e to
move when the muscles attached to it are relaxed. This is done by
flexing the thighs and bending the body forward and towards the
affected side. Pain and crepitus may be elicited on making this
examination.

These fractures are treated by applying a roller bandage or broad
strips of adhesive plaster over the seat of fracture, and by placing
the patient in such a position as will relax the muscles attached to
the displaced fragment--in the case of the iliac spine by flexing the
thigh upon the pelvis; in the case of the crest or ala by raising the
shoulders. Union takes place in three or four weeks.

In young persons, the _anterior superior spine_ has been torn off and
displaced downwards by powerful contraction of the sartorius muscle;
and the _anterior inferior spine_ by strong traction on the
ilio-femoral or [inverted Y]-shaped ligament. These injuries are best
treated by fixing the displaced fragment in position by a peg or
silver wire sutures and relaxing the muscles acting on it.

Fracture of the _ischium_ alone is rare. It results from a fall on the
buttocks, the entire bone or only the tuberosity being broken. There
is little or no displacement, and the diagnosis is made by external
manipulation and by examination through the rectum or vagina.

A longitudinal fracture of the _sacrum_ may implicate the posterior
part of the pelvic ring, as has already been mentioned. In rare cases
the lower half of the bone is broken _transversely_ from a fall or
blow, and the lower fragment is bent forward so that it projects into
the pelvis and may press upon or tear the rectum, or the sacral nerves
may be damaged, and partial paralysis of the lower limbs, bladder, or
rectum result. These fractures are frequently comminuted and compound,
and the soft parts may be so severely bruised and lacerated that
sloughing follows. On rectal examination the lower segment of the bone
can be felt, and on manipulating it pain and crepitus may be elicited.

Fracture of the _coccyx_ may be due to a direct blow, or may occur
during parturition. As a result of this injury the patient may have
severe pain on sitting or walking, and during defecation. The loose
fragment can be palpated on rectal examination. There is considerable
difficulty in keeping the fragment in position, and if it projects
towards the rectum it should be removed. If the lower fragment unites
at an angle so as to cause pressure on the rectum, it gives rise to
the symp