One of the most dangerous fractures is considered to be a fracture of the pelvic bones, in particular the pubic (pubic), which is a paired bone. The bones themselves are connected in the middle by symphysial surfaces, thereby forming a pubic joint. At the same time, the symphysis, until about 16-18 years old, is a cartilage and only bones after adulthood.
Fracture of the pubic bone is very dangerous, as it is accompanied by traumatic shock and large blood loss. In addition, retroperitoneal hematoma may form on the background of the injury, or damage to the vagina, rectum or bladder may occur. According to statistics, about 75% of all traffic accidents result in a fracture of the pelvic bones, including the pubic bone.
International classification
According to the ICD, a fracture of the pubic bone is assigned to section S32.8. The injury is classified as severe, which is often accompanied by shock and an extensive retroperitoneal hematoma. The clinical picture can manifest itself not only against the background of pain in the sacral region, but also be accompanied by painful bowel movements, pain during an attempt to sit down. Urinary retention and loss of sensation in the buttocks may occur.
Risk group and most common injuries
Most often, such injuries appear in the process of traffic accidents. Also at risk are people who are engaged in work at heights or in a hazardous workplace, naturally, provided that safety precautions are not followed. Athletes fall into the risk group, since the risk of getting a severe blow to the pelvic area is much higher for them than for an ordinary person. Such injuries can even occur when skiing.
Fracture of the pelvic bone is characteristic of menopause in women. In men in old age, a fracture can also occur due to the fact that the calcium content in the bones is greatly reduced, less than other substances in the body that are responsible for the strength of bone mass and connective tissue.
However, such fractures do not lead to a violation of the integrity of the pelvis itself. Bones are rarely displaced, and the severity can only be determined after determining the location and size of the damage.
Kinds
Fracture of the pubis can be in the form of a fracture-dislocation, that is, in addition to the broken bone, joint displacement will be diagnosed. There are fractures without displacement, that is, there is no violation of structural integrity.
The following species are also found:
- a fracture with a violation of the integrity of the pelvic ring;
- with violation of the acetabulum ;
- indoor and outdoor;
- bilateral or one-sided.
Symptomatology
A fracture of the pelvic bone is accompanied by severe pain, up to traumatic shock. Minimal movements in the victim cause severe pain and the effect of a sticking heel is pronounced. Subcutaneous hemorrhages and swelling in the pelvic area are often observed. If the integrity of the nerve trunks is violated, then numbness will be observed. Compaction and hardening may occur at the impact site.
Crispy sounds can only be observed if debris from the bone is present. The victim has abundant perspiration and the pressure drops significantly against the background of a rapid heartbeat. Some patients even faint. At the initial examination, it seems that visually the legs are of different lengths, and the pelvic bones are located asymmetrically.
Diagnostic measures
As a rule, after a visual examination of the victim, the doctor conducts an additional examination by palpation to determine the exact place where the fracture occurred. Fingering with fingers also allows you to determine if there are bone fragments, how much and in which direction they are displaced.
When diagnosing, it is very important for the doctor to collect a detailed medical history. Perhaps the patient alone cannot explain the events that led to the injury, but there may be witnesses who can tell. After all, it is very important whether there was twisting or squeezing, or the person fell. Then, an X-ray examination is mandatory to confirm or refute the diagnosis of a fracture of the pubis.
The doctor must pay attention to additional symptoms. In particular, the victim has or does not have problems with urination or stool discharge. If there is suspicion of injury to other organs, then the following examinations are prescribed:
- MRI and ultrasound;
- angiography;
- laparoscopy;
- cystography;
- gynecological examination;
- pyelography;
- urethrography.
But the most informative and reliable examination is an x-ray, which can be both a survey and an aim.
First aid
It is very important to know how to provide first aid for a fracture of the pubic bone, since with such injuries the speed of care is very important, which can become a determining factor in the healing process.
Prior to the arrival of the ambulance crew, the victim must be provided with immobilization. If there are broken off bone fragments, then immobilization will avoid injuring other organs. The patient must be laid on his back, and a roller or other object should be placed under the legs in the knee area.
The victim can be given pain medications. It is necessary to monitor the pulse and rhythm of the heart, not to allow a person to lose consciousness.
If the fracture is open, then the wound must be treated with disinfectants and covered with a piece of clean tissue so that bacteria do not get there. If heavy blood loss is observed, then a tourniquet will have to be applied.
Treatment
Regardless of whether a closed fracture of the pubic bone, open or of another type, the correct diagnosis is very important, which will determine the severity of the injury and its location. If the patient has large blood loss, a blood transfusion procedure is performed.
