Malgaigne Fracture
Description
The Malgaigne fracture is an unstable fracture of the pelvis. The Malgaigne fracture usually results from a vertical shear force causing two ipsilateral pelvic ring fractures.
Fractures are ipsilateral and vertically orientated (one anterior and one posterior to the acetabulum)
The most common disruption involves the superior/inferior pubic rami AND sacroiliac joint/sacral wing rather than the sacroiliac joint with a lateral fragment containing the acetabulum.
The eponymous terms of Malgaigne fracture and Duverney fracture are now falling into disuse. Both fracture types were identified before radiographic interpretation was available. The imaging techniques and pelvic injury classification systems have meant the eponymous terms are less relevant today.
History of the Malgaigne Fracture
1847 – JF Malgaigne provided the first description of the unstable, vertical shear pelvic fracture, involving one hemipelvis – ‘De la double fracture verticale du bassin‘ in his Traité des fractures et des luxations.
Original
English
De la double fracture verticale du bassin
“Je décrirai sous cette dénomination une fracture multiple du bassin qui… mérite d’ailleurs une attention spéciale… C’est une combinaison de deux fractures verticales, découpant sur l’un des côtes du bassin un fragment moyen qui comprend l’articulation coxo-fémorale… De ces deux fractures, l’antérieure occupe presque constamment la branche horizontale et la branche descendante du pubis, séparant cet os de l’ilium et de l’ischion; la postérieure est toujours en arrière de la cavité cotyloïde.
Les causes sont le plus souvent directes; telles sont une chute de haut sur la hanche, une pression du bassin entre deux voitures, le passage d’une roue de voiture sur la hanche, un coup de pied de cheval, etc.”
Double Vertical Fracture of the Pelvis
“Under this name I shall describe under this denomination, a multiple fracture of the pelvis which… merits a special attention… It is a combination of two vertical fractures, cutting out on the one side of the pelvis a median fragment containing the coxo-femoral articulation… Of these two fractures, the anterior occupies nearly always the horizontal and descending branches of the pubis, separating this bone from the ilium and the ischium; the posterior one is always behind the acetabulum.
The causes are most often direct; such as a fall from height onto the hip, press ion of the pelvis between two cars, the passing of a wheel of a car over the hip, a kick from a horse etc.”
In the 1855 atlas volume accompanying his work on fractures and dislocations, Malgaigne shows a specimen taken from the Musée Dupuytren which shows a bilateral anterior subluxation of the sacrum with a fracture-of the pelvic ring anteriorly. The specimen was taken from a 48 year old man who died 5 days after being run over by a carriage and fully reported by Foucher in 1851
The more frequent type of Malgaigne fracture consists of the fractures of the hemipelvis, through the pubic rami in front and the ilium behind, with displacement of the lateral fragment upwards.
1855 Planche XVIII, Fig 5. Luxation du sacrum en avant, avec fracture de l’os iliaque gauche (Musée Dupuytren, no 765). Cette pièce m’avait été communiquée par M. Foucher, qui en a consigné l’observation dans la Revue médico-chirurgicale 1851. J’en ai donné l’analyse tome II: 783.
Associated Persons
- Joseph François Malgaigne (1806 – 1865)
References
- Malgaigne JF. De la double fracture verticale du bassin. In: Traité des fractures et des luxations, 1847; 1: 650-651
- Foucher E. Observation suivie de remarques sur la luxation traumatique du sacrum. Revue médico-chirurgicale de Paris. 1851; IX: 336-339
- Malgaigne JF. Double vertical fractures of the pelvis. In: A Treatise on Fractures, 1859; 1: 523-527
- Bucholz RW. The pathological anatomy of Malgaigne fracture-dislocations of the pelvis. J Bone Joint Surg Am. 1981; 63(3): 400-404.
Resident medical officer in emergency medicine MB ChB (Uni. Dundee) MRCS Ed. Avid traveller, yoga teacher, polylinguist with a passion for discovering cultures.
