First aid for a fractured pelvic bone: symptoms, treatment

A little anatomy

The pelvis is located in the lower part of our body. Its powerful bone ring, connecting the spine with the lower extremities, consists of the sacrum (the large triangular bone at the base of the spine), the coccyx and two nameless bones, also known as the hip bones. Each of them, in turn, consists of three more bones: the ilium, the ischium and the pubis. At the birth of a person, they are laid down as separate, but as his skeleton matures, they become united. The place where they meet forms part of the hip joint and is called the acetabulum.

The bones of the pelvis and the sacrum are connected by ligaments (connective bundles), and together they form a cup-shaped cavity under the rib cage that contains the pelvic organs. In addition to large nerve trunks and blood vessels, it contains the bladder, part of the intestinal loops and reproductive organs. The pelvis both protects these important organs and is where the muscles of the legs, abdomen and thighs are attached.

Objectives of the rehabilitation period

The main feature in the treatment of pelvic bone fractures is a long stay in a forced position. During this period, physical activity is contraindicated.

During this time, a decrease in muscle mass occurs, a change in blood circulation and nutrition of the surrounding soft tissues. Therefore, the main objectives of rehabilitation are the following:

Prevention of trophic changes.
Prevention of congestion in the pelvic organs.
Restoration of normal functioning of internal organs.
Return of full function of support and walking.

Causes of pelvic fractures

The main causes of pelvic fractures are high-energy injuries, which can be caused by the following circumstances:

Impacts during road traffic accidents.
Compression of the pelvis during collapse of any structures.
Falling from height.
Decrease in bone quality in older people caused by osteoporosis. In such cases, fractures are observed when falling even from one’s own height.
Pelvic injuries at the muscle attachment site in young athletes caused by immaturity of the skeletal system.

A set of exercises at the second stage

Elements of daily gymnastics are developed taking into account the patient’s characteristics. Physical activity begins in a lying position and then sitting.

First of all, healthy limbs are trained, finishing with the one in which movements are limited. You can do the following exercises:

Flexion and extension of the hands and feet alternately up to 15 times.
Circular movements in the ankle joints.
Turn your feet in and out.
Trying to hold various objects with your toes.
Flexion and extension of the legs at the knee joints.
Changing position from lying on your back to sitting.
Circular movements with legs alternately.
In the lateral position, perform abduction of the limb.

Important

! Exercises are performed strictly under the supervision of a rehabilitation specialist.

Types of fractures

Since the pelvis has the shape of a ring, a fracture of one of its parts often ends in a fracture or damage to the ligaments of another. Damage to the pelvic bones is determined by the direction of the fracture line, taking into account the traumatic force that caused them.

According to the classification, in modern medicine the following groups of pelvic bone fractures are distinguished depending on whether the structure of the integrity of the pelvic ring is preserved or damaged:

Stable fractures - without disruption of the pelvic ring.
Rotational unstable or partially stable fractures are multiple fractures with disruption of the pelvic ring (for example, one half of the pelvis is displaced upward).
Unstable fractures are a complete rupture of the sacroiliac joint or a fracture of the floor of the acetabulum and its edges, sometimes with hip dislocation.
Fracture-dislocations are fractures with dislocation in the sacroiliac or pubic joint. With this type of injury, a fracture of the pelvic bones is combined with a dislocation in the pubic or sacroiliac joint.

Stable (low-energy) injuries include injuries with preserved anatomy of the pelvic ring and having one fracture line. They usually grow together quite well.

Rotational unstable fractures are characterized by damage to the integrity of the pelvic ring at two or more points. They are characterized by disruption of the pelvic anatomy as a result of high-energy injuries. Depending on the injury, fractures may be vertically unstable or rotationally unstable.

The first are characterized by a violation of the integrity of the pelvic ring in the anterior and posterior sections and displacement of fragments in the vertical plane. Rotational or rotationally unstable fractures include fractures with displacement of fragments in the horizontal plane. Such injuries are accompanied by quite serious complications, including massive bleeding, damage to internal organs or infections. For representatives of the stronger sex, this type of injury can sometimes lead to a fracture of the penis. With timely and effective treatment of complications, partially unstable fractures also heal well.

Fractures of the acetabulum are accompanied by dysfunction of the hip joint and pain, which intensifies with tapping on the thigh and axial load. Hip dislocation is characterized by a violation of the position of the greater trochanter and a forced position of the limb. An example of the most common mechanism for such injuries is a strong blow to the knees of the driver and front passenger during an accident.

With fracture-dislocations of the pelvic bones, in addition to pelvic fractures, there is a complete displacement of the articular ends of the bones relative to each other.

The above fractures can be either open or closed. With the former, damage to the skin in the area of the fracture is observed, and, unlike the latter, they require urgent medical intervention, since they open the way to infection.

It should be noted that there is a difference in the treatment methods for low- and high-energy injuries of the pelvic bones. In case of low-energy injuries, conservative treatment is sufficient, while high-energy injuries require surgical intervention.

Pelvic fractures complicated by damage to the pelvic organs

As soon as a diagnosis of damage to the bladder or urethra is made, the patient must be operated on immediately.

