• 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 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 pelvis, in patients with pelvic fractures can accurately detect injuries of the posterior ring.