_The lateral and posterior aspects_ of the pelvic ring may be implicated either in association with pubic fractures or independently. Thus a fracture of the iliac bone may run into the greater sciatic notch; or a vertical fracture of the sacrum or separation of the sacro-iliac joint may break the continuity of the pelvic brim. In rare cases these injuries are accompanied by damage to the intestine, the rectum, the sacral nerves, or the iliac blood vessels.
[Illustration: FIG. 56.--Fracture of left Iliac Bone; and of both Pubic Arches.]
_Treatment._--It is of importance that the patient be moved and handled with care lest fragments become displaced and injure the viscera. He should be put to bed on a firm mattress, which may be made in three pieces, for convenience in using the bed-pan and for the prevention of bed-sores.
Before the treatment of the fracture is commenced, the surgeon must satisfy himself, by the use of the catheter and by other means, that the urethra and bladder are intact. Should these or any other of the pelvic viscera be damaged, such injuries must first receive attention.
The treatment of the fracture itself consists in adjusting the fragments, as far as possible by manipulation, applying a firm binder or many-tailed bandage round the pelvis, and fixing the knees together by a bandage (Fig. 57).
[Illustration: FIG. 57.--Many-tailed Bandage and Binder for Fracture of Pelvic Girdle.]
When there is displacement of fragments extension should be applied to both legs, with the limbs abducted and steadied by sand-bags.
Compound fractures, being commonly associated with extravasation of urine, are liable to infective complications. Loose fragments should be removed, as they are prone to undergo necrosis.
The patient is confined to bed for six or eight weeks, and it may be several weeks more before he is able to resume active employment.
The #acetabulum# may be fractured by force transmitted through the femur, usually from a fall on the great trochanter, less frequently from a fall on the feet or other form of violence. It may merely be fissured, or the head of the femur may be forcibly driven through its floor into the pelvic cavity, either by fracturing the bone or, in young subjects, by bursting asunder the cartilaginous junction of the constituent bones. When the femoral head penetrates into the pelvis--the _central dislocation of the hip_ of German writers--the condition simulates a fracture of the neck of the femur, but the trochanteric region is more depressed and the trochanter lies nearer the middle line. The limb is shortened, and movements of the joint are painful and restricted, especially medial rotation. In some cases there is pain along the course of the obturator nerve.