The diagnosis is drawn from the pain and difficulty of moving the lower extremities, and from the mobility and crepitus of the fragments, felt on placing the hand on the iliac crest, the pubic spine, and sciatic tu berosity consecutively and moving the leg. The crepitus is most distinctly felt by the hand which rests on the pelvic bones, and scarcely at all by that which rnoves the leg. This useful comparison will distinguish these fractures from those of the neck of the femur. If one ilium be dislocated upward and back wards on the sacrum, and at the same time separated from the other bones by a fractured acetabulum, the femur is drawn up with the ilium, the trochanter turned forwards, the knee and foot turned inwards, and the whole limb shortened, so as to resemble a dislocation at the hip-joint. Deeply-seated fractures, however, often pass undetected, from the rigid contraction of the muscles, the great pain experienced on motion, and fear of in juring the viscera more extensively. They will be more easy to detect on the thin subject, and on the female.
In one of the cases figured and related by Sir Astley Cooper in his Surgical Es says (plate 2. fig. 6.), the head of the fe mur had been driven by violence, applied laterally, through into the pelvic cavity, car rying a comminuted portion of the aceta bulum vvith it. The fracture was Y-shaped, and had radiated from the centre of the acetabulum pretty nearly in the line of the suture,—as we have before remarked in fractures here and in the ischio-pubic ramus. A fracture near or in the latter suture also existed. The limb presented the appearance of a dislocation of the femur backwards. In another case, the posterior part of the acetabulum was broken off, the fracture pass ing across to the pubes, both innominate bones being broken and displaced, and the femur dislocated. The pubic symphysis was separated about an inch, the fibro-cartilage adhering to one bone only. The knee and foot were turned inwards, and the whole limb shortened two inches ; but it was more moveable than in a dislocation, and crepitus was felt on cautious extension being made. In a female whose pelvis had been crushed by a cart against a wall, a fracture was found passing through the body of the left pubis and the left ascending ischial ramus. Both the sacro-iliac joints had separated, part of the osseous sacral auricular surface of the right joint having come off veith the ligaments.
The pubes were separated at the symphysis. Motion and crepitus were felt on applying one hand to the ilium and the other to the pubis, and the posterior superior iliac spine projected upwards considerably. Through the vagina, the pubes were felt projecting into the vaginal cavity. There was much blood effused into the pelvis, and the patient died, sixteen days after, from sloughing of the soft parts.
Otto mentions that, in the Museum of the Veterinary College at Copenhagen, are speci mens of horses' pelves, fractured by excessive muscular action.
Sir A. Cooper mentions three cases of fractured innominate bone which had reco vered. Two were fractures of the ilium, easily detected by the mobility of the crista and crepitus. The third was a fracture of the ischio-pubic ramus about the suture.
Rokitansky found that fractures of the pelvis rarely united without displacement. One of Mr. Barlow's successful cases of Cmsarian operation was necessitated by the results of a fracture of the left innominate bone, which produced an elevation of the head of the thigh bone, shortening of the limb, and lame ness. The contraction of the pelvic diameters resulted mainly from a projection backwards at the symphysis pubis, which was supposed to be caused by ossification of the disarti culated joint, and which reached to within half-au-inch of the sacrum. Burns states that he has seen extensive pointed ossifica tions projecting nearly 2 inches into the pelvis, in consequence of fractured aceta bulum. Naegele also mentions cases in which a bulging of the acetabulum inwards caused obstruction to parturition. Dr. Lever has also seen a bony process, more than an inch long, encroaching upon the pelvic cavity, in a male subject, after fractured acetabulum. Sometimes, after fractures of the pubis, the formation of callus has considerably inter fered with the functions of the urethra. When ankylosis takes place at the sacro iliac joint, after dislocation of the ilium back wards, the pelvis assumes a shape closely re sembling the pelvis oblique °rata of Naegele. A preparation of this kind is mentioned by Dr. Ramsbotham, as existing in the Museum of University College.