large blood vessels, prostate gland and seminal vesicles are located in the pelvic cavity. In women in the small pelvis, in addition to the rectum and bladder, there are organs of the reproductive system: fallopian tubes, uterus, ovaries, and vagina.
Pelvic injuries - severe damage to the human skeleton, accompanied by heavy bleeding from bone fragments and soft tissues, the development of a shock condition as a result of severe pain and blood loss. With this pathology, damage to internal organs, blood vessels and soft tissues often occurs, which contributes to the aggravation of the condition of the victim and poses a threat to his life. The most common injuries are pelvic fractures.
Reasons for the development of pathology
The strong structure of the pelvic bones usually does not allow them to get damaged when they fall from the height of their body. Most often, pelvic injuries occur for the following reasons:
- Exercising when a strong muscle contraction occurs.
- Accident, as a result of which a person received a hit of the pelvic area of ​​great power or when a vehicle collided with it.
- Hit with a blunt object during a fight.
- Fall from a great height.
- Squeezing bones in a collapse of a building or as a result of industrial accidents.
Most often, spinal and pelvic injuries are diagnosed in people of middle and old age. The risk group also includes:
- Children due to insufficiently developed musculoskeletal system, calcium deficiency in the body.
- People with bone disease. Injuries in this case can occur even as a result of a fall from a height of one's own body.
Typically, an injury to the sciatic bone occurs due to a strong physical impact on it, for example, when it falls on the buttocks in winter or during sports. Fracture of the pubic bone occurs as a result of injury to the pelvic ring due to an impact in this area or when it is squeezed.
Pelvic Injuries: Classification
In medicine, it is customary to distinguish four groups of pelvic injuries:
- Fractures, characterized by a fracture of bones with a dislocation in the pubic or sacral joint.
- Stable damage caused by a violation of the integrity of the bone, while the pelvic ring remains intact.
- Unstable injuries in which the bones of the pelvic ring break. A fracture can be in one or in several places, and it can also be accompanied by bone displacement.
- Damage to the bottom and edges of the acetabulum, in some cases, such types of pelvic injuries are accompanied by dislocation of the hip.
Complications and consequences
Bone fractures are accompanied by blood loss (from two hundred grams to three liters). In severe injuries, the urethra, bladder, rectum, and vagina can be affected. The contents of these organs enter the pelvic cavity, provoking the development of complications. Damage to internal organs and bleeding increase the risk of death.
Often, a pelvic injury has the following consequences:
- The development of paresthesia, damage to tendons, blood vessels, soft tissues and nerves.
- The appearance of bleeding, the development of a secondary infection.
- The development of various diseases of an infectious and inflammatory nature.
- The formation of bone growths as a result of abnormal bone fusion.
- Violation of muscle tone.
- Shortening of the lower extremities, loss of motor activity.
- Fatal outcome is observed in 5% of cases in the first days after injury.
General symptoms and signs of pathology
One of the main symptoms of a pelvic injury is a traumatic shock that develops as a result of severe blood loss in combination with damage to the nerves of the pelvic area. In this case, the person becomes pale skin, blood pressure drops, and the pulse increases. Often shock is accompanied by loss of consciousness. Often, the victim has symptoms of damage to internal organs, which may also indicate the appearance of a hematoma in the anterior or posterior abdominal wall. When injuring the urethra and bladder, urination disorders, bleeding from the urethra, hematuria, subcutaneous hemorrhage in the perineum are observed. Also, pain of varying intensity appears when moving with limbs, a person is forced to maintain a certain position of the body.
Local symptoms
Local signs of pelvic trauma are manifested in the form of deformation of the pelvic region, development of pain, swelling of soft tissues. Often, shortening of the lower limb can be observed as a result of the displacement of the bone fragment down, as well as Lozinsky's symptom.
Fracture of the sciatic bone leads to loss of consciousness, the development of hematoma, internal bleeding. An injury to the pubic bone causes pain, swelling, a symptom of a “sticking heel”, limitation of motor activity, subcutaneous hemorrhage, damage to the vessels and organs of the small pelvis. Often injuries of the spine and pelvis lead to limited mobility, in severe cases, to paralysis.
With a tailbone injury, there is difficulty in defecation, a violation of the sensitivity of the gluteal region and urinary incontinence due to infringement of the sacral nerves. Stable fractures provoke the development of pain in the perineum or in the pubic region, which increases with limb movement and palpation. Unstable fractures lead to pain in the pelvic region, which increases with the movement of the legs. Often a person is forced to be in a frog position due to severe pain.
First aid
First aid for a pelvic injury should be provided before the ambulance crew arrives, it should be quick and adequate. Follow the instructions:
- You must not remove the victim from the vehicle if he was injured while in it. In this case, you must wait for the arrival of doctors. Only in case of suspicion of a car explosion, you need to carefully remove a person from the car and move it to the side.
- First of all, the victim is given an anesthetic if he is conscious. In the case of a person’s unconscious state, you can’t put medications in his mouth, as there is a risk of developing asphyxiation.
- After this person is placed on a hard surface in a frog pose, a pillow is placed under bent knees.
- If there are open wounds, they are treated with antiseptic solutions, covered with a sterile bandage or a napkin and fixed with a band-aid.
- It is impossible to independently carry out immobilization in this case, it is necessary to wait for the doctors who will carry out it in accordance with all the rules.
