PELVIC RING FRACTURES Single breaks in the pelvic ring occur with symphysis pubis diastasis, superior and inferior pubic rami fracture, and straddle fractures These are generally considered stable fractures One exception to this is with the open book deformity when diastasis of the pubic symphysis occurs with anterior disruption of the sacroiliac joint With significant disruption of the symphysis pubis, closed reduction and fixation must be considered Unstable fractures of the hemipelvis occur when fractures of the pubic rami or symphysis pubis are associated with a displaced sacroiliac joint dislocation or sacral fractures (Malgaigne fractures) ( Fig 111.33 ) These fractures are associated with a high incidence of injuries to adjacent structures, and lifethreatening hemorrhage can occur from pelvic vein injury, which may require angiographic embolization for persistent bleeding Unstable pelvic fractures are initially managed with bed rest Urgent orthopedic consultation is recommended for pelvic ring fractures