Signs of pelvic fracture on physical exam include ecchymosis in the perineal or lower abdomen, unequal anterior superior iliac spines, unstable movement of the pelvis with manual traction to one leg, and unstable pelvic tilt and compression tests. It is important that tests to check the stability of the pelvis only be performed by one person secondary to the possibility of causing further injury with movement of the fragments.

Ninety percent of all pelvic ring injuries can be detected on an AP pelvis x-ray.1 When pelvic ring fractures are suspected, then additional views should include a pelvic inlet view (45° caudal tilt) and a pelvic outlet view (45° cranial tilt). A CT scan of the pelvis can also be helpful in evaluating comminution and sacral involvement. Once a bony pelvic injury is identified, the primary goal becomes stabilization of the pelvic ring to prevent further injury, decrease hemorrhage, and increase mobilization of the patient.

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