When a pelvic bone injury has occurred, and emergency care cannot be carried out on site for some reason, and if you need to transport the injured person to a medical facility yourself, transport immobilization must be performed, otherwise the bone fragments can move, causing the development of traumatic shock, bleeding, organ damage and death.
If first aid for a pelvic injury is not performed correctly, it can lead to serious complications and increase the risk of death. Doctors recommend before going on hikes, where there is no way to call an ambulance crew, to study the rules for the immobilization of victims.
Immobilization and transportation of victims
If it is necessary to independently immobilize and transport the victim to a medical facility, it is necessary to conduct them in such a way as to prevent the displacement of bone fragments that can damage muscles, nerves and blood vessels, as well as internal organs. To do this, you can use any means at hand: sticks, pieces of cardboard, boards, rags of cloth, gauze or bandages.
Immobilization must be carried out carefully and carefully, since any improper movement can provoke pain shock, a person may lose consciousness. The victim should not move his limbs, it must be conveniently put and dressing, fixing the damaged area as much as possible.
Diagnostics
In the acute period of injuries, diagnosis will be difficult due to the patient’s serious condition, resuscitation is required. In this case, pelvic injuries are diagnosed using the method of palpation and examination of the victim. The doctor draws attention to the presence of asymmetry of the pelvis, subcutaneous hemorrhage, pain, mobility of the lateral fragment of the pelvic bone. An accurate diagnosis is possible only after radiography, the results of which are of great importance for the development of treatment tactics for the victim. This study allows you to evaluate the degree of damage to internal organs and the type of fracture.
Also in severe cases, if there is a suspicion of damage to the internal organs, the doctor can perform laparoscopy, laparotomy or laparocentesis. Examination of the urethra and ultrasound of the bladder is required if the patient is unable to urinate independently, often the doctor prescribes urethrography.
Pathology treatment
In the treatment of victims, traumatologists distinguish two periods:
- The acute period in which therapy is aimed at saving the patient's life.
- The recovery period when the correction of displaced bone fragments is carried out.
The choice of treatment method depends on the age, general condition of the patient, the presence of concomitant injuries, location and degree of displacement of bone fragments.
Treatment of a pelvic injury (uncomplicated) takes about four weeks, while the patient must comply with bed rest. In the presence of large blood loss on the third day after receiving the damage, a blood transfusion is performed.
In severe injuries, anti-shock therapy and resuscitation are performed to remove a person from a life-threatening condition. Usually, victims go to the clinic with multiple fractures of bones of different segments of the pelvis, damage to internal organs, which causes the development of a terminal condition and pain shock. Doctors should direct all efforts to removing the victim from this condition, as well as restore the basic vital functions of the body. In this case, physicians should strive to fully identify all the injuries in order to conduct effective treatment. Antishock therapy involves the use of analgesics, heart drugs, novocaine blockade. Upon reaching stabilization of all vital functions of the body, they begin to treat fractures.
Surgery
When bone fragments are displaced, surgical treatment is performed, during which their normal position is restored. In traumatology, in this case, use knitting needles, metal plates, screws and other devices. This operation is called osteosynthesis, it is performed under general anesthesia. During the operation, the doctor examines the internal organs, eliminates the damage, if any. Surgical procedures usually use a percutaneous apparatus that reliably fixes bone fragments.
In traumatology, operations for pelvic fractures often do not give the desired result, since it is not always possible to correctly collect fragments and hold them in this position throughout the entire treatment period. With a patient's prolonged stay in bed, sepsis and thrombosis, muscle atrophy often develop. In 25% of cases, a person after an injury becomes disabled.
Patient rehabilitation
When pelvic injuries occur, rehabilitation begins only after a full and comprehensive treatment. The rehabilitation course is an integral part of therapy, which is aimed at the fastest restoration of motor activity and the return of a person to a normal lifestyle. This event is carried out strictly under the supervision of a doctor. Rehabilitation activities include:
- Exercise therapy to prevent the development of ankylosis and contractures, normalization of muscle tone.
- The use of vitamin and mineral complexes to strengthen inert tissue.
- Physiotherapy and massage.
- Therapeutic traction.
It is important to eat right during this period, including marine fish, dairy products, vegetables and fruits, nuts, sesame and rose hips in the diet. Doctors recommend taking walks in the fresh air to restore the functionality of the musculoskeletal system.
Effects
With pelvic injuries, the consequences can be very serious. With fractures, a person's motor activity is impaired, which may not normalize even after undergoing treatment. Often, victims periodically experience pain. Women cannot give birth to a baby on their own, they have to perform a cesarean section.
The main condition for a successful cure is the correct first aid and immobilization of the victim, as well as anti-shock therapy. The prognosis of the disease will depend on the severity of the damage, as well as on trauma to the internal organs. After treatment, patients are forbidden to engage in sports and physical activity.
Often, trauma leads to the fact that severe bleeding develops, bones fuse incorrectly, they can displace and damage internal organs and tissues. After an injury, victims often have a disorder of sexual function, osteoarthritis, osteomyelitis develops, bone growths form, nerves and tendons are damaged. Complications of the pathology often lead to death. Long-term effects of pathology can occur throughout a person’s life.
In case of pelvic injuries, first aid must be provided to the victim before the ambulance crew arrives. This must be done quickly and efficiently, as the further state of a person depends on it. In 5% of cases, in the first few hours after damage to the pelvis, death occurs due to a large loss of blood and the development of a shock condition. Therefore, it is important to deliver the victim to the clinic as soon as possible.