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.


METHODS
Retrospective case series.


METHODS
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.


METHODS
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.
Kharrazi
F D
FD
Orthopaedic Trauma Service, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Rodgers
W B
WB
Kennedy
J G
JG
Lhowe
D W
DW
D000328:Adult; D005260:Female; D005593:Fracture Fixation, Internal; D005596:Fractures, Closed / Q000209:etiology / Q000601:surgery*; D006801:Humans; D011631:Pubic Symphysis / Q000293:injuries*; D011644:Puerperal Disorders / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies