Contusions of the pelvis, hip joint and upper thigh

Hip contusions are a common injury caused by multiple factors. The main reasons include falls, impacts, and the consequences of an accident. The patient’s age, the anatomy of the pelvic bones, and gait characteristics can also contribute to bruises.

Bruises may be accompanied by visible damage to the skin or internal hematomas. In mild cases, the consequences of the injury go away on their own, but in case of severe damage to the joints, the help of specialists is required.

Clinical manifestations and signs

When the hip joint is bruised to varying degrees, soft tissue, tendons, and ligaments are damaged. With severe bruises, there may be signs of a hip bone fracture. When palpating the painful area, there is usually no significant pain, since mainly soft tissues are damaged. Typically, patients experience the following symptoms:

• swelling and redness of the skin in the area of ​​the bruise;
• formation of a purplish-bluish hematoma;
• difficulty in habitual joint mobility;
• the appearance of lameness in the area of ​​the bruise.

Complicated bruises are characterized by the addition of throbbing pain due to inflammation, disruption of the functionality of adjacent large articular joints (knee, ankle) due to destruction of bone tissue. Long-term consequences of bruises include enlargement of the inguinal lymph nodes, numbness, radiating pain to the lower extremities and back.

Rehabilitation period

During rehabilitation, the patient is shown performing exercises from therapeutic physical culture complexes. A number of exercises are useful and must be performed as follows:

• Lie on your side so that your sore hip is on top. Gently move your leg back. You need to perform the exercise very slowly, repeat 5-6 times;
• lie down on your back. Begin to make gentle circular movements with the injured limb - first inward, then outward. Repeat the exercise up to 8 times;
• stand against the wall with the side of your body with a healthy lower limb. Move the affected leg slightly to the side and slowly lift it. The arm should be kept straight and to the side. Repeat up to 10 times.

The patient’s performance of exercises to develop the damaged joint should be supervised by a doctor at the initial stages to prevent additional damage.

Also, during the recovery period, the patient may be prescribed physiotherapeutic procedures: laser therapy, magnetic therapy, massage, electrophoresis. The purpose of such procedures is to accelerate regenerative processes in damaged structures.

First aid

When a hip joint is bruised, victims experience severe pain and numbness in the affected area. To alleviate the patient’s condition with a severe bruise, the following rules must be followed:

1. Ensuring immobilization of the affected limb (possible violation of the integrity of bone tissue, dislocation).
2. Applying ice to relieve pain and reduce hematoma.
3. If the skin surface is damaged, the wound should be treated with anesthetics to avoid infection.
4. Apply painkillers to the affected area (if there is no damage to the skin).

If symptoms subside after a few days, you can try gradual active movements of the joint to prevent tissue ossification. For mild bruises, you can use traditional methods to relieve discomfort and pain:

• cabbage leaf compress or aloe juice;
• compresses from alcoholic tinctures of herbs and medicinal plants;
• mint ointment;
• Vishnevsky liniment.

After symptoms decrease, you should consult a traumatologist or surgeon to exclude bone damage, soft tissue detachment, and prevent complications. You should also consult a doctor if unpleasant symptoms increase, if painkillers are ineffective, or if your general health worsens.

Complications[edit | edit code]

Complications from bruises are rare. One of these complications is the already mentioned subfascial hypertension syndrome, accompanied by muscle fibrosis and a decrease in range of motion. Another possible complication is the development of myositis ossificans. To prevent myositis ossificans, early mobilization of the victim is carried out and measures are taken to prevent the development of hematoma. The resulting hematoma may eventually calcify and become clearly visible on radiographs and CT scans. It is distinguished from soft tissue sarcoma by its x-ray appearance and a history of trauma. Myositis ossificans develops in a centripetal direction: first, a belt of calcifications is formed, which then expands inward. If myositis does not cause complaints, you can ignore it; if it is accompanied by pain, then the newly formed bone masses are subject to resection after maturation. Maturation occurs over several months and is best determined by scintigraphy.

Treatment methods

In the overwhelming majority, conservative treatment methods are used to treat bruises. The main aspect of successful therapy is compliance with protective and bed rest. It is permissible to move around and be active in relation to the affected limb to ensure better blood supply and tissue nutrition. The following effective methods are distinguished:

• application of a splint (splints, fixing bandages);
• wearing a bandage;
• application of compresses with warming compounds (in the absence of inflammation);
• the use of non-steroidal anti-inflammatory drugs for inflammation.

3-4 days after the injury and if the victim’s condition is normal, it is necessary to begin physical therapy.

All exercises are recommended to be carried out under the guidance of a specialist.

During exercise there should be no acute pain, malaise, or sudden deterioration in health. With the help of therapeutic exercises, you can strengthen all the muscles of the hip joint.

