The most severe injuries to the human body are pelvic injuries, they account for 18% of the total number of injuries. With such a pathology, a person develops shock of varying severity, which is provoked by severe internal bleeding. Even in modern trauma clinics, the death rate from such injuries is 25%, which is associated with the limited possibilities of treatment methods for severe forms of pathology, as well as the need for resuscitation. After therapy, disability develops in 35% of victims.
Description and characteristics of pelvic injury
The pelvis is a part of the skeleton, which is located at the base of the spinal column, connects the trunk with the lower limbs, acts as a support for the skeleton, protects the internal organs. It consists of an immovable bone ring. The ring is formed by two pelvic bones, each of which consists of the pubis, ischium and iliumbones. They are separated by thin bony sutures. The bones are motionless relative to each other. All three bones are connected to the hip joint. When bones are damaged, injuries of the pelvic organs often occur. In men, the pelvic cavity contains the rectum, bladder, large blood vessels, prostate, and seminal vesicles. In women, in addition to the rectum and bladder, the organs of the reproductive system are located in the pelvis: fallopian tubes, uterus, ovaries and vagina.
Pelvic injuries are severe damage to the human skeleton, accompanied by profuse bleeding from fragments of bones and soft tissues, the development of a state of shock as a result of severe pain and blood loss. With this pathology, damage to internal organs, blood vessels and soft tissues often occurs, which contributes to the aggravation of the condition of the victim and threatens his life. The most common injuries are pelvic fractures.
Causes for the development of pathology
The strong structure of the pelvic bones usually does not allow them to get damaged when falling from the height of their body. Most often, pelvic injuries occur for the following reasons:
- Playing sports when there is a strong muscle contraction.
- A traffic accident, as a result of which a person received a blow to the pelvic region of great force or when he was hit by a vehicle.
- Stab with a blunt object during a fight.
- Falling from a great height.
- Compression of bones from building collapses or industrial accidents.
Most common injuriesspine and pelvis are diagnosed in people of middle and advanced age. The risk group also includes:
- Children due to underdeveloped musculoskeletal system, calcium deficiency in the body.
- People with bone disease. Injuries in this case can occur even as a result of a fall from the height of your own body.
Usually, trauma to the ischium occurs due to a strong physical impact on it, for example, when falling on the buttocks in winter or during sports. A fracture of the pubic bone occurs as a result of trauma to the pelvic ring due to a blow to this area or when it is squeezed.
Pelvic injuries: classification
In medicine, it is customary to distinguish four groups of pelvic injuries:
- Fracture dislocations, characterized by a fracture of bones with dislocation in the pubic or sacral joint.
- Stable damage caused by a violation of the integrity of the bone, while the pelvic ring remains intact.
- Unstable injuries in which the bones of the pelvic ring break. A fracture can be in one or more places, and it can also be accompanied by a displacement of the bones.
- Injuries to the bottom and edges of the acetabulum, in some cases, these types of pelvic injuries are accompanied by hip dislocation.
Complications and consequences
Bone fractures are accompanied by blood loss (from two hundred grams to three liters). In severe injuries, the urethra, bladder, rectum, and vagina can be affected. The contents of these organs enter the pelvic cavity,causing complications. Damage to internal organs and bleeding increase the risk of death.
Often a pelvic injury has the following consequences:
- Development of paresthesias, damage to tendons, vessels, soft tissues and nerves.
- The appearance of bleeding, the development of a secondary infection.
- Development of various infectious and inflammatory diseases.
- The formation of bone growths as a result of improper bone fusion.
- Impaired muscle tone.
- Shortening of the lower limbs, loss of motor activity.
- Death is observed in 5% of cases in the first days after injury.
