Palatine joint ruptures are rare; discrepancies of the pubic joint and symphysitis , inflammation of the pubic joint in the postpartum period , are more often observed . In the dynamics of pregnancy, significant loosening of the tissues of the pubic and sacroiliac joints occurs as a result of the effect of relaxin, which is secreted by the corpus luteum and placenta. Relaxin has a relaxing effect on the ligamentous apparatus of the uterus, increases the extensibility of the neck, vagina and perineum in childbirth. The maximum accumulation of relaxin is observed towards the end of pregnancy. By this time, according to X-ray studies of the pelvis, there is a significant softening of the cartilage tissue of the symphysis and an increase in the gap between the pubic bones. In some women, this condition can cause pain during walking. When the pubic joint is broken, the pubic bones can diverge over a considerable distance. According to the data of X-ray studies of M.F. Eisenberg , the average width of the pubic joint in the first stage of labor in the first-born is 8 mm, in the re -progeny – 7.5 mm. The author determined the expansion of the pubic joint among the first-born in 35% of women, among the multiparous – in 62%. The lobes of the pubic joint are divided into spontaneous and violent. Spontaneous include gaps that occur during spontaneous birth. Violent gaps in childbirth arise from the use of fetal-extracting operations.
Cases of rupture with manual separation of the placenta or manual revision of the uterus are described. It is more likely that the insertion of the hand into the uterus completed the gap or revealed a gap that already occurred in the first or second stage of labor. In pregnant women, a rupture of the pubic joint can occur with damage to the pelvic bones (compression, shock, sprain) or a general injury to the musculoskeletal system. Spontaneous ruptures usually occur if during delivery the greatest discrepancy of the pubic joint is noted (at the birth of a large fetus, violent labor, incorrect removal of the head when providing manual benefits). Violent ruptures are most often the result of significant efforts during delivery operations. Recognition of rupture of the pubic joint is usually not difficult. Patients noted pain in the pubic joint when trying to change the position in bed. With an external examination between the edges of the pubic joint, you can enter several fingers, and sometimes the palm. Vaginal examination supplements the data from an external study. In doubtful cases, an X-ray of the pelvic bones is performed. Upon establishing the gap, the patient is prescribed bed rest, a bandage is applied to the pelvic area. Two longitudinal sleds are placed on the headboard and one block is attached to them at the level of the pelvis.
A wide bandage of dense canvas is applied to the pelvic area, and the ends are attached to wooden planks so that the bandage is not collected. K , Planck reinforcing cords, which pass through the blocks. A load is suspended at their ends, starting from 2 kg, which is gradually increased to 10 kg. With early recognition of a gap, a bandage is applied to obtain a pubic joint fusion for 2-3 weeks , with a late one – for 3-4 weeks . Can be used for these purposes linen bandage in the form of a hammock. The edges of the hammock are strengthened to the longitudinal slabs. The convergence of the pelvic bones occurs under the influence of the patient’s own gravity. The length of stay in the hammock is the same. With timely and proper treatment, the support function of the pelvis is fully restored. With late recognition of the gap, and sometimes regardless of this, symphysitis occurs – inflammatory processes of cartilage weaving , which greatly complicate the fusion and restoration of function.