tion: FIG. 55.--Multiple Fracture of Pelvis through
Horizontal and Descending Rami of both Pubes, and Longitudinal
Fracture of left side of Sacrum.]

Injuries of the membranous urethra and bladder are frequent
complications, less commonly the rectum, the vagina, or the iliac
blood vessels are damaged.

Localised tenderness at the seat of fracture, pain referred to that
point on pressing together or separating the iliac crests, and
mobility of the fragments with crepitus, are usually present. The
fragments may sometimes be felt on rectal or vaginal examination. In
all cases shock is a prominent feature.

_The lateral and posterior aspects_ of the pelvic ring may be
implicated either in association with pubic fractures or
independently. Thus a fracture of the iliac bone may run into the
greater sciatic notch; or a vertical fracture of the sacrum or
separation of the sacro-iliac joint may break the continuity of the
pelvic brim. In rare cases these injuries are accompanied by damage to
the intestine, the rectum, the sacral nerves, or the iliac blood
vessels.

[Illustration: FIG. 56.--Fracture of left Iliac Bone; and of both
Pubic Arches.]

_Treatment._--It is of importance that the patient be moved and
handled with care lest fragments become displaced and injure the
viscera. He should be put to bed on a firm mattress, which may be
made in three pieces, for convenience in using the bed-pan and for the
prevention of bed-sores.

Before the treatment of the fracture is commenced, the surgeon must
satisfy himself, by the use of the catheter and by other means, that
the urethra and bladder are intact. Should these or any other of the
pelvic viscera be damaged, such injuries must first receive attention.

The treatment of the fracture itself consists in adjusting the
fragments, as far as possible by manipulation, applying a firm binder
or many-tailed bandage round the pelvis, and fixing the knees together
by a bandage (Fig. 57).

[Illustration: FIG. 57.--Many-tailed Bandage and Binder for Fracture
of Pelvic Girdle.]

When there is displacement of fragments extension should be applied to
both legs, with the limbs abducted and steadied by sand-bags.

Compound fractures, being commonly associated with extravasation of
urine, are liable to infective complications. Loose fragments should
be removed, as they are prone to undergo necrosis.

The patient is confined to bed for six or eight weeks, and it may be
several week