title: Parturition-induced pelvic dislocation: a report of four cases.
abstract: 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.
authors.affiliation: Orthopaedic Trauma Service, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
authors.forename: F D
authors.initials: FD
authors.lastname: Kharrazi
authors.forename: W B
authors.initials: WB
authors.lastname: Rodgers
authors.forename: J G
authors.initials: JG
authors.lastname: Kennedy
authors.forename: D W
authors.initials: DW
authors.lastname: Lhowe
mesh_terms: 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