Can I walk after a pelvic fracture?

The human body's skeletal structure is very complex, and the pelvis is very critical to the human body. A pelvic fracture can cause the body to lose support and balance, and can also easily lead to some complications. Rest is required after a pelvic fracture, and walking on the ground may cause heavy bleeding.

Pelvic fracture is quite serious because the pelvis is an important bone organ in the body and it supports the whole body. If you have a pelvic fracture, you need to rest for at least 3 months before you can exercise. If you just want to walk, you can usually exercise after a month, but you can't walk for too long and the amount of exercise can't be too much. Rest in bed as much as possible, eat more foods that can supplement calcium, drink more bone soup, soybean soup, pig's trotter soup, and milk. These are all good and helpful for the recovery of the disease. You must also pay attention to getting more sun exposure. Anyway, you must also pay attention to air circulation. You must pay attention to rest, keep a happy mood, and don't go to bed too late.

You must pay attention to bed rest, and it is also necessary to walk around appropriately. Eat more whole grains, soybeans, porridge, and bone porridge. Red bean porridge, mung bean porridge, red bean porridge, white fungus porridge, these are all good. Don't eat raw, cold, fried, spicy food, and don't eat food that hurts your stomach.

You must pay attention to keeping a happy mood and not getting angry often. Don't be too stressed in life or work. You must keep warm and pay attention to air circulation. You can apply hot water to the affected area, which is also very beneficial to your condition. Eat more fruits and vegetables, especially organic vegetables. They are all bitter melon, mustard greens, celery and mushrooms, which are all pretty good.

In daily life, you must be careful not to eat spicy food and do not go to public places. You can do more stretching exercises, but the amplitude should not be too large. Doing some basic stretching exercises is also beneficial for the recovery of the pelvis. You need to take good care of yourself and pay more attention to rest. As long as you take good care of yourself, pay more attention to rest, and exercise properly, I believe your recovery will be relatively ideal.

Classification

Pelvic fractures caused by low-energy trauma are mostly stable fractures, which often occur in falls and low-speed car accidents in the elderly, or avulsion fractures of the anterior superior iliac spine or ischial tuberosity in minors and athletes. The former is caused by the sartorius muscle, and the latter is caused by the violent contraction of the hamstring muscles. Fractures caused by high-energy external forces are mostly unstable fractures. The commonly used classification of pelvic fractures internationally is:

1. Young & Burgess Classification

(1) Separation type (APC) is caused by anterior-posterior compression injury, with common pubic symphysis separation. In severe cases, it causes damage to the anterior and posterior sacroiliac ligaments, accounting for 21% of pelvic fractures. It is divided into three subtypes: I, II, and III according to the severity of the fracture.

(2) Compression type (LC) is caused by lateral compression injury, which often causes sacral fracture (lateral posterior compression) and hemi-pelvic internal rotation (lateral anterior compression), accounting for 49% of pelvic fractures; it is also divided into three subtypes: I, II, and III according to the severity of the fracture.

(3) Vertical (VS) shear force injury, caused by vertical or oblique external force, often leads to vertical or rotational instability, accounting for 6% of pelvic fractures;

(4) Mixed force (CM) lateral compression injury and shear force injury, which lead to damage to the anterior pelvic ring and anterior and posterior ligaments, account for 14% of pelvic fractures.

The advantage of this classification is that it helps to judge the degree of injury and estimate the combined injuries, which can guide rescue and judge the prognosis. According to literature statistics, separation fracture combined injuries are the most serious and have the highest mortality rate, followed by compression type, and vertical type is relatively low; the order of bleeding volume is separation type, vertical type, mixed type, and compression type.

2. Tile's/AO classification

(1) Type A is stable with slight displacement;

(2) Type B: longitudinally stable, rotationally unstable, with intact posterior and pelvic floor structures;

B1: Anterior-posterior compression injury, external rotation, pubic symphysis > 2.5 cm—injury to the anterior sacroiliac ligament + sacrospinous ligament;

B2. Lateral compression injury, internal rotation;

B2.1 Lateral crush injury, ipsilateral type;

B2.2 Lateral crush injury, contralateral type;

B3 bilateral type B injury;

(3) Type C is both rotationally and longitudinally unstable (longitudinal shear injury);

C1. Unilateral pelvis;

C1.1 ilium fracture;

C1.2 sacroiliac joint dislocation;

C1.3 Sacral fracture;

C2. Bilateral pelvis;

C3. Combined with acetabular fracture.

