The Concealment of Significant Pelvic Injuries on Computed Tomography Evaluation by Pelvic Compression Devices

Fractures of the pelvis and acetabulum are relatively rare, with a reported incidence of 3% to 8% of all adult fractures, but occur in approximately 20% of all polytrauma cases. They have high associated morbidity (40% to 50%) and mortality (5% to 30%). It is recommended that an external compression splint be applied in the presence of a suspected pelvic fracture before transfer and definitive investigation and management.

Two cases are presented in which these recommendations were met and the patients underwent computed tomography (CT) scanning upon arrival to the emergency department at a major trauma center with the pelvic binder in situ. In both these cases, CT scanning failed to identify a significant pelvic injury, which was concealed by the pelvic external compression belt. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: When there is high clinical indication of pelvic injury, whether related to mechanism of injury or clinical findings, despite a CT scan where no bony injury is identified, obtaining plain pelvic x-ray studies out of the pelvic compression device to avoid overlooking or neglecting a significant pelvic injury would be prudent.