General symptoms and signs of pathology
One of the main symptoms of a pelvic injury is traumatic shock, which develops as a result of severe blood loss combined with damage to the nerves of the pelvic region. At the same time, the person's skin becomes pale, blood pressure drops, and the pulse quickens. Shock is often accompanied by loss of consciousness. Often, the victim has symptoms of damage to internal organs, which may indicate the appearance of a hematoma in the anterior or posterior abdominal wall. When the urethra and bladder are injured, urination disorders, bleeding from the urethra, hematuria, subcutaneous hemorrhages in the perineal region are observed. There is also pain of varying intensity when moving the limbs, the person is forced to maintain a certain positionbody.
Local symptoms
Local signs of pelvic trauma are manifested in the form of deformation of the pelvic region, the development of pain, soft tissue edema. It is often possible to observe a shortening of the lower limb as a result of the downward displacement of the bone fragment, as well as Lozinsky's symptom.
Fracture of the ischium leads to loss of consciousness, development of hematoma, internal bleeding. Injury to the pubic bone causes pain, swelling, a symptom of "stuck heel", limitation of motor activity, subcutaneous hemorrhage, damage to the vessels and organs of the small pelvis. Often, injuries of the spine and pelvis lead to limited mobility, in severe cases - to paralysis.
When the coccyx is injured, there is difficulty in defecation, a violation of the sensitivity of the gluteal region and urinary incontinence due to infringement of the sacral nerves. Stable fractures provoke the development of pain in the perineum or in the pubic region, which is aggravated by movement of the limb and palpation. Unstable fractures lead to pain in the pelvic region, which increases with movement of the legs. Often a person is forced to be in the frog position due to severe pain.
First aid
First aid for a pelvic injury should be provided before the arrival of the ambulance team, it should be quick and adequate. Follow the instructions:
- You must not remove the victim from the vehicle if he was injured while in it. In this case, you must waitarrival of doctors. Only in case of suspicion of a car explosion, you need to carefully remove the person from the car and move it to the side.
- First of all, the victim is given an anesthetic drug if he is conscious. In the case of an unconscious person, one should not put medicines in his mouth, as there is a risk of developing asphyxia.
- After this, the person is placed on a hard surface in the frog pose, a pillow is placed under bent knees.
- If there are open wounds, they are treated with antiseptic solutions, covered with a sterile bandage or napkin and fixed with adhesive tape.
- It is impossible to carry out immobilization on your own in this case, you must wait for the doctors who will carry it out in accordance with all the rules.
When an injury to the pelvic bones has occurred, and emergency care for some reason cannot be carried out on the spot, as well as if it is necessary to independently transport the victim to a medical facility, it is necessary to carry out transport immobilization, otherwise the bone fragments may move, causing traumatic shock, bleeding, organ damage and death.
If first aid for a pelvic injury is not performed correctly, it can lead to serious complications and increase the risk of death. Before going on hikes, where there is no way to call an ambulance, doctors recommend studying the rules for immobilizing victims.
Immobilization andtransportation of casu alties
If it is necessary to self-immobilize and transport the victim to a medical facility, it is necessary to carry them out in such a way as to prevent the displacement of bone fragments that can damage muscles, nerves and blood vessels, as well as internal organs. To do this, you can use any means at hand: sticks, pieces of cardboard, boards, scraps of fabric, gauze or bandages.
Immobilization must be carried out carefully and carefully, since any wrong movement can provoke a painful shock, a person may lose consciousness. The victim should not move the limbs, it should be conveniently placed and bandaged, fixing the damaged area as much as possible.
Diagnosis
In the acute period of damage, diagnosis will be difficult due to the patient's serious condition, resuscitation is required. In this case, pelvic injuries are diagnosed using the method of palpation and examination of the victim. The doctor draws attention to the presence of asymmetry of the pelvis, subcutaneous hemorrhages, pain syndrome, mobility of the lateral fragment of the pelvic bone. An accurate diagnosis is possible only after an x-ray, the results of which are of great importance for the development of treatment tactics for the victim. This study allows you to assess the degree of damage to internal organs and the type of fracture.
