COMPLICATED CRUSHING INJURIES OF THE PELVIS

¹ Baragwanath Hospital and the University of Witwatersrand, Johannesburg

1. Seventy-five patients sustained fractures of the pelvis with associated soft-tissue complications. Twenty died, and of these, thirteen died within forty-eight hours of admission to hospital.

2. The initial resuscitation and clinical assessment of these patients are discussed, and attention is drawn to the significance of the concomitant retroperitoneal haematoma as a cause of oligaemic shock, and as a dissembler of internal visceral injury.

3. The morphological fracture patterns are classified into six categories, but the fracture patterns are not correlated with specific visceral injuries.

4. Forty-six patients sustained urinary tract injuries. Of these, nineteen had suffered rupture of the urethra; fourteen had rupture of the bladder; two had both urethral and vesical disruption, and one patient had a torn ureter. The diagnosis and management of these injuries is discussed.

5. Twelve patients had a traumatic laceration or perforation of the ano-rectum. Nine of these patients had associated urethral or vesical injuries.

6. Four patients were involved in accidents and sustained pelvic fractures while in the last three months of pregnancy. The tragic outcome of this combination of circumstances is noted.

7. Attention is drawn to peripheral nerve injuries in association with pelvic fractures, and the difficulty of localising these lesions is stressed.

8. Eight instances of damage to the abdominal parietes are recorded. Four patients suffered skin and soft-tissue loss, two patients had diaphragmatic disruptions and two patients had abdominal wall dehiscences.

9. Major accident victims frequently have multiple injuries. This series of patients has been analysed to draw attention to the association of pelvic fractures with bizarre visceral injuries.