Pelvic fracture: Definition, Causes, Site, Clinical feature, Complication, Treatment, Nursing Care of Pelvic Fracture

 

PELVIC FRACTURE

 

 

Definition of Pelvic fracture:

 

          When fracture occurs in the pelvic bones is called pelvic fracture.

 

 

Causes of Pelvic fracture:

 

          It is caused by direct or indirect violence.

          i). Direct violence- by direct hit.

          ii). Indirect violence-

                    -Fall from height.

                    - Road Traffic Accident. (RTA) etc.

 

 

Sites of Pelvic fracture:

 

1.    Ramus of the ischium.

2.    Separation of the pubis symphysis with or without fracture separation in the sacro-illiac joint.

3.    Isolated fracture of the illiac bone.

 

 

Clinical feature of Pelvic fracture:

 

1.    History of trauma.

2.    Severe pain in the pelvic region.

3.    Retention of urine.

4.    Blood mixed urine.

5.    Lower abdomen is distended.

6.    Discoloration of skin of lower abdomen.

7.    Tenderness over symphysis pubis and illium.

8.    Pulse rapid.

9.    Blood pressure low.

10.Patient may be anxious.

11.X-ray to confirm diagnosis.

 

 

Complications of Pelvic fracture:

 

1.    Haemorrhage leading to shock.

2.    Rupture urethra and its complication, e.g stricture of urethra.

3.    Injury to the bladder.

4.    Death.

 

 

Treatment of Pelvic fracture:

 

1.    Complete bed rest.

2.    Check and record TPR and blood pressure.

3.    Analgesic is to be given. Like-Inj. Diclofenac sodium.

4.    Antibiotic is to be started , like-Inj-cloxacillin/ ampicillin/ Ceftraxon.

5.    Sedative should be given, like Inj- Pathedine or Diazepum according to patient’s condition.

6.    Blood transfusion is to be given.

7.    I /V fluid may be given till blood is  available for transfusion.

8.    If the patient is going to shock steroid is to be given , like Inj- Hydrocortisone.

9.    If there is retention of urine or damaged bladder then continuous catheterization is done with aseptic precaution.

10.When complete rupture of urethra-

i). Supra pubic drainage of the bladder should be done followed by urethroplasty.

ii). If possible surgical intervention is done.

iii). If necessary pelvic sling is done.

11.If any external injury-

a). If the patient is not immunized then –

          i). Inj.-TIG 250 i.u 1 ample I/m is to be given if not available then-Inj.-ATS 1500 i.u 1 ample i/m is to be given after skin test.

          ii). Inj.-T.T1 ample i/m started and another one after one month.

b). If the patient is immunized then only Inj.-T.T 1 ample i/m is given (Booster dose).

12. Diet- First 48 hours liquid or i/v fluid then gradually soft rice and normal diet.

 

 

Nursing care of Pelvic fracture:

 

1.    Keep the patient complete rest in firm bed.

2.    Check and record temperature, pulse, respiration and blood pressure ½ hourly.

3.    Check air way- if any secretion then suck by sucker machine.

4.    Oxygen inhalation is given if necessary.

5.    Reassurance to the patient.

6.    Watch i/v fluid or blood transfusion.

7.    Maintain intake output chart.

8.    Watch the catheter drainage if any blockage, leakage or disconnect then correct it.

9.    Watch color and amount of urine. If any abnormalities inform the doctor immediately.

10.Care must be taken of bony Prominence area.

11.Posture should be changed gently and carefully.

12.Mouth care should be given.

13.Head wash and sponging should be given gently and carefully.

14.Observed the pts general condition if any deterioration inform doctor immediately.

15.All medication is to be given as prescribed.

16.Assist the pt during bed panning.