Malgaigne fracture-dislocation: analysis of forces and end results of a method of treatment

ABSTRACT

Thirty-nine patients with Malgaigne fracture-dislocation of the pelvis constituting 10.8% of fractures of the pelvis were studied. There were 111 associated injuries or 2.85 injuries/patient and 17.9% mortality. Treatment was by bilateral skeletal tibial traction and dual pelvic sling, maintained for 4 weeks, then changed to skin traction for 4-6 weeks, followed by non weight-bearing excercises in bed for 4 weeks, then ambulation on crutches. Anatomical reduction was achieved in 65.6% of patients. Instability of fracture sites was demonstrated by stress x-rays in 6.8% of patients who could bear-weight. 3 patients 9.4% with gross neurological damage were disabled. 23 of the remaining 32 patients 71.9% were able to resume their pre-accident work. The remaining 6 patients had to change to a sedentary job because of pain over the sacroiliac joint; only two of these required surgical fusion of that joint. From analysis of the forces acting on the fracture sites, it seems that bilateral tibial skeletal traction is advantageous. It exerts compression at the sites of disruption thus stabilizing the fractures and helps healing