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Abstract: Pelvic fracture is a common and serious trauma that occurs mainly among traffic accident injuries. This patient suffered a severe impact in a traffic accident and suffered a pelvic fracture with massive bleeding, which caused hypovolemic shock. After active treatment, the vital signs were restored to stability, and the pelvic fracture site was re-fixed through conservative treatment to restore the stability of the pelvis, pain was relieved, and the patient gradually resumed normal activities.
Basic information】Male, 40 years old
Disease Type】Pelvic fracture
Hospital】Harbin First Hospital
Date of Consultation】August 2021
Treatment plan】Pelvic pocket fixation + medication (balanced salt solution, amino acid injection) + rehabilitation
Treatment period】7 days of hospitalization, review after 6 weeks
Results】Pelvic repositioning and fixation, pain relief, return to normal activities
I. Initial consultation
The patient had severe pelvic pain, subcutaneous bruising, and pelvic deformity, with one pelvis displaced upward and significant local pressure pain, and the displaced fracture end could be palpated. The specific site of the pelvic fracture and the dislocation were more clearly shown by taking 3D CT. Since the patient’s vital signs were not completely stable in the acute stage, conservative treatment was safer and could ensure smooth healing of the pelvic fracture, and conservative treatment was adopted after full communication with the patient.
II. Treatment process
After the patient fully understood the method of conservative treatment, the pelvis was fixed with a pelvic pocket to stabilize the fracture end and reduce local bleeding. At the same time, the patient was required to take absolute bed rest to minimize the stimulation of the fracture end, and intravenous supplementation of balanced salt solution and amino acid injection to maintain effective blood volume and ensure the patient’s life safety. In addition, rehabilitation treatment was carried out under the guidance of the rehabilitation physician to perform knee and ankle joint activities and actively contract the muscles of the lower limbs to promote the blood supply to the fracture end of the pelvis to ensure smooth healing of the fracture.
III. Treatment effect
The pelvic fracture was fixed firmly through conservative treatment, and the formation of bone scab at the fracture end was promoted. The patient’s pelvic pain symptoms were significantly relieved in 7 days of hospitalization, and the pelvic position was stabilized, and the patient was discharged. Six weeks after discharge, the patient’s X-ray was reviewed and it was found that the bone scab had passed through the broken end of the bone and the fracture end was relatively stable, so the pelvic pocket fixation could be removed at this time. However, the patient still needs to rest in bed and avoid weight-bearing activities at the pelvic fracture site. A follow-up radiograph 2-3 months after discharge confirms complete healing of the pelvic fracture and the patient resumes normal weight-bearing ambulation. After fracture recovery, start light to moderate physical exercise such as walking and elliptical training to enhance hip muscle strength and hip muscle strength to maintain pelvic stability.
IV. Precautions
We are glad that the patient recovered from the pelvic fracture and the symptoms are gradually relieved, but we need to remind the patient that after the pelvic fracture is treated conservatively, continuous bed rest is required, and if he sits up and moves too early, it may cause the fracture end to shift and affect the smooth healing of the pelvic fracture, resulting in delayed healing, non-healing or even deformed healing of the fracture, which will interfere with the weight-bearing walking of both lower limbs and lead to limping symptoms. Patients should increase protein food intake, such as milk and meat, to promote smooth fracture healing. The pressure on the hip joint will be reduced after smooth recovery of pelvic fracture, which can prevent degenerative changes of the hip joint and control weight to reduce pelvic load, which is beneficial to the recovery of pelvic fracture.
V. Personal insight
The human body still has a high bone density at the age of 40, but when the pelvis is subjected to strong external forces during traffic accidents, pelvic fractures can still occur and even threaten life safety, therefore, it is very important to prevent serious trauma. In daily life, strengthening the muscles of the lower limbs as well as the hip muscles can significantly improve the agility of the body, which can quickly evade when encountering the risk of trauma and provide sufficient protection for the pelvic area to minimize the occurrence of injuries to the pelvic bones.