Conservative treatment . The leading role assigned to conservative methods of treatment of patients with pelvic fractures accompanied by disruption of the continuity of the pelvic ring has determined the need to review the fixation and reduction capabilities, which in the generally accepted version do not ensure proper restoration of the pelvic ring.

Treatment with rest on a hard bed . The method is used for slight displacement of bone fragments. An analysis of the placement of patients in bed for treatment using this method shown in the literature showed that none of them provides the necessary muscle relaxation. When moving the body or limbs (patient care, self-care) due to pain, muscle tension increases even more, contributing to the secondary displacement of bone fragments.

The best immobility of the fragments is achieved by laying the patient on his back, bending the hip joints at an angle of 35-40°, knee joints at an angle of 125-135°, raising the head end of the body to flexion in the thoracolumbar spine at an angle of 40-45°; the shins rotate outward at an angle of 45° when the lower extremities are abducted by 5-10°. In this position of the victim, the antagonist muscles, to a greater extent than in any other position, mutually balance each other. Thanks to this, the risk of secondary displacement of bone fragments is significantly reduced. The study of radiographs of the pelvis during treatment using this method made it possible to establish that in this position the victims practically do not experience secondary displacement of fragments, which is often the case during treatment in the typical Volkovich position.

Treatment with controlled pelvic girdle. The limited possibilities of treating patients with ruptures of the pubic symphysis and sacroiliac joint using traditional methods: hanging the pelvis in a hammock, using compression bandages - was the basis for the use of a more advanced device - a controlled pelvic girdle.

The pelvic girdle can be made in any orthopedic and traumatology department. It consists of a fabric part, a leather part and six straps with adhesive edges - three on each side: two are main and 4 are auxiliary, they end with metal rings. A special cut is made for the perineum.

The restraining belts are secured at one end to the lower part of the panel, and at the other ends there are loops sewn at the base of the belts.

The pelvic girdle is applied after preliminary performing an intrapelvic novocaine blockade according to Shkolnikov-Selivanov on both sides. Position the patient on his back, on a bed with a shield. Two standard Balkan frames are installed, the distance between the crossbars corresponds to the width of the bed. The fabric part of the hammock is placed under the pelvis and sacrum; the leather part of the hammock covers the pelvis from the front and sides.

When applying a pelvic girdle, it is necessary that two belts coincide with the upper edge of the ilium, and two are at the level of the greater trochanters of the femurs. All 6 belts cross over the pelvis. Strong cords are secured to the rings, from which the load is suspended through damping springs, having previously threaded the cords through the blocks of the Balkan frame. Weights are installed at the height of each belt. The size of the loads and the direction of the pulls on the belts are selected individually in each specific case, depending on the size of the diastasis and the nature of the displacement of the fragments. Reposition is carried out due to the appropriate direction of the forces of traction on the belts, and compression by suspended weights holds the bones during the treatment process.

Design features make it possible to successfully use the belt in the treatment of both isolated ruptures of the pubic symphysis and sacroiliac joint, and those combined with fractures of the bones of the anterior and posterior semi-rings of the pelvis with large transverse and slight longitudinal displacement of the fragments.

Treatment with skeletal traction. The method is used for the most complex fractures and fracture dislocations of the pelvic bones in order to eliminate the longitudinal upward displacement of half of the pelvis. The effectiveness of the method increases with skeletal traction directly from the pelvic bones. True, when using large loads, pulling on the pelvic bones often causes a complication: the cutting of the spokes through the ilium. To effectively use large loads to restore the anatomical relationships of displaced pelvic fragments, CITO uses rectangular metal plates with holes for knitting needles with thrust pads. Plate dimensions 50 * 30 * 30 mm.

Under local anesthesia, a 3-4 cm long incision is made from the anterosuperior axis of the ilium along its crest. Using a raspatory, soft tissue is bluntly peeled off from the outside of the pelvis and a plate is placed on the smooth surface of the ilium from the inside. Two or more spokes with thrust pads are inserted through the holes in the plate, depending on the direction of the intended thrust. Weights are hung from the free ends of the spokes. The wound is sutured tightly. Traction is carried out in the direction opposite to the displacement of the bones of the pelvic ring, with loads necessary to restore its continuity.

Skeletal traction directly from the iliac bones has the following advantages:

the greatest efficiency of the applied traction forces is achieved without losses in transmission, as is the case with traction by the epicondyles of the femur;
with bilateral traction on the iliac bones and crossing of the cables, it becomes possible to eliminate the rotational displacement of half of the pelvis.

In patients with damage to the pubic symphysis and sacroiliac joint with a significant upward displacement of half of the pelvis, skeletal traction directly from the pelvic bones is combined with traction from the lower limbs.

For bilateral skeletal traction, it is advisable to use paired sliding splints, the supports of which are connected to each other on one side by a hinge, and on the other by a sliding arch with a groove for a fixing screw. This technique creates a constant direction of traction and prevents secondary displacement of fragments.

