Fractures of bones of a basin – heavy injury of a skeleton. Weight of a trauma is caused by big loss of the blood expiring from otlomk of bones of a basin and soft fabrics and also development of the traumatic shock caused by a pain syndrome and blood loss. Local symptoms of a fracture of bones of a basin include pain in the place of a change, deformation of a basin, visible shortening of the lower extremity, violation of movements by legs. The change of a sacrum can be followed by the injury of nerves leading to an urine incontience. The diagnosis is established by results of a X-ray analysis. For an exception of damage of bodies of a basin the uretrografiya, a tsistografiya, ultrasonography of a bladder can be appointed.
Fracture of bones of a basin
Fractures of bones of a basin – heavy injury of a skeleton. Weight of a trauma is caused by big loss of the blood expiring from otlomk of bones of a basin and soft fabrics and also development of the shock caused by a pain syndrome and blood loss. Fractures of bones of a basin according to modern traumatology make 4-7% of total number of changes. Can be followed by the internal injuries which are making heavier a condition of the patient and constituting direct danger to his life.
Basin – system of the bones connected among themselves which settle down in the backbone basis. Basin is a support for a skeleton, protects the internals located in the lower part of a stomach and serves as a link between bones of the lower extremities and trunks. The pelvic ring is formed by three pair pelvic bones (pubic, podvzdoshny and sciatic) and the sacrum located behind. Three pelvic bones from each party are divided among themselves by thin bone seams and are not mobile relatively each other. In front pubic bones are jointed, forming a pubic simfiz. Behind podvzdoshny bones fasten to a sacrum by means of a sacral podvzdoshnykh of joints. In external and side area all three pelvic bones participate in formation of a vertluzhny hollow (a part of a coxofemoral joint).
Various mechanism of a trauma is possible, but, most often fractures of bones of a basin result from falling from height, a sdavleniye at car accidents, collapses of buildings, industrial accidents (for example, in the mine) and accidents of running-down pedestrians. The type of a fracture of bones of a basin depends on many factors, including – on the direction (side, perednezadny) and sdavleniye degrees.
Allocate four groups of fractures of bones of a basin:
- Stable (the fractures of bones of a basin which are not followed by violation of integrity of a pelvic ring). The isolated and regional fractures of bones of a basin enter into this group.
- Unstable (the fractures of bones of a basin which are followed by violation of integrity of a pelvic ring). Depending on the mechanism of a trauma emergence vertically unstable and vrashchatelno unstable changes is possible. At vertically unstable fractures of bones of a basin integrity of a pelvic ring is, as a rule, broken in two places: in back and forward department. Are displaced by Otlomki in the vertical plane. At vrashchatelno (rotatsionno) unstable changes the shift of otlomk happens to shift in the horizontal plane.
- Changes of a bottom or edges of a vertluzhny hollow. Sometimes are followed by hip dislocation.
- Perelomovyvikh of bones of a basin. At this type of damages the fracture of bones of a basin is combined with dislocation in a bosom or sacral a joint.
The accompanying damages
Fractures of bones of a basin are always followed by blood loss. At the regional and isolated changes blood loss rather small (200-500 ml). At unstable vertical changes patients sometimes lose 3 and more than a liter of blood. Heavy fractures of bones of a basin can be followed by injury of an urethra and bladder, is more rare – a rectum and a vagina. At the same time contents of internals get into a cavity of a small pelvis and cause development of infectious complications. Bleeding and an internal injury seriously makes heavier a condition of the patient and increases risk for his life. At some fractures of bones of a basin perhaps sdavleny or the damage of backs and nervous trunks of a lumbar texture which is followed by neurologic frustration.
Local symptoms of a fracture of bones of a basin
Deformation of pelvic area, sharp pain, hematoma or hypostasis of soft fabrics in the field of a change belongs to local symptoms of fractures of bones of a basin. At mobility of bone otlomk the bone krepitation is defined. At a separation of a peredneverkhny awn the visual shortening of an extremity caused by the shift of an otlomk of a knaruzha and from top to bottom and a symptom of a backing of Lozinsky (at the movement by a leg back the patient feels smaller pain therefore he goes a back forward) is observed. Fractures of a podvzdoshny bone and the top departments of a vertluzhny hollow are followed by reduction of volume of movements in a coxofemoral joint. The patient is disturbed by pain in a wing of a podvzdoshny bone. The pains amplifying with a pressure upon the lower part of a sacrum are characteristic of changes of a tailbone and a sacrum. The act of defecation is complicated. At injury of sacral nerves sensitivity of area of buttocks is broken, the urine incontience is possible.
