Symptoms of a fracture
To understand where the pubic bone is and where it can break, you can look at the anatomical drawing.
Very often, when the pubic bone is fractured, internal organs are injured:
- urethra;
- intestines;
- bladder.
Therefore, in addition to treating the fracture, doctors prescribe concomitant treatment for damaged organs. Before this, the patient undergoes examinations confirming the presence of injury.
Important! If you have a fracture of the pubic bone, you should immediately consult a doctor.
Sometimes people mistakenly call the bone a lunar bone, but the correct name for it is the pubis, from the word “womb,” not “moon.”
Treatment of the pubic bone consists of two parts. The first stage is pre-hospital. Includes the first actions in case of a fracture and further hospitalization of the victim. The second stage is stationary. This is hospital treatment. It may vary depending on the symptoms and the location of the lesion.
Rehabilitation period
The patient is required to exert considerable effort in the post-traumatic period. The rehabilitation procedure takes place in several stages:
- gymnastic exercises;
- massotherapy;
- physiological procedures;
- rich nutrition;
- maintaining the groin muscles in a relaxed state;
- elimination of pain;
- slight load on the lower limbs (prevents atrophy);
- normalization of blood pressure and blood circulation;
- strengthening exercises for the back;
- improvement of pelvic muscle tone.
The main task at the first stage of rehabilitation is to remove the patient from a mentally depressed state and tone the muscular system. At the last stage of rehabilitation, the correct gait is restored to the victim and muscle memory of all limbs is trained. After discharge from the hospital, the patient is sent for treatment to a preventive sanatorium, where the patient will be rehabilitated with the help of water procedures under the supervision of qualified doctors. The complete recovery time depends on the individual characteristics of the body. Preventive sports exercises are prescribed by the attending physician. Rehabilitation specialists recommend maintaining a positive mood, otherwise, without the will to restore the patient, any doctor will be powerless.
Prehospital treatment
If you have symptoms of a fracture, the first step is to call an ambulance. It is necessary to warn what kind of injury the injured person has. You cannot transport a patient with such an injury personally; this requires special skills and knowledge. Therefore, specially trained workers must transfer the patient.
What to do while waiting for an ambulance:
- Most likely, the person will suffer from pain. Then you need to take painkillers.
- If there is blood loss, it should be stopped.
- Prepare the person for transportation.
Care should be taken to ensure that the person is positioned correctly so as not to further injure the hip bones. To begin, you need to put the person on his back and spread his legs slightly, bending his knees. The best way to do this is with the help of a pillow or folded blanket - place it under your feet. This pose is called a frog pose, because a person resembles an inverted frog.
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 foods high in calcium, magnesium, phosphorus, manganese and potassium. In addition, you should introduce into your diet foods high in vitamin D and C, vitamins from group B. It is these vitamins that allow you to improve the process of 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 and others.
Inpatient treatment
Doctors will treat you in a hospital using various methods. First, the diagnosis is confirmed by x-ray, after which medications and immobilizing methods are used.
Transportation
When an ambulance arrives on a call, the first thing you need to do is move the victim correctly. For this purpose, special vacuum stretchers are often used, which are safe and easy to use.
You can carry it on a regular stretcher. In this case, the victim is placed on a stretcher with a pillow under his knees. Next, the legs are bandaged towards each other to prevent movement in this area. The patient must be transferred very carefully.
The same patient transfer methods are used for transport to the hospital.
Blood loss
If there is bleeding, doctors will apply a fixative to reduce blood loss. Any other fixation methods can also be used. If there is significant blood loss, the patient is prescribed a blood transfusion.
Fact! This procedure should take place no later than two days after the injury.
Vascular damage
You should make sure that the patient does not have damage to the pelvic vessels. This injury is life-threatening. That is why the patient is examined at the very beginning. If the vessels are injured, you should urgently find the site of injury and bandage it.
This type of injury is life-threatening, so early management of the injury can save the patient's life.
Skeletal traction
For further immobilization, a Beller splint is applied to the injured area. This splint is also used for skeletal traction.
Skeletal traction is used for bilateral fractures of the pubic bone, as well as for other severe hip injuries.
Damage to the pelvic bones
Indications for extrafocal osteosynthesis of the pubic symphysis and its technique Treatment of injuries to the pubic symphysis with a discrepancy of less than 2 cm is conservative. If there are no fractures of other pelvic bones and vertical displacement of half of the pelvis, then on the 2-3rd day the victim is ordered a reinforced pelvic bandage according to his size. In this bandage, the patient can turn in bed, and after 2-3 weeks walk on crutches with support on both legs. If the vertical displacement is less than 1 cm, a bandage is also ordered, but the period of bed rest is extended to 4 weeks. Vertical displacement of more than 1 cm is an indication for the application of skeletal traction for a period of 6 weeks after the achieved reposition.
Tears of the pubic symphysis greater than 2 cm with instability of the severed half of the pelvis were an indication for surgical treatment. Currently, there are two methods of osteosynthesis - extrafocal with various ANFs and submersible - with wires, screws and plates.
