When examining the pelvic area, you should use both hands to feel the right and left sides of the pelvis. In this case, you can feel the crests, anterior iliac spine, symphysis, ischium and pubic bones, ischial tubercles, sacroiliac joints, sacrum, tailbone. Such palpation allows you to determine the most painful places, the displacement of fragments, the asymmetry in the location of the bone protrusions, sometimes crepitus.
The main mass of the pelvic ring is covered with a large thickness of muscles and fatty tissue and is not accessible to palpation, therefore, examination and palpation should be supplemented by the identification of symptoms of transverse compression and rotation of the pelvis. Performing counter compression by applying pressure on the wings of the ilium and large trochanters and turning the pelvic ring by applying pressure on the crests of the ilium, the areas of greatest pain and the presence of fractures in deeply located pelvic bones are determined. The data obtained complement the comparative measurements and the study of limb function.
Violation of the function of the lower extremities is expressed the more, the more severe damage to the pelvis. In case of fractures that violate the integrity of the pelvic ring, the active function is always impaired: the patient cannot lift his leg and hardly bends its IB joints, dragging the heel along the bed. Examination of the patient can be supplemented by internal (rectal) examination, in which you can feel the bottom of the acetabulum, sacrum, coccyx and the area of the pubic joint. Internal research should be resorted mainly to suspected central hip dislocation.
With acetabular fractures, symptoms typical of all intraarticular fractures are revealed: a sharp restriction of movement, pain, forced limb position. In cases where the fracture is complicated by a dislocation of the hip, symptoms typical of one or another type of dislocation are revealed.
With severe damage to the pelvis, the picture of shock comes to the forefront, which should be fought first of all (blood transfusion, warming, morphine, rest, etc.).
For all injuries of the pelvic ring, the clinical examination of the patient should be supplemented with radiography. An x-ray is taken in the anteroposterior direction, you need to shoot the entire pelvis. In addition, a profile picture is advisable in cases of suspected fracture of the sacrum or tailbone.