Clinical Examination of the pelvis is used to assess for mechanical instability. However the sensitivity and specificity of this test have been called into question. In addition, opening and closing the pelvis may destabilise clot that has formed and provoke fresh haemorrhage:

Trauma-list Mailing List:

"Preserve clot [...] Punch anyone who tries to spring the pelvis"

Tim Coats
Royal London Hospital

> How are pre-hospital people treating pelvic fractures in your area?

Preserve clot - minimal movement, gentle handling, minimum of rolling. Punch anyone who tries to 'spring' the pelvis. Fit pelvic belt on basis of mechanism of injury. Minimal iv fluid to preserve systolic of 70 (90 mmHg if associated head injury). Take to a hospital that understands the condition!

Timothy J Coats MD FRCS FFAEM
Senior Lecturer in Accident and Emergency/Pre-Hospital Care
Royal London Hospital, UK.

Evidence

Level III

Grant PT "The diagnosis of pelvic fractures by 'springing'." Arch Emerg Med 1990 7(3): 178-182.

Thirty-six patients were studied prospectively to assess the benefit of 'springing' the pelvis in traumatized patients, to confirm or refute a fracture of the pelvis. None of the patients was multiply injured and half of those with fractures were elderly, sustaining their injuries in simple falls. Springing the pelvis was a poor predictor of the presence or absence of a pelvic fracture, at best it yielded a specificity of 71% and sensitivity of 59%. Its routine use in clinical examination should be abandoned.

Guide to Evidence Appraisals

The definitions of the types of evidence and the grading of recommendations used originate from the US Agency for Health Care Policy and Research