The anatomical and functional outcomes of treatment are of particular importance for pelvic fractures, since persistent violations of the normal anatomical structure of the pelvis and the relationship of its individual parts lead to severe, in most cases irreparable disability. In women, pelvic deformity can interfere with the normal course of “pregnancy and childbirth.
The indications for the use of various treatment methods for pelvic fractures should be based on the classification given. If fractures without a violation of the integrity of the pelvic ring, with the exception of certain types, have a favorable prognosis, then injuries of the second group that violate the continuity of the pelvic ring in connection with a difficult prognosis certainly require special treatment methods.
Of the first group, marginal fractures are most favorable. In these cases, seldom any significant displacements of the detached bone-periosteal fragment are observed, which, when so quickly grows together (3-4 weeks), without causing functional disorders. Only at large displacements, operational fixation of the fragment with (muscles attached to it at the place of separation is shown .
From the group of isolated pelvic fractures having a completely favorable anatomical and functional prognosis, acetabular fractures should be distinguished. These intraarticular injuries, although they do not violate the continuity of the pelvic ring, always threatened by the development of contractures, tugopodvnzhnosti even ankylosis of the hip joint, and therefore in need of early functional treatment.
at the turn of the bottom or roof vertluzh of the hollow without displacement of the femoral head shows early functional treatment by applying adhesive traction to the limb and performing therapeutic exercises from the first days of treatment.If the fracture of the bottom of the acetabulum is accompanied by a central dislocation or subluxation of the femoral head, the treatment should be directed to the direction of the latter, which is achieved removing the head from the pelvis and holding it in the correct position until the bottom of the acetabulum shadan is restored (2.5-3 months).
The most effective method of positioning and holding the femoral head is the method of constant traction using two skeletal rods, one of which is placed on a large trochanter, the second on the condyles of the thigh. Early functional therapy combined with a constant traction system provides a good anatomical and functional outcome. Therapeutic gymnastics for the injured hip joint is carried out for a long time in the supine position of the patient, since the limb load after the central dislocation of the thigh is allowed no earlier than 5 months from the day of the injury.
Fractures of the roof and the posterior edge of the acetabulum are often accompanied by a posterior dislocation of the thigh. In cases where the broken-off fragment is not prejudiced and is not an obstacle to the single-stage reposition head, a reduction should be made urgently, followed by (before fusion), use long extension for the final adhesive to prevent secondary displacement and ran- nyuyu gymnastics. In cases of infringement of the broken off fragment in the joint and failure when trying to simultaneously adjust the hip of the patient, you need to operate.
Fractures, fractures , disrupting the continuity of the pelvic ring, are the most severe multiple injuries, accompanied by a significant displacement of individual fragments, violating the shape and size of the pelvis.
The fragment separated from the pelvic ring under the influence of muscle traction is displaced in the cranial direction, which causes asymmetry of the right and left pelvic half and the relative shortening of the lower limb on the side of the displacement. Such a shift (in the absence of proper treatment will inevitably lead to severe irreversible disability; with rational treatment, the prognosis for both restoration of shape and function is quite favorable.
A powerful layer of muscles enveloping the pelvic ring, a small surface of the fracture planes and a plurality of fractures do not allow us to expect positive results from simultaneous reduction The only effective treatment for double vertical pelvic ring injuries is the skeletal method It provides restoration of the anatomical relationship, holding fragments in the position of achieved board, until the development of bone callus and restoration of normal function.The
extension is not limited to skeletal traction, but represents a system of traction, each of which has a specific purpose. on the side of the pelvic fragment displaced in the cranial direction This main traction eliminates longitudinal displacement with a load of an average of 8 kg.
To keep the body and main body of the pelvis in the correct position, glue traction is applied to the second leg. Traction control, which helps to reduce the displaced fragment, is created by raising the foot end of the bed (body weight) and applying a soft fixing loop through the inguinal region of the healthy side. In cases when a dislocation in the symphysis joins the fractures, after eliminating the displacement of the fragments along the length of the pelvis, the patient should be hung in a wide hammock loop.
Skeletal traction is stopped after l.5 months, replacing it with glue rods for another month. Crutches are allowed after 3 months, without crutches – 4 months after the injury. In cases of isolated discrepancy of the pelvis in the symphysis, which is a typical birth injury, the patient should immediately suspend the pelvis of the patient in a hammock for 6-8 weeks depending on the degree of displacement.
Recently, for chronic injuries, surgical treatment has been used, consisting in osteoplastic replacement of the defect formed in the pubic articulation and restoration of bone continuity of the pelvic ring.