One of the most dangerous fractures is a fracture of the pelvic bones, in particular the pubic (pubic), which is a paired bone. The bones themselves are connected in the middle by symphysial surfaces, thereby forming a pubic articulation. At the same time, the symphysis is cartilage until about 16-18 years old, and only after adulthood it becomes ossified.
Fracture of the pubic bone is very dangerous, as it is accompanied by traumatic shock and great blood loss. In addition, against the background of an injury, a retroperitoneal hematoma may form or damage to the vagina, rectum or bladder may occur. According to statistics, about 75% of all road traffic accidents end in a fracture of the pelvic bones, including the pubic bone.
International classification
According to the ICD, a pubic bone fracture is classified under S32.8. The injury is classified as severe, which is often accompanied by shock and extensive retroperitoneal hematoma. The clinical picture may not beonly against the background of pain in the sacral region, but also accompanied by painful defecation, pain during an attempt to sit down. There may be urinary retention and loss of sensation in the buttocks.
Risk group and most common injuries
Most often, such injuries occur in the process of traffic accidents. Also at risk are persons who are employed in work at heights or in traumatic production, of course, subject to non-compliance with safety regulations. Athletes fall into the risk group, since the risk of getting a strong blow to the pelvic area is much higher for them than for an ordinary person. Such injuries can even occur while skiing.
Fracture of the pubic bone of the pelvis is characteristic of menopause in women. In older men, a fracture can also occur due to the fact that the calcium content in the bones is greatly reduced, and there are fewer other substances in the body that are responsible for the strength of bone mass and connective tissue.
However, such fractures do not lead to a violation of the integrity of the pelvis itself. Bones are rarely displaced, and the severity can only be determined after determining the location and size of the damage.
Views
A fracture of the pubic bone can be in the form of a fracture-dislocation, that is, in addition to a broken bone, a joint displacement will be diagnosed. There are fractures without displacement, that is, there is no violation of the structural integrity.
The following types are also found:
- fracture with violation of the integrity of the ringpelvis;
- with acetabular disorder;
- closed and open;
- two-sided or one-sided.
Symptomatics
Fracture of the pubic bone of the pelvis is accompanied by severe pain, up to traumatic shock. Minimal movements in the victim cause severe pain and the effect of a stuck heel is pronounced. Often there are subcutaneous hemorrhages and swelling in the pelvic area. If the integrity of the nerve trunks is broken, then numbness will be observed. Compaction and hardening may form at the impact site.
Crunching sounds can only be observed if fragments that have broken off the bone are present. The victim is observed to sweat profusely and the pressure is greatly reduced against the background of a rapid heartbeat. Some patients even faint. During the initial examination, it seems that visually the legs are of different lengths, and the pelvic bones are located asymmetrically.
Diagnostic measures
As a rule, after a visual examination of the victim, the doctor performs an additional examination by palpation to determine the exact place where the fracture occurred. Probing with fingers also allows you to determine if there are bone fragments, how much and in which direction they are displaced.
When diagnosing, it is very important for the doctor to take a detailed history. It is possible that the patient cannot independently explain the events that led to the injury, but there may be witnesses who can tell. After all, it is very important whether there was twisting orsqueezing, or the person fell. Then, an X-ray examination is mandatory to confirm or refute the diagnosis of a pubic bone fracture.
The doctor necessarily pays attention to additional symptoms. In particular, whether or not the victim has problems with urination or stool. If there are suspicions of injuries to other organs, then the following examinations are prescribed:
- MRI and ultrasound;
- angiography;
- laparoscopy;
- cystography;
- gynecological examination;
- pyelography;
- urethrography.
But the most informative and reliable examination is an X-ray, which can be both general and targeted.
First Aid
It is very important to know how to provide first aid for a fracture of the pubic bone, since with such injuries the speed of assistance is very important, which can become a determining factor in the recovery process.
Before the arrival of the ambulance, the victim must be immobilized. If there are broken off bone fragments, then immobilization will avoid injury to other organs. The patient must be laid on his back, and a roller or other object should be placed under the legs in the knee area.
The victim can be given painkillers. It is necessary to monitor the pulse and heart rhythm, to prevent the person from losing consciousness.
If the fracture is open, then the wound must be treated with disinfectants and covered with a clean fragmenttissue to prevent bacteria from entering. If there is profuse blood loss, then a tourniquet will have to be applied.
Treatment
Regardless of whether the fracture of the pubic bone is closed, open or of another type, correct diagnosis is very important, which will determine the severity of the injury and its location. If the patient has a large blood loss, then a blood transfusion procedure is performed.
