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 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.