Fractures and Dislocations of the Pelvis

Abstract
One hundred and fifteen patients with fractures of the pelvis, some of whom also had dislocation of the pelvic joints, were treated at the Ochsner Medical Center during a period of fifteen years. Four had avulsions, thirty-four had unstable fractures, and seventy-seven had stable fractures. None of the patients with avulsion fractures had associated injuries or residual disability. Only one patient in the avulsion group and none in the stable group required reduction. Twenty-five per cent of those with stable injuries had major associated soft-tissue injuries. Two died of hypovolemic shock. One had permanent disability from associated injury of nerve roots. The unstable fractures were classified as straddle, vertical shear, pelvic dislocation, lateral compressions, bucket-handle, and total disruption. Special roentgenographic views of the pelvis were found to be helpful in determining displacement of fragments in all three planes. Prompt reduction minimized the amount of blood loss. All unstable fractures were reduced by closed methods. Each type required a particular method of reduction. Seventy per cent of the patients had associated soft-tissue injuries and three died as a result of their injuries. Twenty-seven of the thirty-one survivors of unstable pelvic fractures obtained satisfactory results of treatment. Four patients were permanently disabled because of low-back pain from traumatic sacro-iliac arthritis in three and unknown cause in the other. In two of these four patients reduction was incomplete, and redisplacement occurred in the two others after too early ambulation. We conclude that complete reduction of the displacement and an adequate period of immobilization and recumbency is necessary to obtain the best results in treatment of unstable fractures.