FRACTURES OF THE PELVIC BONES. Children's Orthopedic Institute named after. G.I. Turner

Anatomy of the ischium

The ischium, combined with the pubis and ilium, form the pelvis, the largest pelvic bone in the human body. In an adult, these segments grow tightly together in the area of the acetabulum, the place to which the femur is attached to form the hip joint.

The ischium is located at the base of the spine, and in its anatomical structure there are 2 main parts:

body - takes part in the formation of the acetabulum;
branch - connects with the opposite one at an angle, forming the ischial tuberosity.

The pelvic bones are a reservoir for internal organs. They are durable, so cases of their fractures are diagnosed less frequently than injuries to long bones. Damage poses a danger to human life, since there is always a risk of rupture of the intestine with sharp bone fragments.

The relationship between anatomy and injury

During childhood and adolescence, coaches, parents, and other involved adults must take into account the characteristics of the pelvic structures. This is especially true for girls - if they wear high heels or engage in intense sports (jumping, impacts on the hips and pelvis), there is a high risk of deformation and movement of the bones. All these factors lead to narrowing of the pelvis - a serious complication that interferes with normal childbirth.

However, not only sports loads and heels can lead to deformation of the sciatic sector. This is also affected by:

Causes of fractures

A fracture of the ischium is a serious injury that is difficult to sustain in everyday life. The human pelvis is very strong and can withstand significant loads. However, the pelvic bones can also be damaged if the mechanical pressure on them is not calculated. The most common causes of fractures include:

an unfortunate fall on the buttocks, especially on ice or another hard surface;
excessive compression of the pelvic bones;
Road accident with increased pressure or impact to the pelvic area;
sports-related injuries.

Depending on the nature of the injury, a fracture of the ischium may be stable or unstable. In the first case, the anatomical structure of the pelvic ring remains unchanged - it is a structure formed by the pelvic bones (including the ischium, pubis and ilium) and the sacrum. Unstable fractures occur with a violation of the integrity of the pelvic ring, and therefore are more dangerous for humans. Fragments of the ischium can change their location with any movement in the hip joint, after which they injure internal organs.

Features of the ossification process

The process of ossification of the ischial structure is interesting in human anatomy:

the first points are formed in the 4th month of fetal formation;
if you take an x-ray before childbirth, the upper branches of the sciatic joint will be clearly visible in the pictures;
at the time of birth, all pelvic elements are connected to each other by cartilage, and not by bone structures;
after 4-5 months of life, the lower branches begin to form in the child;
the process of branch formation is completed by 2 years of life.

This process is characterized by an asymmetrical course, so on an x-ray, the baby’s bones on one side may differ significantly from the image of the opposite zone.

Bone fusion begins at the age of 7-8 years. During this period, the lower points connect and the upper ones begin to form. If you look at an x-ray photo of the ischium, you can see the rounding of the top.

By the age of 13-17, the pubic and ischial areas are completely connected, and the acetabulum is formed. By the age of 22-25, depending on the gender of the person, complete ossification, fusion and smoothing of the sutures occurs.

Classification and symptoms

Symptoms of ischium fractures vary depending on the nature of the fracture. The injury is rarely isolated; more often it occurs in combination with large-scale soft tissue damage. However, there are certain signs that indicate a fracture of this particular structure.

The ischium is one of the components of the pelvic bone, along with the pubis and ilium.

If the ischium fracture is stable, localized on one side on a bone that does not participate in the formation of the pelvic ring:

local soreness;
swelling of the tissue around the fracture site;
“stuck heel” syndrome - when lying on your back, it is impossible to raise your leg straight at the knee joint.

A unilateral or bilateral fracture of the ischium, which takes part in the formation of the pelvic ring, may also occur. Identical symptoms occur when the ischium is damaged on one side and the pubis on the other:

the presence of a local focus of pain, which increases when trying to turn or lie on one side;
positive reaction to the sticky heel test.

The most severe clinical picture occurs in those patients who have a broken ischium with disruption of the integrity of the pelvic ring. This injury can be identified by a number of characteristic symptoms:

acute pain in and around the fracture area;
positive response to stuck heel syndrome;
the patient is forced to be in a position where his legs are bent at the knee joints and moved to the sides (frog pose).

