Treatment of pelvic fractures
Traumatology / / May 02, 2016
Depending on the nature of pelvic fractures are the following groups of patients:
1) with boundary fractures that do not participate in the formation of the pelvic ring;
2) with fractures of the pelvic ring without disturbing its continuity;
3) with fractures, break the continuity of the pelvic ring;
4) from the bottom of the acetabulum fractures, including the edges and bottom of the fracture and the bottom of the central dislocation of the hip.
This distribution allows more accurate assessment of the severity of the injury and its prognosis, and choose the right tactics treatment.The victims of the first two groups of active orthopedic treatment can not be.They are conducted mainly procaine blockade fractures places creates convenient ( "painless") position in bed with a mild dilution of the legs and bending of the joints with the help of a hamstring roll, necessarily placed under the pelvis rubber circle.
Treatment position "frog" more tolerable for patients and legkovypolnimo in acute injury.
When rupture symphysis pubis diastasis with less than 5 cm is applied conservative treatment ( "gamachok"), at a considerable discrepancy between the pubic bone is carried out in a planned manner osteosynthesis with metal plate with screws and cancellous autograft from the iliac crest.If the damage of the front and rear half-ring at the same time using different methods of treatment.To eliminate the small displacement of one of the halves of the pelvis is usually used skeletal traction for hip and shin with a gradual increase of traction loads to 14-16 kg (to reposition) for 2-3 weeks, followed by a decrease in the goods up to 5-9 kg (to immobilize).For the treatment of complex fractures of the pelvis, we use devices that operate on the principle of compression-distraction device.
with open fractures (6.6%) accounted for the main efforts directed at the prevention of infectious complications, using all available means - early surgical treatment, primary skin grafting and skin reimplantation, as far as possible the initial restoration of damaged pelvic organs.When these lesions is very important to respect the principle of simultaneous execution of therapeutic measures.
Most patients with pelvic injuries are more fractures of other bones.The most important group is formed by the victims with fractures of the pelvis and hips (fractures and dislocations).Orthopaedic treatment is to place these patients on a hard bed with laying the lower extremities to the functional bus.After anesthesia produce skeletal traction or temporary immobilization with plaster splint, if the victim is preparing for the operation.Simultaneously closed reposition of fragments of the femur is not carried out because of the danger of displacement of bone fragments of the pelvis, strengthening interstitial hemorrhage and shock.Fractures without displacement heal hip plaster cast.This method of treatment is shown in combined fracture of the pelvis and the femur without offsets during childhood and adolescence when necessary to transport the affected (in this case also used tire Deryabina) as an additional means of immobilization, when the retardation fracture consolidation, as well as for the earlier translation of the patient in avertical position.Fractures of the bones of the hip and pelvis without bias in the elderly it is advisable to treat the situation of "frog".
Combinations of fractures of the pelvis and lower leg occur in car crashes and falls from a height, which explains the greater severity of pelvic fractures and the prevalence of bilateral fractures of the shin bone.This also explains the grave condition of the majority of the victims, shock complicating trauma in 67% of them.When conservative treatment of fusion of tibia fractures occur faster than operational.However, the consolidation process significantly influences the severity of a large open lesions tibia, which were subjected to surgery.disability period lasts an average of 9-11 months.Other combinations of fractures of the pelvis and skeleton are less common and much difficulty in the treatment does not cause.
prognosis of multiple and associated fractures of the pelvis depended on the severity of the trauma, massive blood loss, shock, concomitant pelvic injuries and other organs and systems, as well as the development of septic complications.The average bed-day inpatient treatment of victims is 74 days.Great stay at the clinic are mainly related to long-term treatment of concomitant injuries.The longest hospital stay was observed with suppurative complications of urologic injuries and bone extremities with injuries have consolidated fractures of the pelvis.
Transport immobilization with pelvic polifrakturah using reinforced tires Deryabina
- Conservative treatment for multiple bone fractures of extremities
- First aid for multiple fractures pelvis
- spinal cord injuries and cauda equina
- First aid for burns injuries complicated
- damage to abdominal organs and limbs
Recovery disability observed in 75.3% of patients, of them return to the former job69.3%, 6% are replaced by profession.Disability groups I-III are 15.1%.Disability depends not only on the heavy damage the pelvic r sealing rings, affecting the shape of the acetabulum and the effects of trauma urinary organs, but also on major related traumatic brain injuries, spinal injuries, and the effects of the lower extremities.It should be noted that after 2-3 years in some patients disappear pelvic pain, sciatica phenomenon, limited mobility in the hip joints.Persistent disability persists during concomitant bone fractures of extremities, primarily due to the remaining stiffness in the joints and limbs due to amputation.