Treatment with skeletal traction in combination with the pelvic girdle. The method is used when there is a longitudinal upward displacement of half of the pelvis and damage to the joints. With this type of damage, it is necessary, along with restoring the integrity of the pelvic ring and eliminating confusion, to achieve complete adaptation of the articular surfaces of the pubic symphysis and sacroiliac joint. Only eliminating displacement of bone fragments in the presence of damaged pelvic joints is not enough for a favorable treatment outcome. Loose contact of articular surfaces, and even more so micromobility in these places, which occurs when the patient moves in bed, often leads subsequently to the development of functional insufficiency of joints, arthrosis, pain and other adverse consequences of injury. Only complete adaptation of the articular surfaces of the pubic symphysis and sacroiliac joint in conditions of absolute immobilization of bone fragments makes it possible to obtain a good result.

Treatment begins with eliminating the displacement of half of the pelvis in width, and only after that a pelvic girdle is installed and the displacement in width is eliminated. In the pelvic girdle, the patient is allowed to change position in bed. After 6-7 weeks, stop skeletal traction and replace it with cuff traction for 1-2 weeks. The pelvic girdle is inserted for the entire period of inpatient and outpatient treatment; a second examination is carried out 3.5-4 months after the injury; if there are no contraindications, the pelvic girdle is removed and the patient is allowed to walk without crutches.

Treatment using transosseous osteosynthesis. The hardware method of treatment is indicated primarily for multiple and combined injuries of the pelvis, as well as for polyfragmentary fractures. Stable external fixation facilitates the entire treatment process and care for patients in serious condition. It is advisable to use the hardware method of treatment in patients with unfavorable fractures of the pelvic bones, which are usually difficult to treat with conservative methods (ruptures of the pubic symphysis with large transverse and longitudinal divergence of the pubic bones; diagonal fractures of the Malgenya type; bilateral fractures of the anterior and posterior parts of the pelvic ring; fractures, combined with damage to the acetabulum and central dislocation of the hip, etc.).

For treatment using the transosseous osteosynthesis method, CITO has developed the Cherkes-Zade device. Threaded rods are used that can be inserted into the wings of the ilium, pubic bones and into the supraacetabular region of the pelvis. The direction and location of insertion of the rods depend on the type of fracture. Reduction of fractures is carried out on a stationary part of the apparatus attached to the operating table. The rods are connected to each other by threaded beams at two levels, thereby achieving high stability of fixation. Residual displacement of bone fragments is eliminated using connecting nodes by moving the rods along the beams and creating additional levers in the apparatus from standard nodes. After surgery, patients, as a rule, quickly recover from a serious condition, become mobile and, most importantly, switch to self-care.

Primary and delayed osteosynthesis. Surgical methods are more often used for isolated pelvic injuries, which have a significantly less impact on the general condition of the victims than multiple and combined injuries. For fresh fractures of the pelvic bones, surgery is indicated in cases of unsuccessful treatment with conservative methods, provided the patients are in good general condition. The operation should be performed no later than 2.5-3 weeks from the moment of injury. At a later stage, surgical reduction becomes difficult, sometimes even impossible.

For stable fixation of bone fragments during external osteosynthesis of pelvic fractures, CITO uses a special device with a set of plates of a multi-link adjustable design, developed by D. I. Cherkes-Zade. This device contains plates equipped with bushings with an ellipsoidal groove. During the operation, the plates can be connected to each other by means of a figured ring with an ellipsoidal head, thereby achieving the required length and configuration of the prefabricated structure and any desired angles between the links. In all, this allows for strong fixation of fragments in any part of the pelvis.

Precise reposition of fragments and their immobility create favorable conditions for reparative regeneration. Thus, immature intermediary callus after osteosynthesis of the pelvic bones appears already in the first 2-3 weeks after fixation of fragments, and primary bone fusion occurs 4-8 weeks after the operation. With conservative treatment, when proper reposition is not achieved, as a rule, secondary bone fusion occurs, which occurs no earlier than after 3-6 months.

Stable osteosynthesis of pelvic bone fractures allows for active management of the patient without additional external immobilization, significantly reduces the time of hospital treatment, and prevents the development of severe post-traumatic deformities of the pelvis.

Tendon grafts are used to surgically repair damage to the pubic symphysis.

The area of the damaged pubic symphysis is opened layer by layer, and the periosteum is peeled off along the anterior and posterior surfaces of the vertical descending branches of the pubic bones from the center to the periphery in the form of an apron. In the pubic bones, two canals are formed symmetrically on each side in the anteroposterior direction. Tendons are passed through channels at two levels parallel to each other. In cases of uneven-high displacements, a third tendon is additionally inserted in an oblique direction. After repositioning, the tendon is fixed in a state of maximum tension with ligatures and then covered with periosteum, which ensures the sealing of the grafts necessary to maintain the spring structure of the joint. Additionally, plastic surgery of the anterior symphysis ligaments and restoration of the vesico-pubic ligament are performed.

With simultaneous damage to the pubic symphysis and sacroiliac joints with a discrepancy in width without additional upward displacement of half of the pelvis, using the above operation it is possible not only to reduce the pubic bones in the symphysis area, but also to restore the correct anatomical relationships in the sacroiliac joints, provided that the operation performed no later than 7-9 days after injury. If the operation is performed at a later date, it is possible to eliminate only the discrepancy of the pubic bones in width.

