How to treat a fracture of the ischium?

Fracture of the ischium is a violation of the integrity of small pelvic bones. Anatomically, the pelvis consists of two bones that do not have special names. To adolescence each hip bone is divided into 3 separate:

• iliac;
• sciatic;
• the pubic.

After reaching 16 years of age three pelvic bones are fused into one, which is connected by means of cartilage on the femur. The femoral head enters the acetabulum, which is formed by the body of the ischium. The ischium has an important role in coordinating the lower limbs of man.

The symptoms of fracture of the ischium

Pelvic bones in a healthy person are very durable, they can withstand heavy daily load. A fracture occurs most often as a result of unsuccessful landing on the buttocks because of direct blow in the accident. It is estimated that fractures of the ischium are about 10% of all fractures of bones, that is, this type of damage is very common. More common closed fractures in which skin integrity is not broken. The typical clinical picture in the elderly is associated fracture of the several bones of the pelvis in the fall. What happens when a fracture of the ischium:

• the victim feels severe pain at the site of injury;
• impaired mobility and muscle control of the lower limbs, lying on back, people can not raise a straight leg;
• formed edema and hematoma;
• in one third of cases of fracture of the pelvic ring developing traumatic shock;
• there is a delay of urine;
• if the result of the displacement of bone fragments has been damaged urethra, starts bleeding from the urethra;
• if damaged rectum, have bleeding from the anus;
• in fractures with displacement audible crunch;
• possible loss of consciousness;
• possible internal bleeding;
• possible damage to sciatic nerve and major blood vessels.

About the damage to the sciatic nerve can talk such symptoms, like numbness or local changes of sensitivity in the buttocks, thighs, leg, foot.

First aid for fracture

Outside the medical institution to help the person with a fracture of the ischium is only one way - as soon as possible after you bring him to the hospitalor to the emergency room. No other measures without an x-ray in the field will not be effective. Usually the fracture is accompanied by very intense pain, to relieve which it is possible to do the following:

1. Receiving non-narcotic painkillers the pills washed down with water. Name of drug and dosage need to tell the ambulance crew.
2. Ice pack improvised. You can use food ice pack, a piece of frozen meat, a bottle of ice water. A compress applied through the fabric to avoid direct contact with skin. It is impossible to prevent the melted water and condensate in open wounds. Ice can be applied for 15 minutes, and then you want to take a break to prevent hypothermia.

Man with a fracture of the ischium it is impossible to move independently, should adopt the posture of a frog, sitting on my stomach, spreading his knees slightly to the side. Under the knees, you need to put cushions of folded clothing or a small pillow. So bone fragments are not shifted, the ambulance crew transports on the hard stretcher.

Healing of the fracture

In the ambulance, the victim receives an injection of pain medication, often narcotics, e.g., morphine. Fractures of the ischium can be so painful that the person loses consciousness. After arriving at the emergency room the research method:

• x-ray;
• computed tomography;
• magnetic resonance imaging.

To clarify the clinical picture is required to specify not only the location of bone fragments, but the nature of soft tissue injuries. On the basis of all data the decision on necessity of surgical intervention. Compression fractures, resulting in many small fragments, almost always require special fixing materials for fixing bone.

Without this it is impossible to achieve proper splicing. Conservative treatment includes bed rest on an orthopedic bed.

The patient should be kept under observation in hospital for the first time after the injury, because some symptoms do not develop instantly, and for a long time. As a result of increased hemorrhage in the soft tissue can be pinched nerves, the result gradually there is neurological damage. Bed rest is appointed for a minimum of 7 weeks, a part of thistime could be spent at home. Definitely getting painkillers, first injection and then orally. Recovery time depends on many factors:

• the nature of the injury - how difficult is the fracture;
• the age of the victim - the older, the longer it is regenerated bone;
• individual body's ability to restore structural integrity of bones.

The attending physician makes recommendations for equipment home beds in which the patient is located. You may need different kind of cushions and suspensions. Everything needed should be purchased in advance. To accelerate the recovery process needed to enrich the diet of the victim sufficient amounts of calcium, magnesium, vitamins D and E. After healing is prescribed a course of physical therapy aimed at the development of the hip joints and restoring muscle tone. You should be responsible to the exercises, do not overexert, but to refuse to load at all. Especially the importance of therapeutic exercise in the elderly. In any case, required to immediately return to ambulance:

• if increasing edema in the fracture site, especially with redness and a feeling of local heat;
• if rising the overall body temperature more than 38°C;
• if the victim begins vomiting, headache, dizziness, weakness;
• if you have bleeding from the urethra or anus;
• if the lower abdomen or back, there is severe pain;
• if patient complains of increasing pain at the site of injury.

http://www.youtube.com/watch?v=O4bFoUUfbEo

Each of these characteristics suggests that there is either some comorbidities or complications after fracture. In any case, a specialist consultation is required immediately because there are complications and posing a threat to human life, for example, sepsis.

Complications of fracture

Due to the fact that the pelvis is one of the many vital organs and nerves, the list of possible complications after injuries of the ischium is quite large. Some of the complications manifest themselves almost immediately, some only after many years. For prophylaxis is recommended to find a competent doctor and strictly follow his recommendations. What can be complications:

1. If the fracture of the ischium was open and there was an entry wound pathogens, infectious complication is the inflammatory process.
2. If the fracture with displacement was injured the muscles, ligaments, vessels, tendons, nerves, possible violations of the work joint and ligaments, vascular and nervous systems,namely: chronic pain, urinary incontinence and fecal incontinence, problems in the sexual sphere, varicose veins, etc.
3. Improper reduction or fusion of bone fractures of the ischium can lead to restriction in the movements of the legs can form bone spurs, occur shortening of the limb.
4. If affected vessels, can develop or atrophy or hypertrophy of muscles of the pelvis.

http://www.youtube.com/watch?v=-tFTEtYuAOo

However, thanks to advances in modern medicine even at the most serious fracture of the ischium mortality in the first days of its accompanying complications is less than 5% of cases.