Surgery

In rare cases, radical treatment methods are used - surgery. The main indications for treatment are the ineffectiveness of conservative therapy, complicated bruise, and long-term consequences with a difficult to control course. There are several intervention methods:

• puncture to remove the exudative component and relax the ligamentous apparatus;
• extraction of large detachments when adipose tissue diverges;
• Ossification is a surgical operation to remove ossified tissue formed due to a bruise.

Against the background of any surgical methods, it is possible to cut the fascia to reduce intramuscular pressure. Typically, after surgery, all symptoms subside noticeably.

Surgical treatment requires a certain period of recovery and hospital stay.

Causes

A pelvic contusion occurs due to mechanical shock resulting from a fall from different heights. The cause may also be a strong blow from a heavy object. It could be stone, brick or ice. Injury can also occur as a result of a car accident when a person falls on the road or hits the side of a car in a collision.

A fall can injure your hip:

• While playing sports. When skating, gymnastics or acrobatics, a person can fall by hitting various objects.
• He is playing a fitness game.
• Falling while ice falls on the road.

Soft tissue bruises are also determined when construction workers perform their professional duties.

Recovery time

It is impossible to accurately determine the duration of the recovery period. Elimination of the consequences of injury and rehabilitation directly depend on the general clinical history of the patient, his age and the severity of the injury.

Recovery Features

For a full recovery, it is very important to wear tight knitwear, a corset or underwear to reduce the load on the sore limb. Additionally, massage and physiotherapeutic procedures (UHF heating, electrophoresis, infrared heating) may be prescribed.

Symptoms

The severity of symptoms during injury depends on the severity of the injury. The main symptoms of a pelvic injury from a fall:

1. The strength of the pain syndrome varies in intensity: from aching to quite sharp. At the very beginning, after injury, the pain is distributed throughout the entire limb. A day later, the pain syndrome is determined mainly around the injured area.
2. Movement of the injured limb is almost impossible due to severe pain.
3. In the area of ​​injury there is a hematoma, cyanosis and slight swelling. The damage reaches its maximum permissible size and characteristic purple color after a couple of days.
4. Upon palpation, a local increase in temperature is detected.
5. The damaged area turns red, which is associated with dilation of the blood vessels of the epidermis.
6. Changes in the functional activity of the limb. The person experiences discomfort. Lameness occurs due to the fact that swelling hinders movement.

It is important to understand that if a day has passed since a pelvic injury from a fall, and the symptoms are becoming more and more pronounced, then this should alert you. It is important to take immediate action to help the person, which will greatly facilitate the process of treating a hip injury and rehabilitation.

Prevention and prognosis

It is important to understand that pain, nagging sensations and other unpleasant symptoms disappear within a few days. Symptoms of a bruised joint take a long time to resolve in the following categories of patients:

• in older people;
• in persons with a burdened history of diseases of bones, joints, cartilage;
• in victims with a depressed deep bruise associated with complications.

There is no specific prevention against bruises of the hip joint. Patients of any age and gender can be injured. Nonspecific prevention is maintaining a healthy lifestyle, correcting excess weight, and monitoring general health.

The prognosis for bruises of the hip joint is favorable in terms of health and ability to work with timely treatment and correct diagnosis. Compliance with medical recommendations significantly speeds up the recovery process, reduces the risk of complications and improves the patient’s quality of life.

Content

• 1 Thigh bruise
• 2 Main symptoms
• 3 Prevention
• 4 Clinical picture 4.1 History and complaints
• 4.2 Physical examination
• 4.3 Radiation diagnostics
• 4.4 Special methods

How to treat

There are two treatment methods - conservative and surgical. When choosing the first option, treatment includes: first aid and further following the doctor’s recommendations. If you follow your doctor's instructions, pain symptoms can be reduced quickly. During the first week, you cannot put any weight on the leg; the limb remains at maximum rest.

To reduce swelling, the leg should be kept in an elevated position. For example, at night you can put a pillow. The outflow of blood will increase, and swelling will not appear in the morning.

Pain distracts, interferes, brings discomfort to life, so the doctor prescribes painkillers. Now doctors are more inclined to drugs of non-steroidal origin: ibuprofen, Nise and others. They relieve pain, swelling, and reduce the inflammatory response. It is possible to use ointments: fastum, febrofid - they act directly on the lesion.

When these symptoms begin to decrease, the doctor writes a recommendation for physical therapy. This includes electrophoresis using potassium iodide, magnetic therapy, and UHF. After undergoing the procedures, blood flow improves and hematomas resolve.

