Traction vertical shear pelvic ring fracture: a marker for severe arterial injury? A case report.

Vertical shear pelvic ring fractures have been described as being produced only by a force directed cephalad, typically from falls or motor vehicle collisions. We report a seemingly similar vertical injury with the displacement of the hemipelvis being caudad rather than cephalad. Caudad displacement of the hemipelvis might disrupt the pelvic floor and vasculature far more than a standard vertical shear injury would and might be more prone to vascular injury. The clinical examination of the pelvic wound in our patient was not impressive and the magnitude of displacement seen on the admission radiograph was not different from that seen with a typical vertical shear injury. It is the caudal direction of the displacement that we think should alert the surgeon to the possibility of massive vascular injury and potential for limb loss.