# 258 Is that pelvis broken?
A nice tip originates from a large Australian centre (The Alfred Hospital, Melbourne, Victoria) in a small study.
Patients were prospectively screened with a test of straight leg raise eliciting pain and then X-rayed to determine if the pelvis was fractured. From the cohort of 328 patients, 35 patients had proven fracture. 32 alert patients (GCS=15) could not straight leg raise or did so only with pain. "Sensitivity of 91.43% (95% CI: 76.94–98.2%) and a negative predictive value of 98.57% (95% CI: 95.88–99.70%)" was claimed. The other 3 patients with fracture could lift without pain; these patients had GCS<15. For the sub-group who were alert, there was 100% sensitivity and 100% specificity in the test.
Older methods of examination by 'spreading' and 'squeezing' the Iliac Crests and pressing upon the Symphysis Pubis have been criticized as increasing injury that may dangerously lead to increased concealed internal hemorrhage which can be fatal.
As
always, be cautious in eliciting subjective symptoms in patients who are
impaired.
This report is gaining traction among various emergency professionals with presently 127 retweets.
Bolt, C., O'Keeffe, F., Finnegan, P., Dickson, K., Fitzgerald, M. C., & Mitra, B. (2017). Straight leg elevation to rule out pelvic injury. Injury. {Abstract & Paywall} [PDF]
DOI: https://doi.org/10.1016/j.injury.2017.10.009. PubMed: 29132904.
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