Pelvic injuries in pelvic fractures

Pelvic fractures, especially combined damage to the anterior half ring, can be complicated by damage to the bladder or urethra.

Bladder rupture occurs with pelvic fractures 5 times less often than rupture of the urethra.
With an intraperitoneal rupture of the bladder, dullness over the pubis is absent percussion , sharp pain in the symphysis region and above the pubis is noted, in addition, tension and pain in the lower abdomen. Symptom Brush, on-Blumberg pronounced. During catheterization, an insignificant amount of urine is released, often liquid blood and blood clots.
Urinary tract ruptures are less common in women than in men. There are partial or incomplete ruptures (ruptures of the mucous membrane of the urethra) and complete.

With a rupture of the urethra, sharp pains are noted in the middle of the perineum, dullness over the pubis. The bladder is domed under the abdominal wall. Convulsive contraction of the internal sphincter leads to urinary retention in the overflowing bladder. From the external opening of the urethra, drops are released. In the perineum and scrotum, hematomas are formed, reaching large sizes. When (catheterization of the urethra (before operation) does not pass the catheter into the bladder.

For a more accurate diagnosis is advisable to apply urethrogram by Rusanov , which is introduced into the urethra 10-20 ml of 40% solution sergozina penicillin and instantly produce a radiograph. Stepping beyond the limits of the boundaries of the urethra of the contrast medium indicate a rupture of the
canal.In case of damage to the urinary tract, one of the first, very important measures is surgery, apply mine after withdrawal (of a patient from a state of shock. This is primarily necessary to eliminate the possibility of urinary infiltration during extraperitoneal ruptures of the bladder or urethra and peritonitis during intraperitoneal ruptures of the bladder.

In all cases of intraperitoneal rupture of the bladder, laparotomy, suturing bladder wounds, sutures on the integument, and the insertion of a permanent catheter through the urethra and bladder.
With extraperitoneal ruptures of the bladder under local anesthesia, a suprapubic section of the bladder is produced, the wound is sutured if possible. A drainage tube is inserted into the suprapubic opening of the bladder to divert urine.

With ruptures of the urethra and the grave condition of the patient, surgical intervention should be limited to the imposition of suprapubic fistula. Restoring patency of the urethra is postponed for 11 / 2-2 months.
If the divergence of the edges of the torn urethra is small, the urethra is sutured above the catheter through the perineal wound, which is sutured. The catheter is left for 18-24 days.
drainage tube is inserted into the cystotomy opening to divert urine. A purse string suture is placed around the bladder wall to seal the drainage.
Vaginal ruptures are accompanied by bleeding from the genital gap; they are most easily identified by inspection using a vaginal speculum.
Rupture of the rectum is rare. With a rupture of the rectum, sharp pain in the anus is noted. The nature and degree of rupture is easier to determine with a rectal mirror.
Disability after a pelvic fracture, accompanied by a rupture of the pelvic organs, is restored extremely slowly. The duration of treatment in the hospital is long, sometimes up to 4 months. A significant part of patients (about 65%) is transferred to temporary or permanent disability.

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