In case of polyfocal fractures of the pelvic bones in combination with damage to the pubic symphysis, allotendoplasty of the symphysis will be supplemented with osteosynthesis.

Untimely displacement of fragments of the pelvic bones due to combined damage to internal organs, multiple fractures of long tubular bones, aggravating traumatic shock, and in some cases the ineffectiveness of conservative treatment or the impossibility of timely provision of specialized care for injury are the causes of complex and interrelated anatomical changes: pelvic deformation , spine, functional disorders in the joints of the lower extremities. These changes make walking difficult, change statics, cause pelvic distortion and scoliotic alignment of the spine. All this is accompanied by pain and significantly reduces the ability of patients to work, and in many cases causes disability.

Surgical treatment of chronic pelvic injuries with disruption of the continuity of the pelvic ring is one of the difficult problems of traumatology and orthopedics.

The literature describes only isolated cases of reconstructive operations for chronic ruptures of the pubic symphysis, isolated or combined with a rupture of the sacroiliac joint.

Surgical interventions are performed aimed at restoring the pelvic ring (its anterior and posterior sections), using autoplastic materials and various fixing structures.

Indications for osteoplastic surgery to restore the pelvic ring are:

chronic injuries of the pubic symphysis and sacroiliac joint with a discrepancy of the pubic bones of more than 5 cm;
chronic injuries of the pubic symphysis and sacroiliac joint with a discrepancy of the pubic bones of more than 5 cm, with an improperly healed fracture of the anterior pelvic ring;
chronic ruptures of the pubic symphysis with divergence of the pubic bones by more than 5 cm, accompanied by damage to the sacroiliac joint with dislocation of half the pelvis and improper fusion of the bones of the anterior and posterior sections of the pelvic ring.

If there is a significant discrepancy of the pubic bones (more than 10 cm) and it is impossible to eliminate it with conservative methods, the first stage of restorative treatment consists of applying a rod-based external fixation device, with the help of which the pubic bones are brought together as much as possible.

In cases where the divergence of the pubic bones occurred in one plane and there was damage to the sacroiliac joint, the Ilizarov apparatus is used. If a rupture of the symphysis is combined with damage to the sacroiliac joint and displacement of half of the pelvis, the Cherkes-Zade apparatus is used, equipped with a reduction device that allows simultaneously eliminating any type of displacement of the pelvic bones and holding them in the achieved position for the required time. In the absence of pain in the posterior part of the pelvic ring and bony fusion of the sacroiliac joint, confirmed by X-ray, an external fixation device is not applied to bring the pubic bones closer together, but is limited to restoring the anterior half-ring of the pelvis.

The second stage of surgical rehabilitation of patients with chronic injuries of the pelvic ring is aimed at stabilizing its posterior section, which, as is known, bears the main static load. For this purpose, arthrodesis of the sacroiliac joint is performed using shaped plates of a multi-link structure for osteosynthesis, the length and configuration of which are selected during the operation. The use of this design ensures reliable, stable fixation of the pelvic bones and the development of ankylosis in the sacroiliac joint.

Method of osteoplastic restoration of the posterior semi-ring of the pelvis. The patient is placed on his stomach. The incision begins two transverse fingers anterior to the posterior superior axis of the ilium, continues along the iliac crest posteriorly, and ends parallel to the midline. The sacroiliac joint is exposed, and the remains of ligaments, cartilage and scars are excised. After the bones come together, the autograft is tightly inserted into the groove made in the sacrum and ilium. The pelvic bones and autograft are fixed with a shaped plate and a plaster cast is applied.

The third and final stage of surgical rehabilitation involves osteoplastic restoration of the anterior pelvic ring. The remaining defect between the pubic bones is replaced with a bone autograft of the required size, taken from the wing of the ilium. The autograft is fixed with shaped plates.

Method of osteoplastic restoration of the anterior semi-ring of the pelvis. The skin incision is made parallel to the lower transverse fold of the abdomen, 1 cm below it. Using a raspatory, the periosteum is separated from the bone and retracted towards the anterior surface of the pubic symphysis to the pubic tubercles. It is important not to injure the tubercles, especially at the site of attachment of the pupart's ligament. After exposing the anterior surface of the pubic symphysis, the rectus abdominis muscles are dissected at the points of attachment to the pubic bones to the pubic tubercles and the finger is penetrated along the posterior surface of the pubic symphysis into the prevesical space. The prevesical fascial plate with the anterior wall of the bladder is bluntly displaced posteriorly. This discharge is produced throughout the entire diameter of the wound. Then, using a raspator, sections of the edge of the pubic symphysis are skeletonized. Cartilaginous tissue is removed from the symphysis area and a wedge-shaped groove is made with a chisel on the lateral surfaces of the pubic bones. The height of the ledge must correspond to the height of the autograft, which can vary from 2 to 4 cm, which is necessary for its stable adherence to the pelvic bones.

