The Journal of Bone and Joint Surgery (American). 2008;90:2119-2125.
doi:10.2106/JBJS.G.01559
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Single-Leg-Stance Radiographs in the Diagnosis of Pelvic Instability

Jodi Siegel, MD1, David C. Templeman, MD1 and Paul Tornetta, III, MD2

1 Department of Orthopaedic Surgery, G2, Hennepin County Medical Center, 701 Park Avenue South, Minneapolis, MN 55415
2 Department of Orthopaedic Surgery, Boston University Medical Center, 850 Harrison Avenue, D2N, Boston, MA 02118. E-mail address: ptornetta{at}pol.net

Investigation performed at Hennepin County Medical Center, Minneapolis, Minnesota, and Boston University Medical Center, Boston, Massachusetts

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: In the nonacute setting, the diagnosis of pelvic instability is difficult. Patients who present with pelvic pain may have underlying instability. The purpose of the present study was to report the effectiveness of single-leg-stance radiographs in the diagnosis of pelvic instability in a consecutive series of patients presenting with pelvic pain.

Methods: Thirty-eight consecutive patients (twenty-four women and fourteen men) ranging in age from eighteen to seventy-eight years who presented with pelvic pain and a history of injury (twenty-seven), childbirth (seven [four primiparous and three multiparous]), or osteopenia (four) were evaluated with a visual analog scale pain score and a standard series of radiographs in an attempt to identify pelvic instability. The average time from the onset of symptoms to the evaluation was forty-one months (range, six weeks to twenty-seven years). Each patient was evaluated with supine anteroposterior, inlet, and outlet pelvic radiographs; a standing anteroposterior pelvic radiograph; and two single-leg-standing pelvic radiographs (one with the patient standing on the left leg and one with the patient standing on the right leg). A positive finding was defined as ≥0.5 cm of vertical translation measured at the symphyseal bodies between the two single-leg-stance radiographs.

Results: Of the thirty-eight patients, twenty-five demonstrated pelvic instability (average, 1.98 cm; range, 0.5 to 5 cm). With the numbers available, the average visual analog scale pain score for the patients with a stable pelvis was not significantly different from that for the patients with an unstable pelvis (6.4 ± 2.9 compared with 7.3 ± 1.9; p = 0.28).

Conclusions: Standing anteroposterior and single-leg-stance pelvic radiographs aid in the diagnosis of pelvic instability more effectively than do the standard three radiographs of the pelvis made in the supine position or a standing anteroposterior radiograph of the pelvis alone. Additional studies will be needed to correlate this instability with clinical symptoms.

Level of Evidence: Diagnostic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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