Pelvic Fracture
Pelvic fractures is mostly due to a strong external force. Because of strong bone structure and the structure of the basin which contains important organs, blood vessels and nerves, therefore there is a lower incidence of pelvic fractures and high mortality. Pelvic fractures can be divided into the following types:
Type A: stable,
Type B: unstable rotation,
Type C: rotary and vertical are unstable.
1.Stable pelvic ring fractures (A-type):
(1) pelvis edge avulsion fracture: Such fractures with or without displacement, generally do not need special treatment, there is no effect after fracture healing function. Just treat with symptomatic treatment, and rest in bed. Protect fracture from muscle contraction stretch.
(2) Before the anterior superior iliac spine or iliac spine avulsion fracture: During the patient in bed, use a soft pillow to elevate the knee. and maintain proper hip flexor bit to relieve pain. After the pain disappears, weight-bearing activities can be accepted.
(3) Patient with Ischial tuberosity avulsion fracture in bed rest should set the thigh in extension, external rotation position.
2. iliac wing fracture
(1) simple iliac wing fracture is not necessary to be reduced and fixed. Just stay in bed for 3 to 4 weeks. After the pain disappears, weight-bearing activities can be accepted.
(2) If the fragment is large and there is a serious shift, to ensure a smooth fracture healing and early ambulation, You need to consider open reduction and internal fixation with cancellous bone screws or steel screws.
3. single horizontal branch or under pubic branch fractures
Because a single branch or ischial pubic branch fractures detract from the integrity and stability of the pelvic ring, generally patients need bed rest for 2 to 3 weeks to ambulation. Set in the knee with a soft pillow bed, to keep the hip in flexion to relieve pain.
4. Sacral 2-3 following transverse fracture
If the Fracture of patients is without displacement or shift slightly, they just need to stay in bed to avoid pressure touch. Pain will subside after a few weeks. Fracture dislocation were entirely from the anus hand pointing to push more difficult to reset, and there is the risk of damage to the rectum, consider open reduction.
5. Unilateral pubis, lower branch fracture
Because there is no significant shift fractures and no effect on weight-bearing function after fracture healing, pelvic ring remaining intact, so patients only need symptomatic treatment, such as bed rest or maintain proper hip flexion. Then the pain disappears after ambulation.
6. Mild pubic symphysis separation
(1) Push on both sides of the pelvis by extrusion technique, so that the pubic symphysis after involution with fixed pelvic strap, to reduce pain and make patients feel comfortable. 4 to 6 weeks of bed rest. In general, even if a reset is not complete, there is rarely a permanent dysfunction.
The patients merger with the urethra or bladder injury, can be fixed after surgery with pelvic external fixation ring external, in favor of postoperative care and early ambulation.
7. Sacroiliac subluxation
(1) conventional therapy is manual reduction and plaster pants with bilateral fixed three months. To reduce the number of complications in bedridden, some scholars advocate manipulative half dislocation percutaneous sacroiliac screw fixation put pressure off.
(2) If there is persistent pain in old subluxation, sacroiliac joint fusion should be applied.
8. Bilateral pubic next branch fracture
Treatment is similar with unilateral pubis, under branch fracture, bed rest is advisable. During bed rest, put a soft pillow in patients with knee pads,, keeping hip flexion appropriate to relieve pain. For failure complicated by urethral or bladder injury, usually without pelvic external fixation.
Rotation unstable pelvic ring fractures stable longitudinal (B type)
1. It can be divided into separate fractures and compression type (pronation type) fracture.
2. Rotation unstable pelvic fractures often is associated with internal bleeding and pelvic visceral injury, seriously injured. The key is the treatment of hemodynamic stability and handling merger visceral injury, but as soon as possible to reduce and fix the fracture, because this is the necessary measures to control bleeding.
3. Sustained and stable fixation to prevent fracture activity leads to clot off and solidified rebleeding.
4. Longitudinally stable pelvic fracture rotatory instability is particularly suitable for external fixation line with external fixation, and bone ends have control bleeding quickly relieve pain and there is advantages of ease of care, as a final definitive treatment.
Pelvic ring rotation and vertical fractures are unstable (C-type)
1. Restore the stability of the load-bearing structure of the pelvic ring as soon as possible.
2. When there are a lot of bleeding, and the general condition of the patient is not stable due to unbearable and internal fixation, the pubic shifted can be symphysisly and internally or by external fixation device while the surgical treatment damages organ.
1. Eat more nutritious, containing crude fiber-rich fruits and vegetables.
2. Minimize moving dramatically patient to prevent fracture fixation, shedding. Been placed on the cushion bed, lying and healthy alternate side, to prevent pressure sores.
3. Observe incision and drainage situation bleeding, and prevent infections.
4. Early non-sitting, bed rest, it is desirable when the contralateral turning in the next, only stretching exercises for the upper limbs in bed.
5. The method of exercise should be carried out according to damage the integrity of the pelvic ring doctor.
6. When it does not affect the integrity of the pelvic ring fractures alone, none of injures is associated.
7. Patients who affect the integrity of the pelvic ring without complications:
(1) practising semi-recumbent position 2 weeks after injury, and lower limb muscle contraction exercises.
(2) hip, knee activity in bed three weeks After injured.
(3) fracture healing, removal of traction fixed crutches to walk, 6-8 weeks after injury.
(4) weight-bearing gradually walking exercise, 12 weeks after injury.
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