Depending on the degree of damage, conservative therapy or surgery is performed. If the fracture was accompanied by splintering of multiple fragments, then surgery is required. Small bones that cannot be folded into a dense structure are removed. The remaining bone fragments are connected and fixed by metal wire, plates and screws.
Treatment of a fracture of the pelvic bone with damage to the internal organs of the small pelvis also often requires the intervention of a surgeon. In addition to bringing the bones to the anatomical position, stitches of the walls of the vagina, rectum, blood vessels, or other damaged organ are sutured.
Skeletal traction
With a fracture of the pubic and sciatic bones , skeletal traction may be required. The technique is also used for bilateral fractures and damage to the pelvic ring.
The procedure involves the use of a hammock, which is made of double dense fabric. The width of the design is determined by the doctor. Round cord spacers are sewn into the ends of the hammock, which are held through the blocks, which in turn are attached to the Balkan bed frame.
To control the healing process, several x-ray pictures are taken. Skeletal traction lasts about 1.5 months, then glue traction is carried out for 1 month. Only after 3 months the patient will be allowed to rise and move around, but only with crutches. Full load can only be given 4-6 months after injury.
Rehabilitation
The pubic bone after the fracture requires a long rehabilitation period in order for it to fully restore its functionality. The patient will need a lot of effort and patience. The following measures are included in the rehabilitation course: massage, gymnastic exercises, physiotherapy. In addition, patients who have undergone a similar type of fracture are recommended spa treatment, nutrition adjustment. All rehabilitation measures are complex therapy, and if the patient follows all the recommendations of the doctors, then he will have huge chances for a full recovery.
Even at the stage of inpatient treatment, the patient must perform breathing exercises that strengthen the movements of the feet. Was there a fracture of the pubic bone without displacement or with it? First of all, it is necessary to restore the psychological state of the victim with the simultaneous removal of the pain syndrome. Measures are being taken to improve the general tone of the whole body and lower extremities.
At the later stages of rehabilitation, patients are advised to visit the pool, at home it is recommended to carry out swings. Walking gives very good results. The terms of rehabilitation completely depend on the individual characteristics of the victim’s body, as well as on his desire to return to the usual rhythm of life faster.
Effects
A fracture of the pubic bone to the right or left can lead to a noticeable decrease in the length of one limb. In some patients, a serious violation of the proportions of the body is observed, which subsequently leads to a partial or complete loss of leg mobility.
Such damage is a stimulating factor in the formation of osteoarthritis and osteomyelitis. In women, cases of the appearance of disturbances in the functioning of the pelvic organs are not rare. There may also be a decrease in susceptibility of the pelvic organs and legs. Outgrowths may also appear, especially if abnormal bone fusion has occurred. Some patients experience lameness after an injury. Therefore, any trauma in the pelvic area can cause severe complications that can lead to loss of motor function, and therefore, to a deterioration in the quality of life.
Can traditional medicine help?
In the process of restoring the body after a fracture of the pubis, it is recommended to use more boiled onions, which allows you to accelerate the process of bone restoration. You can make compresses or rubbing with gum turpentine. During massage it is recommended to use essential oils: juniper, fir, eucalyptus, cedar and others. You can speed up the recovery process using bathtubs with sea salt, you can add gum turpentine.
The special role of diet in treatment
Many skeptics may ask: how can food help? In fact, after a fracture, it is recommended to adjust the menu and add products with a high content of calcium, magnesium, phosphorus, manganese and potassium to it. In addition, foods with a high content of vitamin D and C, vitamins from group B, should be introduced into the diet. It is these vitamins that help improve the absorption of calcium and protein by the body, that is, the substance that is the basis for bones.
Recommended foods include:
- bananas
- nuts
- herring;
- Beans
- pumpkin;
- mushrooms;
- sesame seeds and others.
Prevention
It is clear that with the rapid pace of life, it is quite difficult to protect yourself from injuries and accidents, to radically change the diet. Nevertheless, if the stairs in the house are slippery, there are many of them, it is better to cover them with a carpet, install handrails. If there is a vehicle, then try to drive as carefully as possible, avoid traffic accidents.
When playing sports, do not forget about safety rules, do not allow heavy shells to fall on your body. You should also beware of falling on any hard surfaces, on sports equipment.
If possible, refuse to work at heights or in hazardous workplaces, in workplaces associated with vibration and contact with complex equipment, which could result in personal injury. It is clear that no one is safe from injury, but if this has already happened, then in no case should you lose heart and find a real professional in medicine, trust him and maintain a positive attitude until the end of treatment and rehabilitation.