Depending on the degree of damage, conservative therapy or surgery is performed. If the fracture was accompanied by chipping of multiple fragments, then surgical intervention is mandatory. Small bones that cannot be folded into a dense structure are removed. The remaining bone fragments are connected and fixed with metal wire, plates and screws.
Treatment of a fracture of the pubic pelvic bone with damage to the internal organs of the small pelvis also often requires the intervention of a surgeon. In addition to bringing the bones into an anatomical position, stitching of ruptures of the walls of the vagina, rectum, blood vessels or other damaged organ is performed.
Skeletal traction
Skeletal traction may be required if the pubis and ischium are fractured. The technique is also used for bilateral fractures and damage to the pelvic ring.
The procedure involves the use of a hammock, which is made of double dense fabric. The width of the structure is determined by the doctor. Round cord spacers are sewn into the ends of the hammock, which are passed through the blocks, which in turnturn attached to the Balkan bed frame.
Several x-rays are taken to control the healing process. Skeletal traction lasts about 1.5 months, then adhesive traction is carried out for 1 month. Only after 3 months the patient will be allowed to rise and move, but only with crutches. Full load can be given only 4-6 months after the injury.
Rehab
The pubic bone after a fracture requires a long rehabilitation period so that it fully restores its functionality. The patient will need a lot of effort and patience. The rehabilitation course includes the following activities: massage, gymnastic exercises, physiotherapy. In addition, patients who have suffered a similar type of fracture are recommended sanatorium treatment, dietary adjustments. All rehabilitation measures are a complex therapy, and if the patient follows all the recommendations of doctors, then he will have great chances for a full recovery.
Even at the stage of inpatient treatment, the patient must perform breathing exercises that strengthen foot movements. Whether there was a fracture of the pubic bone without displacement or with it - first of all, it is necessary to restore the psychological state of the victim while simultaneously relieving the pain syndrome. Measures are being taken to improve the overall tone of the whole body and lower limbs.
At the later stages of rehabilitation, patients are advised to visit the pool, at homeit is recommended to swing your legs. Walking gives very good results. The terms of rehabilitation completely depend on the individual characteristics of the victim's body, as well as on his desire to quickly return to the normal rhythm of life.
Consequences
Fracture of the pubic bone on the right or left can lead to a noticeable decrease in the length of one limb. In some patients, there is a serious violation of body proportions, which subsequently leads to partial or complete loss of leg mobility.
Such damage is a stimulating factor in the formation of osteoarthritis and osteomyelitis. Women are not uncommon cases of violations in the work of the pelvic organs. There may also be a decrease in the susceptibility of the pelvic organs and legs. Growths may also appear, especially if there is an incorrect fusion of the bones. Some patients experience lameness after injury. Therefore, any injury in the pelvic area can cause the formation of severe complications that can lead to loss of motor function, and consequently, to a deterioration in the quality of life.
Can traditional medicine help?
In the process of restoring the body after a fracture of the branch of the pubic bone, it is recommended to consume more boiled onions, which allows you to speed up the process of bone restoration. You can do compresses or rubbing with gum turpentine. During massage, it is recommended to use essential oils: juniper, fir, eucalyptus, cedar and others. You can speed up the recovery process with sea s alt baths, you can add gum turpentine.
The special role of diet in treatment
Many skeptics may ask: how can food help? In fact, after a fracture, it is recommended to adjust the menu and add foods high in calcium, magnesium, phosphorus, manganese and potassium to it. In addition, you should introduce foods with a high content of vitamin D and C, vitamins from group B into the diet. It is these vitamins that improve the absorption of calcium and protein by the body, that is, the substance that is the basis for bones.
Recommended foods include:
- bananas;
- nuts;
- herring;
- beans;
- pumpkin;
- mushrooms;
- sesame and others.
Prevention
It is clear that with the rapid pace of life it is quite difficult to protect yourself from injuries and accidents, to radically change the diet. However, if the stairs in the house are slippery, there are a lot of them, it is better to cover them with carpet and install handrails. If you have a vehicle, then try to drive as carefully as possible, avoid traffic accidents.
When going in for sports, do not forget about safety rules, do not let heavy projectiles fall on your body. You should also beware of falling on any hard surfaces, on sports equipment.
If possible, avoid working at heights or in hazardous work environments, workplaces with vibration and contact with complex equipment that can cause injury. understandablethe fact is that no one is immune from injury, but if this has already happened, then in no case should one lose heart, but find a true professional in medicine, trust him and maintain a positive attitude until the end of treatment and rehabilitation.
