PELVIS. 



tachments and the opposing fractured sur- 

 faces, but by the original direct violence. 



By such displacement of comminuted and 

 spicular fragments in the true pelvis, the 

 bladder and urethra, particularly if the former 

 be distended at the time of the accident, 

 often suffer great laceration, which may even 

 extend to the peritoneal investments and open 

 the cavity of the abdomen. Such extensive 

 injuries are invariably followed by extravasa- 

 tion of the urine into the pelvic areolar struc- 

 tures or peritoneal sac ; and violent peritonitis 

 carries off the patient, even if he survive the 

 first shock of such a formidable accident. 

 The external soft parts, also, generally suffer 

 greatly from the violence, and from the great 

 extravasation of blood which usually takes 

 place from the torn vessels. Gangrene may, 

 in these cases, succeed to a great extent, and 

 destroy the patient. It is these injuries, and 

 their consequences to the soft parts and in- 

 ternal structures, that render fracture of the 

 pelvis, like those of the cranium, so dangerous 

 and fatal to life. 



The diagnosis is drawn from the pain and 

 difficulty of moving the lower extremities, 

 and from the mobility and crepitus of the 

 fragments, felt on placing the hand on the 

 iliac crest, the pubic spine, and sciatic tu- 

 berosity consecutively and moving the leg. 

 The crepitus is most distinctly felt by the 

 hand which rests on the pelvic bones, and 

 scarcely at all by that which moves the leg. 

 This useful comparison will distinguish these 

 fractures from those of the neck of the femur. 

 If one ilium be dislocated upward and back- 

 wards on the sacrum, and at the same time 

 separated from the other bones by a fractured 

 acetabulum, the femur is drawn up with the 

 ilium, the trochanter turned forwards, the 

 knee and foot turned inwards, and the whole 

 limb shortened, so as to resemble a dislocation 

 at the hip-joint. Deeply-seated fractures, 

 however, often pass undetected, from the 

 rigid contraction of the muscles, the great 

 pain experienced on motion, and fear of in- 

 juring the viscera more extensively. They 

 will be more easy to detect on the thin 

 subject, and on the female. 



In one of the cases figured and related 

 by Sir Astley Cooper in his Surgical Es- 

 says (plate 2. fig. 6.), the head of the fe- 

 mur had been driven by violence, applied 

 laterally, through into the pelvic cavity, car- 

 rying a comminuted portion of the aceta- 

 bulum with it. The fracture was Y-shaped, 

 and had radiated from the centre of the 

 acetabulum pretty nearly in the line of the 

 suture, as we have before remarked in 

 fractures here and in the ischio- pubic ramus. 

 A fracture near or in the latter suture also 

 existed. The limb presented the appearance 

 of a dislocation of the femur backwards. In 

 another case, the posterior part of the 

 acetabulum was broken off, the fracture pass- 

 ing across to the ptibes, both innominate 

 bones being broken and displaced, and the 

 femur dislocated. The pubic symphysis was 

 separated about an inch, the fibro-cartilage 



adhering to one bone only. The knee and 

 foot were turned inwards, and the whole 

 limb shortened two inches ; but it was more 

 moveable than in a dislocation, and crepitus 

 was felt on cautious extension being made. 

 In a female whose pelvis had been crushed 

 by a cart against a wall, a fracture was found 

 passing through the body of the left pubis 

 and the left ascending ischial ramus. Both 

 the sacro-iliac joints had separated, part of 

 the osseous sacral auricular surface of the 

 right joint having come off with the ligaments. 

 The pubes were separated at the symphysis. 

 Motion and crepitus were felt on applying 

 one hand to the ilium and the other to the 

 pubis, and the posterior superior iliac spine 

 projected upwards considerably. Through 

 the vagina, the pubes were felt projecting into 

 the vaginal cavity. There was much blood 

 effused into the pelvis, and the patient died, 

 sixteen days after, from sloughing of the soft 

 parts. 



Otto mentions that, in the Museum of the 

 Veterinary College at Copenhagen, are speci- 

 mens of horses' pelves, fractured by excessive 

 muscular action. 



Sir A, Cooper mentions three cases of 

 fractured innominate bone which had reco- 

 vered. Two were fractures of the ilium, 

 easily detected by the mobility of the crista 

 and crepitus. The third was a fracture of 

 the ischio-pubic ramus about the suture. 



Rokitansky found that fractures of the 

 pelvis rarely united without displacement. 

 One of Mr. Barlow's successful cases of 

 Caesarian operation was necessitated by the 

 results of a fracture of the left innominate bone, 

 which produced an elevation of the head of the 

 thigh bone, shortening of the limb, and lame- 

 ness. The contraction of the pelvic diameters 

 resulted mainly from a projection backwards 

 at the symphysis pubis, which was supposed 

 to be caused by ossification of the disarti- 

 culated joint, and which reached to within 

 half-an-inch of the sacrum. Burns states 

 that he has seen extensive pointed ossifica- 

 tions projecting nearly 2 inches into the 

 pelvis, in consequence of fractured aceta- 

 bulum. Naegele also mentions cases in which 

 a bulinn"- of the acetabulum inwards caused 



" T~v T 



obstruction to parturition. Dr. Lever has 

 also seen a bony process, more than an inch 

 long, encroaching upon the pelvic cavity, in 

 a male subject, after fractured acetabulum. 

 Sometimes, after fractures of the pubis, the 

 formation of callus has considerably inter- 

 fered with the functions of the urethra. 

 When ankylosis takes place at the sacro- 

 iliac joint, after dislocation of the ilium back- 

 ward's, the pelvis assumes a shape closely re- 

 sembling the pelvis oblique avata of Naegele. 

 A preparation of this kind is mentioned by 

 Dr. Ramsbotham, as existing in the Museum 

 of University College. 



BIBLIOGRAPHY. Naegele, Das schrag verengte 

 Beckon (and' Appendix). liiijbii, Midwifery (in 

 Tweedie's Pract. Medicine, vol. vi.). Dr. Robert 

 Lee, Lectures on Parturition (in Lund. Med. (Ja- 

 zette, 1843.). Hull, Defence of the Ctesarian Sec- 