At changes of a pelvic ring without violation of its integrity crotch pain (a fracture of sciatic bones) or in pubic area (a fracture of pubic bones) develops. Pains amplify at the movements by a leg, palpations and sdavleniya of a basin in the side direction. The pains in a crotch and a basin amplifying at a side and perednezadny sdavleniye and the movement of legs are characteristic of changes with violation of integrity of a forward pelvic half ring. At changes of a sciatic and top branch of a pubic bone the patient is in a frog pose (on a back, with the halfbent and divorced in the parties legs). At changes near a simfiz and its gaps the patient slightly bends legs and reduces them together. The attempt of cultivation of legs is sharply painful.
At changes of a back half ring the patient lies on a healthy side, the movements of a leg on the party of defeat are painful, limited. Changes Malgenya (with simultaneous violation of integrity of back and forward half rings) are followed by asymmetry of a basin, pathological mobility at a side sdavleniye, bruises in a crotch and area of a scrotum. The violation of functions of a coxofemoral joint, a pain syndrome amplifying at a pokolachivaniye on a hip and axial loading are characteristic of changes of a vertluzhny hollow. At the combined dislocation of a hip violation of provision of a big spit, the compelled position of an extremity is defined.
The general symptoms at fractures of bones of a basin
In case of the isolated fractures of bones of a basin traumatic shock develops at 30% of victims, at the combined and multiple injuries – at 100% of patients. Shock is caused by massive blood loss in a combination to a sdavleniye or damage of sensitive nervous elements of pelvic area. At shock the victim's skin pale, is covered sticky cold then. Arterial pressure is reduced, pulse is speeded up. Consciousness loss is possible.
Sometimes fractures of bones of a basin are followed by symptoms of an internal injury (clinic of "a sharp stomach") which can be caused both by an injury of internals, and a zabryushinny hematoma at a fracture of bones of a basin in back departments or a hematoma in a forward belly wall at a fracture of pubic bones. At injury of an urethra the characteristic triad of symptoms develops: an urine delay, bleeding from an urethra, bruise in a crotch. At ruptures of a bladder there are violations of an urination, the gematuriya develops.
The diagnosis of a fracture of bones of a basin is exposed by the traumatologist on the basis of symptoms and data of a X-ray analysis. At suspicion on "a sharp stomach" and satisfactory condition of the patient observation in dynamics is made. At serious condition of the patient with suspicion of an internal injury waiting tactics is inadmissible. The laparoscopy, , sometimes - a diagnostic laparotomy is carried out. The impossibility of an independent urination, even in the absence of other symptoms of a trauma of uric ways, is the indication to ultrasonography of a bladder and inspection of an urethra. In doubtful cases carry out an uretrografiya.
The complex of antishock actions includes adequate anesthesia, compensation of blood loss and an immobilization of a change. Anesthesia of the place of a change, intra bone or intra pelvic anesthesia is carried out. Novocaine has hypotensive effect therefore at shock large amounts of medicine need to be entered after compensation of blood loss. At changes Malgenya the patient is given a medical anesthesia. To patients with the isolated fractures of bones of a basin carry out fractional blood transfusion within 2-3 days after a trauma. At heavy damages of a basin, the combined trauma and heavy shock for compensation of blood loss transfusion of large volumes of blood within the first hours after a trauma is shown.
The look and duration of an immobilization depend on localization of damage, existence or lack of violation of integrity of a pelvic ring. At the isolated and regional changes fixing on a board or in a hammock, sometimes – with use of tires of Beler or rollers in popliteal area is carried out. Violation of integrity of a pelvic ring is the indication to imposing of skeletal extension. Performing expeditious treatment of fractures of bones of a basin is shown in case of damage of pelvic bodies, a considerable divergence of lonny bones at a rupture of a simfiz, inefficiency of conservative recovery of the provision of otlomk at their considerable shift.
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