Clinical effectiveness of the physical examination in diagnosis of posterior pelvic ring injuries

Objective: To determine if physical examination (PE) of the posterior pelvis in awake and alert trauma patients with known pelvic ring injuries can accurately predict a potentially unstable posterior ring injury and guide the use of computed tomography (CT) more effectively. Design: Patients with pelvic fracture noted on anteroposterior (AP) pelvic radiographs were prospectively evaluated over a 21-month period. AP. inlet, and outlet radiographs as well as CT scans were obtained on all patients. Setting: Level I trauma center. Patients: Patients were excluded who had a Glasgow Coma Scale score less than or equal to 12, were unable to cooperate with a PE, were 12 years old or younger, or had concomitant acetabular fracture. Intervention: A focused PE protocol With emphasis on the posterior pelvis. including posterior palpation of the sacrum and sacroiliac joint, AP and lateral iliac wing compression, active hip range of motion. and a digital rectal examination. If an individual PE parameter resulted in tenderness. it was considered positive. Main Outcome Measurements: The 4 PE modalities were compared with CT scan results using sensitivity, specificity. negative predictive,e value. positive predictive Value, likelihood ratio, and McNemar's test for discordant pairs, Results: The study group included 66 patients. Of patients. 49 (74%) had posterior pelvic injury diagnosed by CT scan. Of the patients With positive posterior CT scan findings. 48 (98%) had pain with posterior palpation. Sensitivity and specificity were 0.98 and 0.94. and the likelihood ratio was 16.3. Conclusions: PE, specifically palpation of the posterior pelf is. in patients With pelvic fractures can accurately detect injuries of the posterior ring.