More detailed diagnostics are carried out using instrumental methods. The most common diagnosis is closed fractures of the ischium. The fragments do not change location, so treatment is quick and without consequences. When the ischium is fractured without displacement, the internal organs are not injured if the victim does not make sudden movements and aggravate the situation.

General manifestations of a fracture

A fracture of the ischium is a serious, painful injury. The patient experiences traumatic shock with a sharp depression of the functions of all organ systems. Painful shock develops in more than a third of patients with a simple pelvic fracture. If the injury is combined with damage to the integrity of internal organs, a state of shock occurs in 100% of cases. It is manifested by pallor of the skin and mucous membranes, the appearance of cold sweat, a decrease in blood pressure along with an increase in heart rate, as well as fainting.

If you suspect damage to the ischium, place the victim in a frog position and place a bolster under his feet.

The following symptoms may appear immediately at the time of injury or after it:

if the urethra is damaged by fragments of the ischium - bleeding from the genitals;
impaired urine output;
the appearance of an extensive painful hematoma;
visual change in the structure of the pelvis - it becomes asymmetrical, but the patient cannot return it to its normal position;
inability to support limbs;
severe pain, which especially intensifies when trying to move the leg or transfer weight to it;
if the intestinal walls are damaged, intestinal bleeding is observed;
imbalance of normal intestinal microflora.

The first sign that a fracture has occurred with mixing is bleeding. In most cases, the patient remains in a state of shock after injury and may not feel pain. Pelvic fractures with and without displacement require urgent hospitalization, and you should not transport the victim yourself.

First aid to the victim

The first thing you can do to help the victim is to call an ambulance. While waiting, you should not try to analyze the injury, conduct tests or any other manipulations. Before the doctors arrive, it is recommended to be in the frog position - lie on your back, bend your legs at the knee joints and spread them apart. This way the pain will be less pronounced. To relieve pain and prevent swelling, you can take a pain reliever and apply a cold compress to the injured area.

Diagnostic methods

The purpose of diagnosis for pelvic fractures is to determine which bones were damaged and in what area. In addition, it is important to determine the nature of the fracture and the presence of complications. The first diagnostic test is radiography. The photographs clearly show all the bones and their fragments, as well as some internal organs.

For additional diagnostics of the urinary system organs, contrast agents are used. They are inserted into the lumen of the urethra, and then pictures are taken. In this way, the integrity of the urinary tract can be determined. If damage to the bladder is suspected, it is examined using cystography.

Treatment

Treatment of a fracture of the ischium is a set of measures aimed at restoring its integrity. First of all, the patient must be taken to the hospital and at the same time try not to provoke mixing of bone fragments. In a hospital setting, the patient is in a supine position, in a frog position, and his legs are placed on a low bolster.

Conservative treatment

Non-surgical treatment is possible for uncomplicated fractures if there is no risk of complications. The first condition for the treatment of all fractures is immobilization of the damaged bone. For tubular bones of the limbs it is convenient to use plaster casts, but for pelvic injuries this option is not available. There are several options for fixing the ischium:

a fixing hammock that supports the lower back and pelvis, removing all stress from it;
Beler splints - a rigid structure that prevents all movement of the patient in the area of the fracture.

To restore bone integrity, the victim must spend at least several months in fixation structures

Provided that the bones are securely fixed, healing occurs within 2-3 months. Treatment can be continued at home, but it is important to follow all doctor’s recommendations.

Surgical intervention

Surgery is necessary to treat complicated fractures with damage to internal organs. During the intervention, the surgeon stops the bleeding, sutures the wounds and treats them with disinfectant solutions. In addition, the integrity of the bones can be restored surgically - for this you will need metal plates.

Medicines

Drug therapy is prescribed for both conservative and surgical treatment of pelvic fractures. The patient may be prescribed the following groups of drugs:

antibiotics - to destroy pathogenic microflora and prevent it from entering the wound;
anti-inflammatory and painkillers;
calcium and phosphorus preparations, vitamins;
chondroprotectors - tablets or ointments that stimulate the regeneration of cartilage and bone tissue.