At the end of the operation, a bilateral shortened coxite plaster cast is applied to the knee joint for 2-3 months or fixation in the rod apparatus is continued. After removing the plaster cast or apparatus and X-ray control, a course of physical therapy, massage and physiotherapy is prescribed; The patient is discharged for outpatient treatment wearing an orthopedic compression belt.

Thus, the prospect of improving the results of treatment of patients with pelvic injuries is associated with the use of improved conservative and surgical treatment methods. The use of such methods made it possible to avoid, in the long-term period after injury, the forced expansion of indications for surgical treatment due to improper fusion of the pelvic bones and unresolved divergence of the pubic symphysis and damage to the sacroiliac joint.

Symptoms of a pelvic fracture

During the initial visual examination of the victim, the following is recorded: discolored skin, increased sweating, rapid heartbeat, drop in blood pressure, as well as unbearable pain in the pelvic area and the inability to rise to one’s feet. Destruction of the pelvic bones due to impact or compression is often accompanied by separation of their parts, which causes swelling and inflammation caused by complications due to the fracture.

Bone fragments can damage soft tissue, causing additional injury and bleeding. Hematomas are observed in the area of injury, a crunch is heard when palpated if there are moving bone fragments, which, in turn, can cause rupture of the bladder or urethra. Open fractures increase the risk of infection and the development of purulent inflammation (bloody urine may appear). Along with traumatic shock as a result of an impact or compression of the pelvis, paralysis may develop as a result of damage to the nerves and vessels of the pelvic area by bone fragments.

Upon a more detailed examination, specialists note the following signs in the victim that are characteristic of a fracture of the pelvic bones:

“Volkovich position” (“frog pose”): on the back, with hips apart and legs bent at the knees and hip joint, the feet of which are turned (rotated) to the outside. (The name bears the name of Professor N.M. Volkovich, who first described it in 1928).
Symptom of a “stuck heel”: the inability to lift and hold a straightened leg on your own and keeping it raised if someone helped to lift the leg. This symptom is considered the most important in diagnosing pelvic fractures.
“Verneuil's symptom” - increased pain in the event of even slight compression of the wings of the pelvis.
“Larrey's symptom” is increased pain when the wings of the pelvis are separated.
Acute pain does not allow the victim to independently take a sitting position, since taking this position is associated with tension in the rectus abdominis muscles, which are attached to the site of the most common pelvic fractures - its anterior section.
Turning the feet outward, characteristic of a reflex reduction in efforts from the adductor muscles of the thighs.
The inability to move the leg back and to the side (to the places of muscle attachment) while being able to stand up and walk is evidence of avulsion fractures.
Extensive hemorrhages in the perineum and groin also confirm a fracture of the anterior pelvis.
A change in the shape of the pelvis (asymmetry or visible deformation) is a clear demonstration of a severe fracture.
Drops of blood in the external opening of the urethra, as well as the inability to urinate independently or blood at the end of urination, are evidence that a fracture of the pelvic bones is complicated by a rupture of the urethra and injuries to the bladder, and sometimes the kidneys.

Making a final diagnosis and prescribing treatment if such disorders are detected is preceded by a comprehensive study in a hospital setting.

Symptoms

Symptoms of displacement (distortion) of the pelvis can be either moderate or severe and significantly impair the functionality of the body. With moderate misalignment, a person may feel unsteady when walking or may experience frequent falls.

The most common symptoms such as pain are:

In the lower back (with irradiation to the leg)
Pain in the hip, sacroiliac joints, or groin
Pain in the knee, ankle or foot Achilles tendon
Pain in shoulders, neck

If the pelvis is misaligned for a long time, the body will correct and compensate for biomechanical imbalances and asymmetries and corresponding adaptations of muscles, tendons and ligaments will occur. Therefore, treatment may require some time. In addition, pelvic distortion can be difficult to correct, since over time a pathological pattern of movements is formed. The longer the period of pelvic distortion, the longer it takes to restore normal muscle balance.

First aid for a pelvic fracture

Correctly provided first aid at the slightest suspicion of a fracture of the pelvic bones will help to avoid unpleasant consequences, and the speed and professionalism of those nearby will prevent death if the victim has severe pelvic injuries.

In the event that doctors are immediately next to the victim, the first step is to relieve the shock symptom and reduce the pain syndrome. To do this, pain relief is carried out, in particular, the introduction of special medications directly into the fracture site (pain blockades). If the injury is accompanied by bleeding, it is necessary to treat open wounds, apply pressure bandages to bleeding vessels, and in case of significant blood loss, restore blood circulation. Only after this the patient should be carefully transferred to a stretcher and transported to the nearest medical facility.

However, doctors are not always immediately available, which is why up to 30% of victims with isolated trauma are admitted to the hospital in a state of traumatic shock. Statistics show that death in such cases occurs in 6% of cases. This is one third lower than in those hospitalized with multiple pelvic fractures, where shock is observed in almost all victims, and death occurs in 20% of cases, mainly as a result of heavy internal bleeding.

