Presentation
Fall from height.
Patient Data
Disruption of the pubic symphysis, with a diastasis of 34 mm and an associated fracture of the left pubis. The left sacroiliac joint is widened as well. The left hemipelvis is cranially displaced.
This association of injuries can be described as a Malgaigne fracture.
Case Discussion
Vertical shear fractures are a subgroup of pelvic fractures.
Pelvic fractures are related to pelvic trauma with a risk of grave hemorrhage. If they are suspected, proper physical examination and radiographic studies are extremely important.
Malgaigne fractures were classically defined as the combination of a longitudinal fracture through the sacrum and the ipsilateral superior and inferior pubic rami. The classic definition has been extended to account for other patterns of fractures that will also cause instability of a hemipelvis.
The hemipelvis instability can be caused by a combination of vertical disruption through the anterior and posterior aspects of the pelvis:
anterior: superior and inferior pubic rami, or pubic symphysis and
posterior: sacroiliac joint, ilium, or sacrum
These fractures have a high association with urethral trauma. In the present case, a urethral injury was later diagnosed.
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