Possible dangers of a fractured iliac bone

Causes of fracture

A fracture of the iliac bone of the pelvis occurs due to a fall, a traffic accident, or mechanical impact in the form of a blow or compression. Often such damage occurs in people who play sports professionally. In this case, the cause of injury is excessive stress on the lower limbs.

A fracture occurs not only due to physical influence. There are other causes of injury:

• Hormonal imbalances;
• Pathologies of the circulatory system, which include leukemia and others;
• Bone diseases caused by infections;
• Failure of collagen synthesis;
• Age-related thinning of bone tissue;
• Oncological pathologies of malignant bones;
• Age-related bone pathologies;
• Lack of vitamins and minerals in the body, in particular calcium;
• Bone marrow diseases.

Possible complications

The consequences of a sacral fracture appear if a person is careless about the requirements to limit motor activity and loads on the spinal column. Often this is exactly what happens - the patient is discharged from the hospital and thinks that he is healthy, starts playing sports or lifting heavy bags, and here lies his main mistake.

The list of common consequences:

• improper fusion of bones;
• acquisition of chronic pain syndrome;
• the appearance of problems with the pelvic organs, including sexual dysfunction;
• disruption of excretory processes in the body;
• change in posture;
• difficulty walking;
• loss of sensation in tissues and limbs.

Treatment and consequences of a sacral fracture are always a controversial point; success largely depends on the doctor and his attentiveness. However, you yourself influence whether the listed complications will occur to you. Take the requirements for the rehabilitation period seriously - this is important so that in the future you do not suffer an even more dangerous injury and remain disabled.

Symptoms

A fracture of the ilium is not always visible to the naked eye. If you ignore the injury, it will complicate the therapy and cause complications. To prevent this from happening, doctors recommend familiarizing yourself with the symptoms that occur during a fracture:

• Severe pain in the pelvic area, which intensifies during movement;
• The occurrence of tissue swelling in the area of ​​injury;
• Decreased muscle sensitivity in the gluteal region;
• Disproportional length of the lower limbs;
• Lack of normal movement of the leg on the side on which the suspected fracture occurred;
• Traumatic shock - increased sweating, irregular pulse, weakness, loss of consciousness, instability of blood pressure and its sharp decrease.

How to Diagnose an Injury

One of the main dangers of such damage is mild symptoms. Sometimes a person does not immediately understand that he has broken something, but gradually the pain syndrome begins to increase. Here are the main symptoms of a sacral fracture:

• Severe pain in the lower spine. It can also radiate to the lumbar region, which makes diagnosis more difficult.
• The appearance of swelling at the site of injury. On palpation, pain may occur and swelling may be felt.
• The appearance of a hematoma at the site of a contusion or large bruise.
• Difficulty in motor activity. The patient may complain that it is uncomfortable for him to sit, it hurts to lie down, or something interferes with walking. All such complaints need to be collected and documented in order to better understand which treatment method is best to use.

For the initial diagnosis of damage, a physician uses radiography, but this method does not give a completely clear picture and may show a strong deviation or the presence of fragments. The picture is taken in two projections. If the x-ray did not reveal anything, and suspicion of a fracture in this area remains, an MRI is performed. The method is painless and allows you to understand the current state of not only the bone itself, but also the tissues surrounding it.

First aid

If there is a suspicion of an iliac fracture, the patient is given first aid. The absence of one can cost a person his life. The victim is placed on his back. The legs are slightly bent at the knees and a cushion made from any available items is placed under them - a jacket, sweater, blanket and others. The patient is then hospitalized.

The victim is taken to a medical facility by an ambulance team. If the injury occurs in places remote from populated areas, the patient is taken to the hospital on their own. The main thing is not to change your body position. You cannot apply a splint to the damaged area yourself. This will lead to displacement of the bone and more dire consequences.

What are the consequences of a fracture?

If the ilium is broken, the surgeon determines by the following signs:

• Severe swelling in the damaged area.
• Sharp, acute pain with increasing character during any movement.
• Large bruise on the thigh.
• Spontaneous contraction of muscles in the abdominal area.
• Lack of sensation in the buttocks.
• Disproportional leg length.

A fracture results in:

1. Increased sweating.
2. Impaired pulsation.
3. Weakness, lethargy, loss of consciousness.
4. Sudden jumps in blood pressure.

Bruises at the site of injury are very dangerous:

• An enlarged hematoma indicates internal hemorrhage.
• Bruising in the lower abdomen indicates a tear in the urinary tract or bladder.

Even after correct and timely treatment of a fracture, complications in the form of:

1. Irreversible consequences in internal organs, which is accompanied by resection or removal.
2. Disturbances in the genitourinary systems.
3. Lack of limb movement.
4. Leg length imbalances.
5. Loss of sensitivity of the skin in the injured area.
6. Infectious infection with massive blood loss.
7. Incorrect fusion of bones.