Also in severe cases, if there is a suspicion of damage to the internal organs, the doctor may perform a laparoscopy, laparotomy or laparocentesis. Examination of the urethra and ultrasoundbladder is required when the patient is unable to urinate independently, often the doctor prescribes urethrography.
Treatment of pathology
In the treatment of victims, traumatologists distinguish two periods:
- Acute period in which therapy aims to save the patient's life.
- Recovery period when displaced bone fragments are corrected.
The choice of method of therapy depends on the age, general condition of the patient, the presence of concomitant injuries, the location and degree of displacement of bone fragments.
Treatment of a pelvic injury (uncomplicated) takes about four weeks, while the patient must remain in bed. If there is a large blood loss on the third day after the injury, a blood transfusion is performed.
In severe injuries, anti-shock therapy and resuscitation are carried out to remove a person from a life-threatening condition. Usually, the victims are admitted to the clinic with multiple fractures of the bones of different segments of the pelvis, damage to internal organs, which leads to the development of a terminal state and pain shock. Doctors should direct every effort to remove the victim from such a state, as well as restore the basic vital functions of the body. In this case, physicians should strive to fully determine all existing injuries in order to conduct effective treatment. Antishock therapy involves the use of analgesics, cardiac drugs, novocaine blockade. Upon reachingstabilization of all vital functions of the body begin to treat fractures.
Surgical treatment
When bone fragments are displaced, surgical treatment is carried out, during which their normal position is restored. In traumatology, in this case, knitting needles, metal plates, screws and other devices are used. This operation is called osteosynthesis, it is performed under general anesthesia. During the operation, the doctor examines the internal organs, eliminates damage, if any. During surgery, a percutaneous device is usually used, which securely fixes the bone fragments.
In traumatology, operations for pelvic fractures often do not give the desired result, since it is not always possible to correctly collect the fragments and keep them in this position throughout the entire period of treatment. With a long stay of the patient in bed, sepsis and thrombosis, muscle atrophy often develop. In 25% of cases, a person becomes disabled after an injury.
Patient rehabilitation
When pelvic injuries occur, rehabilitation begins only after a complete and comprehensive treatment. The course of rehabilitation is an integral part of therapy, which is aimed at the fastest restoration of physical activity and the return of a person to a normal lifestyle. This event is carried out strictly under the supervision of a doctor. Rehabilitation activities include:
- exercise therapy to prevent the development of ankylosis andcontractures, normalization of muscle tone.
- The use of vitamin and mineral complexes to strengthen bone tissue.
- Physiotherapy and massage.
- Therapeutic traction.
It is important to eat right during this period, including sea fish, dairy products, vegetables and fruits, nuts, sesame and rose hips in the diet. Doctors recommend walking outdoors to restore the functionality of the musculoskeletal system.
Consequences
In case of pelvic injuries, the consequences can be very serious. With fractures, a person’s motor activity is disturbed, which may not normalize even after treatment. Often, the victims periodically experience pain. Women cannot give birth on their own, they have to perform a caesarean section.
The main condition for a successful cure is correctly rendered first aid and immobilization of the victim, as well as anti-shock therapy. The prognosis of the disease will depend on the severity of the damage, as well as on the injury to the internal organs. After treatment, patients are prohibited from doing sports and physical activity.
Often, an injury leads to severe bleeding, the bones grow together incorrectly, they can move and damage internal organs and tissues. After an injury, the victims often experience a disorder of sexual function, osteoarthritis, osteomyelitis develop, bone growths form, nerves and tendons are damaged. Complicationspathologies often lead to death. Long-term consequences of pathology can manifest themselves throughout a person's life.
In case of pelvic injuries, it is necessary to provide first aid to the victim before the arrival of the ambulance team. This must be done quickly and efficiently, since the further state of a person depends on this. In 5% of cases, in the first few hours after pelvic injury, death occurs due to large blood loss and the development of a state of shock. Therefore, it is important to deliver the victim to the clinic as soon as possible.