Before doctors arrive, it is especially important to properly prepare the victim for transportation. Below is an approximate algorithm of actions of rescuers located next to the victim:

Call the doctors, assess breathing, pulse and examine the victim for injuries.
Provide rest to the victim and, if necessary, immobilize the cervical spine.
Relieve pain shock with affordable medications, if they are at hand. For those who are conscious and without obvious signs of severe injuries to the pelvic organs, two Analgin tablets and one Diphenhydramine tablet (or Aspirin with butadione), as well as strong sweet coffee, are recommended as an anesthetic.
Drink plenty of warm fluids to relieve traumatic shock. It is recommended to give the victim warm water (up to 3-4 liters), adding 1 tbsp. a spoonful of table salt and 1 teaspoon of baking soda for every liter.
Give the patient tincture of valerian (up to 20 drops) and 20 drops of cordiamine (Valocordin or Corvalol) to prevent heart failure and calm down in order to avoid complications during transportation.
Place the injured person with his back on a hard surface, for example, a shield covered with a mattress or a door removed from its hinges, in the “frog” position: with legs half-bent at the knee joints, raised by about 30 cm, a pillow or an improvised bolster placed under them, knees apart.
Wrap a scarf, sheet or other available material around the pelvis to prevent further displacement of the broken pelvic bones.
Cover the limbs, if they are not injured, with heating pads (bottles) with hot water and wrap the victim warmly, regardless of the air temperature.
Constantly monitor the pulse until the doctors arrive and, if it is difficult to determine, raise the foot end of the improvised stretcher by 30–45 cm.

In cases where it is impossible to call an ambulance, the victim must be transported on his own. In such cases, it is necessary to gently fix his knee joints and feet and strap the injured person to an improvised stretcher.

Exercises for pelvic distortion

Exercises for pelvic distortion are recommended to be performed from the first day of diagnosis. This condition occurs especially often in adolescents against the background of existing scoliosis of the lumbar region. Before you start exercising, you should definitely consult a doctor, since with this diagnosis it is prohibited to perform certain movements. Allowed exercises must be performed carefully and with great care. And if pain appears during exercise, then you should stop exercising for a while. You also need to remember that the pelvis can be skewed in different directions, and it is advisable to take this indicator into account when doing exercise therapy.

Exercise therapy complex

You should start with a fairly simple exercise - put your feet shoulder-width apart, and press your feet to the floor. Next, rise on your toes and raise your hip. Then lower your leg again and return to the starting position. Repeat up to 10 times for each leg.

The second simple exercise is to swing your hips to the right and left, as well as in a circle. Hands should be kept either on the belt or pressed to the hips. Next, your legs should also be shoulder-width apart and your feet should be pressed to the floor. Bend your upper body and try to touch your fingers to the floor. If it doesn’t work out right away, then you need to rock the body smoothly and slowly until your fingers can touch the floor. At this time, you need to monitor your pelvis - it should not lean back.

After your fingers touch the floor, take the starting position and bend back. Repeat 10 times.

Treatment of pelvic distortion with exercises can be performed in the following way. Stand up straight, feet, pelvis and chest should be on the same plane. Imagine that you are between two high walls that restrict your movement.

Move your hips from side to side, and you should bend not only your pelvis, but also your body. Lean to the right, and with your hands on your hips, try to push them in the opposite direction. In total, you need to do 10 repetitions in each direction.

The fourth exercise is as simple as the other three. Stand up straight, clasp your palms behind your head. The elbows should be open to the side. Lower your buttocks down, as if you were squatting, but your knees should maintain an angle of 90 degrees, no more. Look only forward. Repeat 5 times.

Other options

Of course, pelvic distortion cannot be corrected by exercise alone. To get rid of this pathology, it is necessary to accurately determine the cause of the disease and eliminate it. But some exercises will be very useful, even with the maximum possible variant of the defect.

Here are two of them.

Lie on the floor, preferably on a mat. Place a small cushion under your feet. After this, you should begin to roll to the right and left on your stomach. Be sure to rock your hips as you roll. You cannot lift your pelvis off the floor. The total duration of execution is from 5 to 10 minutes. Perform up to 3 repetitions per day.
When performing the next exercise, you also need to lie on the floor and place a small pillow under your knees. Then you need to stretch your legs and swing them right and left, the range of movements should be no more than 1 cm. Completion time - 10 minutes.

Then, without getting up, spread your arms to the sides, palms facing down. Tighten the muscles of your buttocks, and use your heels to make sliding movements along the floor that will resemble steps. In this case, the pelvis will rise slightly.

Consequences

Pelvic distortion is one of the dangerous conditions that necessarily requires treatment. If nothing is done, spinal dysfunction and deformation may begin. At the same time, radiculitis, osteochondrosis, hernias begin to appear, that is, all those diseases that are considered the most common.

Over a long period of time, the disease leads to dysfunction of the upper and lower extremities. Pain may also appear, which is practically not relieved by painkillers. Many patients are diagnosed with carpal tunnel syndrome, which has no cure and can haunt a person throughout their life.

If the disease is not treated, then after a while you can become disabled and incapable of self-care.

Diagnosis and treatment

If you suspect a fracture of the pelvic bones, it is important to deliver the victim to a medical facility as quickly as possible, where, based on the results of the diagnosis, he will be prescribed qualified treatment.