A fracture of the ilium can result in the formation of:

• Paresthesia.
• Osteomyelitis.
• Osteoarthritis.
• Traumatic bleeding.
• Bone growth.
• Muscle atrophy.
• Damage to tissues, tendons, nerve endings and blood vessels.

Sometimes a clinical case leads to death, the cause is internal bleeding:

• Urethra.
• Bladder.
• Ovaries.
• Intestines.
• Rectum.
• Uterus.
• Vaginas.

It happens that a fracture is accompanied by:

1. Fecal phlegmon.
2. Urinary leakage.

Such complications become a source of purulent septic severe infection , and after recovery the person remains disabled.

Treatment

Treatment for the ilium depends on the nature of the damage. The doctor may prescribe the following therapeutic measures:

1. Local anesthesia, if there is no need for surgery;
2. General anesthesia if surgery is required;
3. Blood transfusion if the patient has slight blood loss;
4. Surgical intervention in case of significant blood loss, in which the damaged vessel is tightened and normal blood levels are restored;
5. Surgical treatment for complicated trauma, in which bones are joined;
6. Apply a splint and immobilize the patient until complete recovery.

A patient with a fracture of the ilium is required to remain in bed for a month after receiving the injury. If it is violated, it will lead to unpredictable consequences.

If the ilium is broken, how exactly the operation is performed is sometimes of interest to victims. The surgeon connects the bones and secures them with rods, screws or screws. They hold all the elements in one position, due to which they grow together. When the process is completed, a repeat operation is performed to remove the fixing elements.

Stress fractures (fatigue fractures) of the pelvis and femur

Stress fractures or stress fractures of the pelvis and femur occur as a result of bone overload rather than impact or trauma. Bone overload essentially means repeated, long-term, repetitive microtrauma. Typically, stress fractures occur in female athletes, but they can also occur in active young people.

Several factors predispose to stress or stress fractures, which can be divided into extrinsic and intrinsic: extrinsic factors include footwear, playing field or track surfaces, and exercise intensity, and intrinsic factors include osteopenia (decreased bone strength) and various disorders of normal skeletal anatomy. , for example, congenital varus (inward deviation) deformity of the femoral neck. All these factors must be taken into account to prevent stress fractures. Thus, long-distance runners are better off wearing shoes with soft, elastic soles and running on a surface that is not too hard. In addition, gradually, rather than suddenly, increasing the load during training reduces the likelihood of any stress fractures.

Internal predisposing factors are more difficult to influence. Anatomical defects can be corrected using orthopedic devices. Osteopenia is more common in female athletes and is part of the so-called triad of female athletes (including, in addition to osteopenia, an eating disorder and amenorrhea). It requires more active intervention from a doctor and the prescription of medications and a special diet.

In the hip area, there are stress fractures of the femoral neck, sacrum, pubic ramus, ischium, acetabulum and femoral head.

Stress fractures are very different from traditional traumatic fractures. For example, a hip fracture is diagnosed and treated completely differently, so we will not dwell on this issue now.

Diagnosis

Depending on the location of the stress fracture, patients complain of pain in the lower back, buttocks, groin, hip, and even knee. It first appears after physical activity, training, and then begins to occur during physical activity and even during simple standing and walking. Patients do not recall any obvious injuries immediately preceding the onset of pain.

The inspection is not very informative. Patients often spare the affected leg when walking. With fractures of the sacrum and pubic bone, palpation in the area of ​​the fracture is painful; with fractures of the femoral neck, the point of greatest pain cannot be found. With fractures of the femoral neck, the range of motion in the hip joint (especially the range of internal rotation) is reduced due to pain. For sacral fractures, the Patrick test is positive (the patient, lying on his back, places the foot of one leg on the knee of the other, and the doctor presses the knee of the bent leg to the couch, which is accompanied by pain in the lower back or buttocks). With pubic bone fractures, pain may occur when the pelvis is compressed.

To confirm or rule out osteopenia, female athletes undergo a biochemical test of blood and urine.

Stress fractures can be incomplete (marginal) or complete, passing through the entire thickness of the bone. Changes on radiographs (sclerosis, clearing, cortical hypertrophy) may not appear for a long time, sometimes up to a month. Unfortunately, x-rays often show only complete fractures, but with good quality images, this research method allows one to suspect a marginal stress fracture.