The course of taking medications can continue long after the fixatives are removed. At this stage, products can be used in the form of ointments or creams.

Recovery period

Properly performed surgery for a fracture of the pubic or ischial bone will avoid unpleasant consequences in the form of disability. But even after a correctly performed procedure, the patient requires a rehabilitation period. Its duration can be quite significant, since such injuries are considered serious injuries.

For one month or more, the patient must remain in bed. Only after this time can the doctor allow light loads.

During rehabilitation, it is imperative to regularly perform special therapeutic exercises that will help the patient recover faster. Their main task is to strengthen the tone of the pelvic muscles and their development. Gymnastics must be done constantly, but without overexerting.

Recovery from an ischium injury also consists of several procedures:

Massage;
Electrotherapy;
Thermal radiation treatment;
Balneotherapy;
Diet therapy;
Medicines containing collagen.

Rehabilitation after fractures

An equally important stage is recovery after a fracture. The pelvic bones will not be able to immediately bear a large load, so you will have to return to your normal life gradually. Doctors have several recommendations on how to quickly rehabilitate and get in shape after a fracture of the ischium:

physical therapy - exercises to develop the strength and elasticity of muscles and ligaments; they should not be accompanied by painful sensations;
physiotherapy - procedures to improve blood circulation, lymphatic drainage and regenerative processes in cells, due to which they are quickly renewed;
massage - useful only after eliminating acute inflammation and pain;
diet - the diet should contain a large amount of foods with calcium and vitamin D (dairy and fermented milk products, cheese, nuts, vegetable oils, fish and others).

A fracture of the ischium is a serious injury. Even after recovery, you can forget about serious sports and intense physical activity. Bones remain fragile and prone to damage, especially in old age.

The relationship between diseases and bone abnormalities

In the area of the sciatic plexus there are many nerve endings, blood vessels, part of the spine and internal organs are very densely located. Constant pain and discomfort in this area indicate injury, inflammation and infection:

injuries are dangerous because the sciatic joint is displaced under the influence of a fracture or dislocation, its functions are disrupted;
sometimes the cause of acute pain is intense physical activity - a person needs to reduce the amount of exercise, otherwise excessive stress will lead to additional injuries and inflammation (bursitis);
neoplasms – shooting pains can occur due to tumors that form in cartilage or internal organs;
blood diseases such as leukemia and bone marrow pathologies can cause constant discomfort throughout the body;
tuberculosis and osteomyelitis of bones are infectious infections that cause high fever and other symptoms;
due to a lack of calcium, potassium, magnesium, and vitamin D, metabolic processes are disrupted, which in the first stages causes pain and then bone pathologies.

Diagnosis requires instrumental research methods; it is impossible to make a diagnosis “by eye”. Regularly taking NSAIDs or other medications to try to relieve pain can be harmful to the body.

Possible complications

If treated promptly, non-displaced pelvic fractures are treatable. However, in difficult cases, in the presence of fragments and displacement of fragments, dangerous consequences of a fracture may occur:

insufficient rate of fusion of fragments;
bone fusion in the wrong position;
impaired sensitivity of the lower extremities;
shortening of legs;
contracture (immobility) in the hip joints;
entry of bacterial microflora and development of purulent inflammation;
the need for additional therapeutic measures to restore damaged internal organs.

A fracture of the pelvis and ischium is a dangerous injury. Compared to injuries to other skeletal bones, it occurs much less frequently, but more often causes dangerous consequences. If you suspect a fracture of the pelvic bones, it is not even recommended to provide first aid to the victim - this can provoke displacement of bone fragments and injury to internal organs. The treatment is long, and even after full recovery the patient still has a list of limitations.

Functions of the ischial joint

In addition to the fact that the correct position of the sit bones is very important for women, their normal development ensures the implementation of additional functions:

protection of organs located in the abdominal cavity, including: the bladder, intestines, elements of the reproductive system;
supporting role - the ischium is part of the system of attachment of the lower limbs to the body.

Any unpleasant symptoms that bother you for a long time should alert a person. Fractures, bruises, cracks and dislocations, as well as some other pathological processes are extremely dangerous to the health of both an adult patient and a child.