30. Fracture of the bodies of the iliac bones

Isolated pelvic fractures

Isolated pelvic crest fracture

• Result from direct impact over the pelvic crest
• Bruising and edema at fracture site
• Palpable pain at place of fracture
• Bone crepitation or pain during motion of leg
• X ray confirms diagnosis
• Treatment- bed rest for 30 days and pain control

Fracture of superior branch of pubic bone

• Bruising and palpation pain under the inguinal ligament are found
• Symptom of the "fixed heel" becomes positive - the patient cannot raise the leg on the affected side

Avulsion fractures

• Form in fragmentary mechanism in cases of intensive contraction of a larger muscle
• Seen more in athletes!
• Treatment- rest for 3-4 weeks
• Surgery rarely needed!

Injuries interrupting pelvic ring

Rotationally unstable injuries

• Patients are in a poor performance status
• Forced to lie back with lower limbs externally rotated!
• There is a significant symphysiolysis radiologically
• Treatment- "closure" of the pelvis in any possible way
• Can also be placed in a hammock for 45-60 days

Absolutely unstable injuries

• Rotator instability is co-existing with dislocation of the posterior structures
• Bruising, edema and prominent posterior spinae are found
• Radiologically, there is a posterior rupture in the form of luxation or fracture
• Treatment- anti-shock procedures
• Closure of the pelvis is achieved via external fixation and posterior stabilization
• Cannulated iliosacral screws for stabilisation of posterior pelvic parts

Butterfly fracture

• Bilaterally, both the rami of the pubic bone are fractured
• Rotatory unstable fracture!
• Symptoms- legs take frog position, anterior pelvic pain
• Treatment- 45 day stay in bed
• Verticalisation could be discussed after the 60th day!

Malgaigne fracture

• Vertically unstable fracture!
• Occurs in traffic accidents or falls from large heights
• Variations:
• Symmetrical to the front and back
• Bilateral to the front and unilateral to the back
• Symptoms- vertical displacement of pelvic half, muscular contraction shortens the limb, patient could be in shock, very severe damage to organs and systemns
• X-ray- shows interruption of the pelvic ring anteriorly and posteriorly with dislocation
• Treatment- anti-shock procedures
• Direct extension for repositioning of the vertical dislocation unilaterally or bilaterally for 2-3 months