For immersion osteosynthesis, I almost always use a metal reconstruction plate with at least 4 or more AO screws. It provides proper stability and the possibility of early activation of patients in certain cases.
Osteosynthesis of the sacroiliac joint is performed with screws with a 32 mm thread along the AO or with a bolt behind the iliac crests. The prognosis for pure ruptures of the sacroiliac joint is not very favorable. Restoration of the ligaments of this joint occurs only if the rupture of the pubic symphysis is completely eliminated within 1 week and no vertical displacement remains. The more time has passed since the injury, the more difficult it is to compare the separated halves of the pelvis and the worse the result. The ligaments are not restored, but are replaced by a scar, as a result of which mobility in the sacroiliac joint is maintained, manifested by pain and instability when walking. Some patients cannot sit.
I was able to operate on my patient on the 9th day after the injury, since he was transferred from another hospital after a week's stay there. Indications for submersible osteosynthesis of the pubic symphysis and technique for its implementation
In our country, preference is given to extrafocal osteosynthesis of the pubic symphysis, and the number of traumatologists who have experience in internal osteosynthesis is not as large as abroad, where the picture is exactly the opposite. There, extrafocal osteosynthesis is mainly a method of temporary immobilization for unstable ruptures of the pubis, forming part of the “damage control” system.
After stabilization of the victim’s condition, on the 5-7th day they switch to immersion osteosynthesis. The main contribution to the development of modern methods for fixing the pubic symphysis belongs to the AO group, which proposed using a reconstructive plate and spongy 3.5 and 4.5 mm screws for this purpose. This technique is currently generally accepted. The advantages of internal stable osteosynthesis of discrepancies of the symphysis pubis along the AO compared to extrafocal fixation are as follows.
Timely internal osteosynthesis allows the patient to walk independently in the early stages, he quickly adapts to normal life, and can be in society without causing compassionate glances from others. Patients with non-physical work return to their previous activities quite early. With surgical treatment, it becomes possible to more accurately compare the pubic bones with the removal of cartilage, interposition of ligaments and other soft tissues. This ensures the restoration of the ligaments that support the penis and serves as a prevention of impotence, which is of great importance for young men.
Technique of internal osteosynthesis of the pubic symphysis with reconstructive plates: Before the operation, be sure to catheterize the bladder with a Foley catheter and make sure that urine is released into the urinal. This procedure is to prevent damage to the bladder during surgery.
The size of the diastasis between the pubic bones is of great importance. The larger it is, the larger the surgical incision is required and the more dangerous this incision is, since it involves the spermatic cords, the external iliac artery and vein, and the femoral nerve.
A transverse suprapubic Pfannenstiel-type incision was used as an operative approach. First, the skin, tissue and aponeurosis are dissected. In this case, due to a discrepancy of more than 15 cm, a large incision had to be made to expose the spermatic cords and iliac arteries. Access 4 x fenestrated.
1.General information
Strictly speaking, the lunate bone in ancient times (and in the modern Latin nosological lexicon) is called “lunar”: os lunatum. However, its crescent shape resembles a crescent moon rather than a lunar disk, and therefore in many languages its name was later transformed into “semilunar bone” (the semilunar bone, le semi-lunaire os, etc.). This is a relatively small carpal bone, which is located at the base of the palm; It is separated from the radius by the scaphoid bone; nearby are the trapezoid and other bones of the wrist joint.
In general, the lunate bone does not differ in anything remarkable, with one exception: of all carpal dislocations recorded in traumatology, the largest share is due to dislocation of the lunate bone. It is located in such a way that, while providing the unique mobility of the human hand, it is also the most vulnerable to “careless” impacts and strains.
A must read! Help with treatment and hospitalization!
Diagnostics
Diagnosis begins with a visual examination, palpation of the injured area and questioning of the patient if he is conscious. Next, the doctor will order laboratory blood tests.
X-rays, including targeted ones with lateral images, are used as instrumental methods for studying fractures. To determine the location of bone fragments as accurately as possible, MRI and CT may be prescribed.
Patients who have received such damage are recommended to undergo a full examination. This procedure will prevent damage to internal organs.
If a bladder injury is suspected, cystography is performed - radiography using a contrast agent that fills the bladder. This procedure allows you to determine the condition of the organ from the image. In case of damage to the uterus and ovaries, a woman is prescribed an ultrasound of the pelvic organs.
Possible complications and consequences
Such a serious injury cannot pass without leaving a trace on the body. The difference is that for some victims these consequences are like dull echoes, while for others they are the cause of disability and lifelong suffering. What are the possible consequences:
- Decreased mobility in the pelvis.
- Various limb lengths.
- Osteomyelitis. With open wounds, the infection may have time to affect the bone tissue. Against the background of the development of pathogenic flora, bone tissue is deformed and softened. As a result, long and complex antibacterial therapy or even amputation.
- Lifelong immobility of one or both limbs. Damage to nerve structures sometimes becomes impossible to recover. As a result, the nerve innervation of the limb ceases and so it loses mobility.
- Violations of the function of internal organs.