Change of a vertluzhny hollow – violation of integrity of a basin in the field of an articulate pole of a coxofemoral joint. Usually results from a high-energy trauma (road incident, falling from height). It can be combined with dislocation of a coxofemoral joint and a fracture of a neck of a hip. It is shown by pains, the compelled position and dysfunction of an extremity. For confirmation of the diagnosis the X-ray analysis and KT is used. Treatment is more often conservative. At heavy damages and inefficiency of conservative therapy surgical intervention is shown.
Change of a vertluzhny hollow
Change of a vertluzhny hollow – the difficult damage making 15-16% of total number of fractures of bones of a basin. The Vertluzhny hollow participates in formation of a coxofemoral joint therefore damages of this area quite often become the reason of development of a heavy post-traumatic coxarthrosis. An indispensable condition of a happy end is exact restoration of an anatomic configuration of a vertluzhny hollow and reliable fixing of otlomk.
Such injuries usually result from the road accidents, is more rare – as a result of falling from height that causes the high frequency of the combined damages. Changes of a vertluzhny hollow are often combined with dislocation of a coxofemoral joint, fractures of a neck or a head of a femur. Also damages of other areas of a basin (including – with violation of a continuity of a pelvic ring), fractures of bones of extremities, fractures of edges, injuries of a thorax, ChMT, a stupid injury of a stomach, injury of kidneys and a rupture of a bladder are possible. Treatment is performed by traumatologists.
The Vertluzhny hollow is located in a junction of three pelvic bones (sciatic, pubic and podvzdoshny) and has the hemisphere form. Its central part connects to a femur head, forming a coxofemoral joint. Distinguish the arch or a roof, two walls (forward and back) and two columns (forward and back) a vertluzhny hollow. Columns provide durability of this anatomic education and connect among themselves in the field of the arch, forming the turned letter Y.
All changes of a vertluzhny hollow in traumatology share on simple and difficult. Simple include a cross change, a change of a forward column, a change of a forward wall, a change of a back column and a change of a back wall. At difficult damages the line of a break passes through two or more elements of a vertluzhny hollow. Carry complete fractures of both columns, a back cross change in combination with damage of a back column to number of difficult changes, the T-shaped change, a change of a back wall in combination with a cross change, and also a simultaneous change of a back wall and a back column.
Patients complain of pains in a coxofemoral joint or inguinal area. The extremity is in the compelled situation reminding the clinical picture observed at dislocation of a coxofemoral joint: the leg is shortened also a rotirovana of a knaruzha. The support is impossible, the movements are sharply limited. At the isolated damages the condition of the patient usually remains stable. At a combination to other injuries violations of haemo dynamics and development of traumatic shock are possible.
For specification of the diagnosis carry out a survey X-ray analysis of a basin and a X-ray analysis of the injured joint in three additional projections. Whenever possible the patient is directed to basin KT as this technique allows to estimate more precisely weight of a trauma and character of shift of otlomk. The diagnostic value of a computer tomography increases at damages of a back column and splintered changes. For an exception of an open change conduct a vaginal or rectal research. As this trauma in 30% of cases is combined with injury of a sciatic nerve, the patient appoint consultation of the neurologist or neurosurgeon for exact assessment of the neurologic status.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Treatment is performed in the conditions of traumatologic office. Treatment tactics in many respects depends on existence or absence of dislocation of a coxofemoral joint. In the presence of dislocation make its emergency reposition under the general anesthesia. If dislocation is inclined to a retsidivirovaniye, impose skeletal extension for hip nadmyshchelka. Further at shift in the field of a roof no more than 3 mm, lack of intra articulate otlomk and preservation of congruence of articulate surfaces conservative therapy – skeletal extension within 4-8 weeks is shown. To the patient appoint anesthetics, UVCh and LFK. To be convinced of saving the correct provision of otlomk, carry out repeated x-ray pictures in dynamics.
The indication to surgical intervention are large intra articulate otlomk, a large fragment of a back wall, shift of otlomk in the field of a hollow more than on 2-3 mm and impossibility of deduction of fragments by means of skeletal extension. Operation is performed within 2 weeks after receipt, after full inspection of the patient. An indispensable condition is the compensated condition of the patient.
In some cases surgical interventions are carried out in the emergency order. Indications to the emergency operation are open fractures, not reducible back dislocation of a femur, signs of injury of a sciatic nerve, an extensive otsloyka of soft fabrics and the shift of a head of a hip to the center, towards a podvzdoshny bone. Surgeries are performed only after stabilization of haemo dynamics and in the absence of symptoms of traumatic shock.
For fixing of otlomk at reconstruction of a vertluzhny hollow use the special pulling together screws and basic plates. In the postoperative period carry out prevention of formation of blood clots and geterotopichesky ossifikat. At satisfactory condition of the patient hold events for its activization, appoint LFK (the passive and active movements in a joint without axial loading). Full load of an affected extremity is resolved after emergence of radiological signs of formation of a bone callosity, usually – in 8-12 weeks after operation.
At adequate restoration of a configuration of a vertluzhny hollow forecast rather favorable. The most widespread complication is the geterotopichesky ossifikation which according to various data is observed at 3-69% of patients. Because of intensive impact on fabrics during operation paresis of branches of a sciatic, femoral and top buttock nerve in some cases can develop. In 7% of cases the site of an avaskulyarny necrosis (usually – is formed at damages of the back departments of a vertluzhny hollow which arose owing to a high-energy trauma).