Complicated crushing injuries of the pelvis.

In the last two years we have seen seventy-five cases of pelvic girdle injuries with soft-tissue complications in patients admitted to the hospitals serving the African population of Johannesburg and its environs. These injuries had been caused by motor vehicle accidents, railway accidents, falls from heights, and assaults. Twenty of the patients died from their injuries, eight of them within four hours of admission to hospital, and five within forty-eight hours. Multiple injuries, shock, and major head injuries contributed to the early deaths. Watson-Jones (1938) compared the bony injuries sustained by the crushed pelvis to the hinge-like opening of an oyster. The element of surprise associated with the opening of oysters is also present in the diagnosis of soft-tissue and visceral injuries in patients with pelvic fractures. Wakeley (1929) encountered eleven visceral injuries in his series of 100 pelvic fractures. Watson-Jones (1938) classified the morphological types of pelvic fracture and commented on only two cases of urethral disruption in 143 pelvic fractures. In 1948 Holdsworth described fifty patients with pelvic fractures, of whom four had urethral injuries and eight had retroperitoneal haematomata large enough to warrant special mention. Kisner (1958) reviewed nearly ten years’ experience of urethral injuries in our hospital group; he described eighty-seven urethral injuries in a group of 442 pelvic fractures. In this series we consider only those patients with injuries complicating the pelvic fractures. Most patients had additional injuries ranging in severity from a Colles’s fracture to fracturedislocation of the cervical spine with tetraplegia.