To confirm the assumption of a fracture of the pelvic bones, made on the basis of existing symptoms during a visual examination of the patient, a specialist prescribes radiography and ultrasound examination of the pelvic organs. In some cases, computed tomography is used to confirm the diagnosis, as well as a surgical research technique - diagnostic laparoscopy, which allows you to see the condition of the abdominal cavity without large incisions.

Based on the results of a comprehensive study, the patient is prescribed treatment.

General principles of treatment

The treatment procedure, as a rule, is carried out in several stages and involves both taking medications and a number of surgical and physiotherapeutic procedures:

Anesthesia (intraosseous or intrapelvic anesthesia with novocaine blockades) and antishock therapy (morphine).
Fractional blood transfusion within 2-3 days after injury for isolated pelvic fractures. Transfusion of large volumes of blood, in particular, the administration of plasma, glucose, saline or blood substitutes in the first hours after injury in cases of severe pelvic injuries.
Immobilization, the type and duration of which depends on the location of the injury and the condition (damage or integrity) of the pelvic ring. Thus, in cases of marginal or isolated fractures, conservative treatment is sufficient, for example, fixing the patient on a special board or in a hammock using bolsters and splints, but violations of the integrity of the pelvic ring require skeletal traction technology.
Surgical intervention is indicated for fractures with severe displacement in cases of the presence of bone fragments, for their fixation, as well as for damage to internal organs. It should be borne in mind that the procedure for composing bones for fractures (reposition) should be carried out in the first three weeks after the injury. After this time it is practically impossible.
Rehabilitation after a fracture of the pelvic bones is a long process and requires sufficient strength and attention. The patient is prescribed medications that contain the protein collagen, which promotes normal bone restoration, and special ointments and gels.

Fracture of the ischium of the pelvis

Such injuries can be caused by severe impact on the pelvic area, in particular, a fall on the buttocks during icy conditions or while playing sports. Its symptoms include severe pain, loss of consciousness, bruises and swelling in the pelvic area, and the possibility of internal bleeding.

To confirm the diagnosis, an x-ray is performed to determine the type of fracture and the location of internal damage. Conservative treatment lasts about a month, during which the patient is required to strictly adhere to bed rest. Another 2-3 weeks are spent on rehabilitation, after which the victim returns to normal life.

Fracture of the pubic pelvis

Injury to the pubic bone can be caused by compression of the pelvis or a blow to it; as a rule, it does not result in damage to the pelvic ring, but is extremely dangerous due to the possibility of damage to internal organs. Its symptoms include swelling, inability to move, stuck heel syndrome, subcutaneous hemorrhages and disruption of the genitourinary system.

In more than a quarter of cases, such a fracture is accompanied by damage to internal organs and traumatic shock.

Treatment can be either conservative or surgical and consists of 6 weeks of immobilization and a long rehabilitation period, the duration of which is individual and dependent on a number of factors.

Acetabular fractures

Injuries to the acetabulum caused by motor vehicle accidents or falls from a height account for approximately 16% of all pelvic fractures. They are accompanied by a violation of the integrity of the pelvis in the area of the articular fossa of the hip joint, pain, forced position of the victim and impaired function of the limbs. To confirm the diagnosis, radiography and computed tomography are performed.

Conservative treatment for such fractures is indicated in more than half of the cases. It consists of skeletal traction on a special bed with a load of 6-8 kg for one and a half to two months. During traction, therapeutic exercises are performed and the victim is necessarily prescribed a course of fraxiparine to prevent the formation of blood clots (phlebothrombosis).

If conservative treatment is ineffective, as well as in the case of severe damage in the acetabulum area, the question of surgical intervention arises. However, such operations differ in their scale, duration and seriousness.

Features of treatment for pelvic injuries

Patient management tactics depend on the type of injury and the presence of concomitant disorders of internal organs. If there is no change in the configuration of the pelvic ring and the function of other systems is preserved, the orthopedist recommends a protective regime in the supine position with legs apart and bent at the knee joints. The duration of treatment with positioning takes 5-6 weeks .

Displacement of the fragments requires the application of a plaster cast or fixation using special devices. In this case, the period is extended to 8-12 weeks . If necessary, reconstructive operations of the pelvic organs are performed in order to restore their function.

Surgery for pelvic fracture

Surgical intervention is inevitable for displaced pelvic fractures, when the surgeon needs to fasten individual fragments of the damaged bone. For such cases, pelvic surgery provides devices such as knitting needles, screws, metal plates, pins and other metal structures for fixing (connecting) bones.

Surgical manipulation of the pelvic bones using such implants is called osteosynthesis and is carried out using general anesthesia. During the operation, the surgeon will have to carefully examine the internal organs that are located in the pelvic area and eliminate damage resulting from injuries using internal fixation (immersion osteosynthesis). During this manipulation, implants can be installed directly on the bone, inside it, or in combination, while remaining inside the body forever.

Osteosynthesis is also divided into closed (extrafocal) and open, based on the method of its implementation (exposing the manipulation area). In modern pelvic surgery, minimally invasive osteosynthesis is increasingly used, in which the installation of implants is preceded by mini incisions or punctures of the skin.

