The Hip
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– Physical Exam



  - Presence of Shock
  - Inspection
  - Palplation:
       - symphysis, pubic rami, iliac crests, sacroiliac;
       - bimanual compression & distraction of the iliac wings, & abduction & adduction of the hip should be done to detect instability;
       - manual traction can aid in the determination of vertical instability
               - grasp both legs and pull one caudad while pushing the other cephalad
     - Neurologic Injury
  - Associated Fractures:
       - Spine
       - Femur
  - Gyn, Urinary & Rectal Injuries:
       - RUG vs. Suprapubic catheter;
       - Rectal and Vaginal exams should be performed in order to determine whether the pelvic injury communicates w/ these structures.
               - lacerations indicate an open fracture (need for colostomy)
               - during the rectal examination, the examiner can gently palpate the sacrum for tenderness or asymmetry.