Fractures of the pelvis are severe fractures. This is due to the possibility of damage to internal organs, with a large hemorrhage in fractures of the pelvis, with the emergence of shock due to blood loss and pain.
Taz is located at the base of the spine. He serves as a support to the spine and around the skeleton of man. With the help of the lower limbs of the pelvis are connected to the body. In addition, the pelvic bone and the bone bed formed by them - the pelvic ring - are a repository of the internal organs, which are called pelvic.
The pelvic ring is formed by the bodies of the pelvic bones (ilium, pubis and ischium), and the sacrum behind. In front of the center line right and left pubic bones are joined by the pubic symphysis. Behind the iliac bones articulate with the bones of the sacrum, and form the sacroiliac joint. Body of ilium, ischium and pubic bone on the outer-side surface form a hip socket, which is an articular surface for the hip joint. In the inner pelvic cavity is the bladder, rectum, the uterus and vagina of women, men, the prostate and seminal vesicles. The most common fractures of the pubic and ischial bones.
The mechanism of traumatic injuries of the pelvis may be different. But most often it is in the compression of car accidents, hit a pedestrian, collapses buildings, land, etc. Compression can be anterior-posterior, lateral.
Fractures of the pelvis are: stable unstable.
Unstable pelvic fractures are characterized by the possibility of displacement of the pelvis at any time by normal loads (movement legs, trunk rotations, and even tension of the abdominal muscles). For stable fractures of the pelvic bones are broken, do not lead to a breach of the integrity of the pelvic ring. This is a marginal or isolated fractures (fractures of the iliac wing, pull broken spines of the ilium, marginal fractures of the sacrum and coccyx fractures), fractures of the branches of the pubic bone, ischial bone fractures.
Unstable fractures are fractures, accompanied by a violation of the integrity of the pelvic ring. They can be rotary (rotation) fragile. The displacement of the fragments may occur in the horizontal plane.
Vertically unstable fractures lead to displacement of bone fragments in the vertical plane. Most often it is double vertical fractures of the pelvis in which the continuity of the pelvic ring is broken in two places: in the front and rear sections. In this case, the conditions for the displacement of bone fragments in the vertical. Separately isolated fractures of the acetabulum. There are fractures of the acetabulum, or the edges of its bottom. Fractures of the acetabulum may be accompanied by dislocation of the hip.
Almost all traumatic injuries of the pelvis are accompanied by more or less severe bleeding. Blood loss can be from 200 ml of fractures of the wing of the ilium, to 3500 ml of blood in the vertical unstable fractures. Bleeding from the bone can take up to 7 days.
Fractures of the pelvis may be accompanied by injury and compression of the nerve trunks and roots of the lumbar plexus. Damage may be subject to the urinary tract, the end sections of the colon. The contents of the urinary tract and bowel falls into the pelvic cavity, causing infectious complications and greatly aggravate the condition of the patient. Patients with pelvic fractures complicated by bleeding or damage to internal organs are in serious condition. Often they are unconscious or in shock.
Careless transportation of a patient may lead to displacement of bone fragments and further aggravate his condition. If the patient is conscious, he complains of pain at the site of the fracture. There is a violation of the configuration of the pelvis, swelling at the site of the fracture. Movement of legs sharply painful. Reliance on foot impossible. Often the victims are taking a characteristic pose - "frog posture", with divorced and half-bent at the knee and hip joints of your feet.
If the damage of the urinary tract in the urine appears blood, in case of damage of the rectum - the blood can be released from the anus. Transportation of victims to the hospital carried out on stretchers or on hard board. Legs are bent at the knee joints, they planted a roll of clothing or blankets.
The diagnosis of fracture of the pelvis refine X-ray examination. First, conduct a review shot in the anterior-posterior direction. Then make more shots in special projections.
If necessary, perform a CT scan. If there is suspected damage to the arteries in the pelvis, produces computer angiography. Be sure to research conducted finger rectum, as sometimes fragments of the pelvic bones palpated through the wall of the rectum and colon to eliminate gaps. In women with the same objective examination appointed by the gynecologist.
Appointed by the X-ray of the urinary tract and bladder with contrast, to avoid damage to the walls of the bladder and urethra. If you suspect damage to internal organs of the pelvis and abdomen performed laparoscopy.
If the patient is heavy, held antishock measures. In a large loss of blood, blood substitutes appointed by the introduction, plasma or blood. Be sure to painless fracture and intrapelvic anesthesia performed by a special method (method Shkolnikov, Selivanov). When solutions of boundary fractures of local anesthetics are injected directly into the fracture site. Boundary and isolated fractures are rarely associated with significant blood loss and shock.