The use of osteosynthesis for injuries of the acetabulum is not always justified and is determined by the nature of the fracture and its location (wall or floor). In particular, the effect of such surgical intervention in the case of a comminuted fracture of the bottom is much lower than in cases of a large-comminuted fracture of the posterior wall.

In some cases, external fixation is used (percutaneously), in which Ilizarov apparatuses, rod apparatuses and their other analogues are used. They are distinguished by their superficial location in relation to the bone.

How long does it take for a pelvic fracture to heal?

A pelvic fracture is a serious injury, the outcome of treatment of which determines the future fate of a person. If the treatment is incorrect or the patient does not follow medical instructions, the bones may heal incorrectly and cause permanent problems in the future.

In general, it can take four to six months for the pelvic bones to heal and recover from injury, but for severe injuries, full recovery can take years. Despite advances in the field of modern traumatology, the number of people with disabilities after pelvic injuries remains quite significant (approximately 15%). In addition, pelvic injuries almost always derail the careers of professional athletes.

Although there is no specific time frame for complete healing of such injuries, there are a number of factors that are taken into account when making a prognosis.

These include the following:

Type of fracture: open or closed.
The location of the damage and the number of injured bones and tissues.
Level of blood supply to damaged bones.
Age of the victim: It can take six months for the bones of adults to heal, but only one for children.
General health: level of bone mineralization, blood and muscle tissue.
Presence of aggravating factors: bad habits, concomitant and chronic diseases, etc.

Recovery stages

Rehabilitation after a pelvic fracture takes a long time. This is a joint work of medical staff, relatives and the patient himself. Work to return to normal life is carried out, starting with bed rest, and includes several stages.

First period

This stage is aimed at preventing trophic changes in soft tissues. For this purpose, special devices and pillows filled with silicone material are used. They are placed under the areas of contact of the body with the surface of the bed.

This allows you to reduce pressure on the areas and restore local blood circulation. Anti-inflammatory and analgesic therapy is carried out using medications. The doctor recommends a diet that helps normalize digestion.

Second period

During the next stage, motor activity is restored. Exercises begin while lying in bed.

The patient is allowed to roll over as far as possible, taking into account the characteristics of the injury and immobilization. Massage of the torso and limbs is indicated to increase muscle tone and improve blood circulation.

Third period

At this stage, the restoration of physical activity continues. The patient learns to walk with the help of supporting devices and then independently.

At the beginning, the transition from a horizontal to a vertical position should be supervised by a medical professional. This is due to changes in the patient's condition during movement. After being in a forced position for a long time, the pressure may drop sharply and a collapsible state may occur.

In addition, decreased muscle tone of the lower extremities impedes normal supporting and motor function. Therefore, in the absence of outside support, falls are possible with the occurrence of re-injury.

Rehabilitation after a pelvic fracture

A pelvic fracture is a severe injury to the musculoskeletal system and requires a professional approach from specialists not only in diagnosis and treatment, but also in carrying out rehabilitation measures until the victim’s complete recovery.

Depending on the severity of the fracture, complete recovery from pelvic injuries may take from one and a half to six months. Individual complexes developed specifically for each case and including a number of the following activities will help with this:

Daily physical therapy to maintain muscle tone, including special exercises to prevent the development of ankylosis, contractures and other complications in the joints.
Taking special medications that help strengthen bones and nourish them with collagen for complete restoration of the musculoskeletal system.
The use of ointments, creams and gels that restore joint function and relieve pain and swelling of tissues.
Therapeutic massage, physiotherapy.
Walking in the fresh air with a gradual increase in their duration.
Proper diet. Consumption of foods high in calcium: sea and river fish, dairy products, herbs, vegetables, nuts, persimmons, green beans, poppy seeds, sesame seeds, rose hips.

Manifestations of skew

Depending on the severity of the displacement, the intensity and variety of clinical manifestations of the problem may differ. A slight distortion of the pelvis may not show itself symptomatically at all, but this does not mean that there is no pathological effect on organs and systems. The disorder needs to be corrected in any case, which is why preventive visits to specialists in childhood are so important.

Common symptoms that may occur when the pelvis is distorted: – pain that occurs mainly during physical activity; – restriction in movements (stiffness); – imbalance of balance, which can lead to frequent falls and unsteadiness during movements; – pain in the lower back, buttocks, thighs, which can radiate to different parts of the body; – pain in the groin area; – formation of differences in the length of the lower limbs of varying degrees of severity (shortening of one leg); – disturbances in the functioning of the bladder with symptoms of diseases of the urinary system; – disruption of the intestines with the possible formation of symptoms of diseases of the digestive tract; – various disorders of the reproductive organs; – externally visible asymmetry of the pelvic region, as well as various postural disorders. The variety of clinical manifestations of pelvic distortion is due to the fact that displacement of bone structures can lead to compression of the nerves, which is reflected by pain in different areas, at first glance, not related to the pelvic joint. Displacement of organs in the pelvis can lead to disruption of their functioning and provoke a variety of diseases. At the same time, again, it is not always possible to immediately notice a direct connection between the disease and the musculoskeletal system.