Fracture of the pelvis
If a fracture of the pelvis is an isolated result of a fall the treatment can be simple and consist of rest and painguided mobilisation. If the fracture is part of a multitrauma it can be more complicated with severe bloodloss. Emergency surgery may then be indicated (1). In a secondary stage definitive surgery can then be performed.
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The patiënt in this example has suffered a major trauma but did not have severe bloodloss and definitive surgery could be planned after easy temporary reduction of the fracture with a bandage. The x-ray shows a total disruption of the symphysis, the connection in front of the two parts of the pelvis (2,3). Also in the backside a disruption, although not to big, can be seen, a so called sacro-iliac dislocation. With the bandage a reasonable reposition could be accomplished as can be seen in the 3-D reconstruction of a ct-scan (4,5).
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In this kind of dislocations one must be aware of the possibility of a rupture of the urethra or bladder. A contrast x-ray showed normal continuity in this case.
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Through a horizontal incision above the pubic bone the skin is opened and the symfysis is freed. The abdominal cavity is not opened. With a clamp reduction is achieved and maintained and a plate with screws is inserted. In this way mobilization is possible. After several months the plate must be removed, because the symfysis is actually a joint with small motions. In time therefore, fracturing of the plate is likely.