The examination of the pelvis in the secondary survey should include a test for stability. Warning the patient in advance, the heel of the hand is placed on the symphysis pubis. Pressure is applied in a posterior direction. An intact pelvis is felt to 'spring back'; in the presence of a fracture, this manoeuvre is likely to be painful.
Laterally, the same resistance can be applied by pressure in a medial direction on the iliac crests.
Suspicion of a pelvic fracture should prompt a pelvic X-ray.
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