Pelvic injuries

When treating uncomplicated pelvic fractures, it is convenient to use A. V. Kaplan’s classification, according to which the following types of pelvic fractures are distinguished:

• Fractures of the pelvic bones not involved in the formation of the pelvic ring: avulsion fractures of the upper and lower anterior iliac spines;
• longitudinal and transverse fractures of the iliac wing;
• sacral fractures in an area not involved in the sacroiliac joint;
• fractures of the coccygeal vertebrae

• Polyfocal fractures of the anterior and posterior sections of the pelvic ring: unilateral and bilateral vertical Malgenya type fractures;
• diagonal fracture;
• various combinations of bone fractures and ruptures of the pubic symphysis and sacroiliac joint

• Fractures of the acetabulum: fracture of the acetabulum with and without dislocation of the hip, including transacetabulum.

Depending on the specific circumstances (the severity of blood loss, the presence or absence of damage to internal organs, etc.), treatment of pelvic fractures is carried out either simultaneously with the provision of emergency resuscitation care, or after the patient has been removed from a serious condition. A factor that directly influences the outcome of a pelvic injury is the amount of prehospital care at the scene of the incident, as well as during transportation of the victim to a specialized medical facility. Along with carrying out emergency treatment measures (performing various types of blockades, infusion therapy, administration of hemostatic drugs, etc.), the scope of prehospital care should include pelvic immobilization, which significantly increases the effectiveness of anti-shock therapy, prevents secondary displacement of bone fragments, and facilitates gentle transportation from the scene of the accident to hospital, and then during the patients’ stay in the intensive care unit.

Transport immobilization. To immobilize the pelvis, a tightening belt-bandage has been developed, which provides rigid immobilization of bone fragments and is characterized by portability, low weight, and ease of use. The belt consists of a fabric part (strong fabric like a panel) applied to the back surface of the pelvis and sacrum; a leather part that covers the pelvis from the front and sides, and belts with an adhesive edge intended for attaching a pelvic bandage to the patient. If necessary, the pelvic girdle combines well with splints for transport immobilization of the upper and lower extremities; the use of a belt allows X-ray examinations of victims without fear of relapse of shock and resumption of bleeding; the belt can subsequently be used for medicinal purposes. Transportation of victims must be done on a stretcher, the shield of which must be made of x-ray permeable material. This subsequently eliminates the need to transfer patients from a stretcher to a table and back during an X-ray examination.

The severe nature of the injuries dictates the need to continue anti-shock therapy and resuscitation measures initiated by traumatologists of a specialized machine in order to remove patients from a threatening condition. The majority of victims entering the clinic in serious or extremely serious condition have multiple and combined injuries - fractures of bones of various segments of the musculoskeletal system and damage to internal organs, contributing to the development of severe shock and terminal condition.

The use of the pelvic girdle as a means of transport immobilization has revealed the following advantages:

• ensuring gentle transportation of victims to a medical facility; sufficient rigidity of pelvic immobilization increases the effectiveness of anti-shock measures and facilitates the removal of patients from shock;
• due to the ease of application of the device, the time required to perform emergency measures is reduced;
• if necessary, the pelvic girdle combines well with splints designed for transport immobilization of the upper and lower extremities;
• provides free access, the possibility of visual control, diagnostic and therapeutic manipulations on traumatic lesions in case of combined and multiple injuries;
• allows for X-ray examination of victims without relapse of shock and resumption of bleeding.

Victims with multiple and combined injuries to the pelvis, as well as isolated injuries that were accompanied by the development of traumatic shock, are taken to the intensive care unit, where they are observed until they are removed from this condition and the basic vital functions are restored.

In the intensive care unit, anti-shock therapy is carried out in a differentiated manner, taking into account that the effectiveness of treatment measures depends on the correct identification of the dominant injury, which has a direct impact on the outcome of the injury. However, it is not always the case that the identification of only one, albeit dominant, lesion allows for a fairly targeted planning of therapeutic measures included in the complex of anti-shock therapy. The disadvantage of such planning is the fact that it does not take into account other, non-dominant, but numerous injuries that have a mutually aggravating effect on each other, and ultimately on the outcome of the injury. All this gave reason to believe that in case of multiple and combined pelvic injuries, one should strive for the most complete and early identification of all existing injuries and take them into account when carrying out resuscitation measures. Identification of non-dominant injuries facilitates the resuscitation of victims and correctly guides them regarding the volume of anti-shock and transfusion therapy.

Antishock therapy for isolated pelvic injuries includes the use of analgesics, cardiac drugs; To reduce the flow of impulses from the source of damage, an intrapelvic novocaine blockade is performed according to Shkolnikov-Selivanov. The need for more intensive anti-shock therapy arises with multiple injuries of the musculoskeletal system. In these cases, novocaine blockade of fracture sites and therapeutic immobilization of damaged segments are additionally performed. Treatment of fractures of the pelvic bones and extremities in the acute period seems to fade into the background until the period when stable stabilization of the main life-supporting functions of the organs is achieved.