X-ray of a complete stress fracture of the femoral neck

To study the ischium, radiographs of the pelvis are required, at least in a direct posterior projection and an oblique caudal projection (“entrance to the pelvis”), as well as a radiograph of the lumbosacral spine in a lateral projection. To study the pubic bone, radiographs of the pelvis are required in the direct posterior projection, oblique caudal (“entrance to the pelvis”) and cranial (“exit of the pelvis”) projections and posterior oblique projection (according to Judet). To examine the femoral neck, a radiograph of the pelvis in the direct posterior projection, a radiograph of the hip joint in the direct posterior projection and a radiograph of the pelvis in the bilateral posterior projection are required with the patient positioned with the legs bent and apart at 45° (in the frog position).

Computed tomography is of great value in the diagnosis of stress fractures. Tomograms show the same signs of stress fractures as radiographs: sclerosis, cortical hypertrophy, and a light fracture line. Bone scintigraphy shows foci of isotope accumulation at the site of stress fractures. Scintigraphy has high sensitivity but low specificity for stress fractures, with a false-positive rate of up to 30%.

Magnetic resonance imaging, unlike scintigraphy, is not only a highly sensitive, but also a highly specific method that allows one to distinguish stress fractures from the physiological response of the bone to high load.

Magnetic resonance imaging showing a marginal stress fracture of the femoral neck

Diagnosis of stress fractures is very important, and should be the first suspect diagnosis for hip pain in young, active people. Stress fractures of the femoral neck are especially dangerous. The fact is that if you miss a stress fracture of the femoral neck, the consequences can be very severe. Without proper treatment, a marginal fracture can progress to a complete femoral neck fracture, which is much more difficult to treat and may require surgery.

In addition, a complete fracture of the femoral neck may heal slowly or even not heal at all. Another complication of a stress fracture of the femoral neck is osteonecrosis (aseptic or avascular necrosis of the femoral head), which may require major surgery such as femoral osteotomy or hip replacement.

Treatment

Treatment of stress fractures of the pelvic and femur bones is usually conservative, i.e. non-surgical. To unload the sore leg, you can use crutches at first. Then, as the pain subsides, they are allowed to step on the affected leg, gradually increasing the load until pain appears. The same tactics are used if bone pain is caused not by a fracture, but by simple overwork; in this case, recovery occurs faster.

During the recovery period, exercises that strengthen the leg muscles, but at the same time relieve the bones of the need to support body weight, are useful. Such exercises include, for example, swimming, water aerobics, and exercise on an exercise bike.

Treatment for stress fractures of the femoral neck depends on their location. According to the mechanism of their occurrence, lower stress fractures are compression; they rarely progress to complete fracture and are therefore treated conservatively. The sore leg is unloaded based on complaints. If supporting the leg is painful, the patient is placed on crutches for up to one and a half months; then, if supporting the leg no longer causes pain, the ban is lifted and physical exercise is prescribed. It is necessary to increase the load extremely carefully, focusing on the severity of pain. If long-term conservative treatment is ineffective, surgery is indicated.

Surgery. Upper stress fractures of the femoral neck more often develop into a complete fracture with displacement of bone fragments, therefore they are considered an indication for preventive percutaneous fixation (osteosynthesis) of the head and neck of the femur. Under fluoroscopic guidance, three hollow screws are screwed into the head through the outer surface of the femur, parallel to each other, positioned at the corners of an imaginary isosceles triangle for maximum stability.

Osteosynthesis of the femoral neck with three screws for a stress fracture

The prognosis for stress fractures is good, with the exception of only superior stress fractures of the femoral neck, which require major surgical treatment. If treatment for a stress fracture of the femoral neck is inadequate, serious complications are possible and recovery will not always be complete. Return to sports may take up to 6 months (for stress fractures of the femoral neck, less for other fractures). Repeat X-rays and bone scintigraphies help determine whether the fracture has healed sufficiently to resume training. As the load on the affected leg increases, x-rays are repeated to ensure that the fracture is not progressing.

Materials used when writing this article:

Bencardino JT et al: Magnetic resonance imaging of the hip: sports-related injuries. Top Magn Reson Imaging 2003; 14(2): 145.

Shin AY, Gillingham BL. "Fatigue Fractures of the Femoral Neck in Athletes" J. Am. Acad. Ortho. Surg., Nov 1997; 5: 293 - 302.

Rehabilitation period

The rate of bone tissue fusion is influenced by several factors:

• Age of the victim;
• The presence of harmful addictions - smoking and alcohol abuse;
• Nature of injury;
• The presence of pathologies in a chronic form.

Activities prescribed by the doctor during the rehabilitation period:

1. Taking medications that accelerate bone healing;
2. Massotherapy;
3. exercise therapy;
4. Physiotherapy and others.

Bone tissue fusion occurs within a month to a month and a half.

It takes 6 months or more to fully restore motor function.