Obstetric fracture-dislocation of the pelvis; report of a case with injury to lumbosacral trunk and first sacral nerve root

Management of pelvic injuries in pregnancy

Pelvic fractures in pregnant women are usually high-energy injuries associated with risk of mortality to both mother and fetus. The mother's life always takes priority in the acute setting as it offers the best chance of survival to both the mother and the fetus. Indications for operative intervention of acute pubic symphysis rupture depend on presence of an open disruption, amount of displacement, and degree of disability. Chronic symphyseal instability related to pregnancy is a challenging problem and the first line of treatment is nonoperative care. A previous pelvic fracture is not a contraindication by itself to vaginal delivery.

Lumbosacral dislocation: a review of the literature and current aspects of management

Lumbosacral fracture dislocation is a very rare lesion and was first described by Watson-Jones in 1940. Two anatomical classifications are described in the literature, all other reports are case presentations. This fracture type is characterised by an antero- or retrolisthesis or a lateral translation of the 5th lumbar vertebra in relation to the sacrum. Biomechanics are discussed controversially. Most patients suffer from a high energy trauma with concomitant severe injuries. There is a high rate of additional neurological deficits. Fractures of the transverse process are thought to be sentinel fractures. MRI and CT scans are essential to detect the whole extent of the lesion. Circumferential fusion is recommended by several authors to regain stability at the lumbosacral junction.

Parturition-induced pelvic dislocation: a report of four cases

OBJECTIVE

To describe our experience with four cases of severe pelvic dislocation associated with difficult parturition.

DESIGN

Retrospective case series.

PATIENTS

Four patients, each with rupture of the symphysis pubis and sacroiliac joints during labor. All injuries were associated with significant initial pain and disability. All developed persistent symptoms related to the sacroiliac disruption.

INTERVENTIONS

The three patients who had presented acutely were freated with closed reduction and application of a pelvic binder. Two underwent closed reduction of their pelvic dislocation while anesthetized with a general anesthetic. One patient (N.A.), who presented late, had not been treated with a binder.

RESULTS

All four patients had persistent posterior pelvic (sacroiliac) pain. In two patients a postpartum neuropathy persisted.

CONCLUSIONS

Severe pelvic dislocations are rare during labor, with conservative treatment reported to be successful in most cases. The persistence of symptoms in our patients emphasizes the need for careful examination and follow-up of these rare injuries. Because the outcome in our patients was poor and results in the literature are equivocal, we suggest the consideration of an operative approach to treatment in patients with symphyseal diastasis of > 4.0 cm.