Clinical manifestations

1. The patient has a history of severe trauma, especially trauma involving pelvic compression.

2. The pain is widespread and worsens when moving the lower limbs or sitting. Local tenderness, congestion, rotation and shortening of the lower limbs, bleeding from the urethral orifice, and swelling of the perineum may be seen.

3. The umbilical spine distance can be seen to increase (dissociated fracture) or decrease (compression fracture); the posterior superior iliac spine can be increased (compression fracture), decreased (dissociated fracture), or moved upward (vertical fracture)

4. The pelvic separation compression test, figure-of-four sign, and torsion test are positive, but are contraindicated in examining patients with severe fractures.

examine

For most pelvic fractures, the AP X-ray can be used to determine the mechanism of injury and determine the initial first aid plan. Other imaging examinations can help classify the fracture and guide the final treatment method.

1. X-ray examination

(1) Pelvic AP X-ray is a routine and necessary basic examination. 90% of pelvic fractures can be detected by AP X-ray examination.

(2) When taking pelvic entrance radiographs, the tube is tilted 40° toward the head end to better observe sacral wing fractures, sacroiliac joint dislocations, pelvic anterior-posterior and rotational displacements, pubic ramus fractures, pubic symphysis separation, etc.

(3) When taking pelvic outlet radiographs, the tube is tilted 40° caudally to observe whether the sacrum and sacral foramen are fractured and whether the pelvis is vertically displaced.

2. CT examination

CT is the most accurate test for pelvic fractures. Once the patient's condition stabilizes, CT scan should be performed as soon as possible. For injuries to the posterior pelvis, especially sacral fractures and sacroiliac joint injuries, CT examination is more accurate. CT examination should also be performed when there is an acetabulum fracture. CT three-dimensional reconstruction can more realistically display the anatomical structure of the pelvis and the positional relationship between fractures, forming a clear and realistic three-dimensional image. It is of great value in determining the type of pelvic fracture and deciding on the treatment plan. CT can also simultaneously display retroperitoneal and intra-abdominal bleeding.

3. Angiography

Used to diagnose and treat large vessel bleeding, ruptured large blood vessels can be detected through angiography and bleeding can be controlled by embolization of the blood vessels.

complication

1. Hemorrhagic shock

The main cause of shock is rupture of the anterior sacral venous plexus caused by bleeding from the fracture ends and damage to the posterior structure. Rupture of large blood vessels is less common. Other causes include open wounds, hemothorax, intra-abdominal hemorrhage, long bone fractures, etc.

2. Retroperitoneal hematoma

The bones of the pelvis are mainly cancellous bones, the pelvic wall is rich in muscles, and there are many arterial and venous plexuses nearby, with rich blood supply. The gap between the pelvic cavity and the posterior skin membrane is composed of loose connective tissue, and there is a huge space to accommodate bleeding, so fractures can cause extensive bleeding. Large retroperitoneal hematomas may extend to the renal area, below the diaphragm, or to the mesentery. Patients often suffer from shock and may have symptoms of peritoneal irritation such as abdominal pain, abdominal distension, decreased bowel sounds, and abdominal muscle tension. In order to differentiate it from intra-abdominal bleeding, diagnostic abdominal puncture can be performed, but the puncture should not be too deep to avoid entering the retroperitoneal hematoma and being mistaken for intra-abdominal bleeding. Therefore, close and careful observation and repeated inspection are necessary.

3. Urethra or bladder injury

The possibility of lower urinary tract injury should always be considered in patients with pelvic fractures, as urethral injuries are far more common than bladder injuries. Patients may experience difficulty urinating and bleeding from the urethra. The incidence of membranous urethra injury is higher in cases of bilateral pubic ramus fractures and pubic symphysis separation.

4. Rectal injury

Unless the pelvic fracture is accompanied by an open injury to the genitals, rectal injury is not a common complication. If rectal rupture occurs above the peritoneal reflection, it can cause diffuse peritonitis; if it occurs below the reflection, perirectal infection may occur, often with anaerobic bacteria.

5. Nerve Damage

It often occurs when the sacrum is fractured. S1 and S2, which make up the lumbar sacral nerve trunk, are most vulnerable to injury. The gluteal muscles, hamstrings and calf gastrocnemius muscles may become weak, and there may be loss of sensation in the posterior calf and lateral part of the foot. When the sacral nerve is severely injured, the Achilles tendon reflex may disappear, but sphincter dysfunction rarely occurs. The prognosis is related to the degree of nerve damage. Mild injuries have a good prognosis and can generally be expected to recover within a year.