Occult bladder wall injury with pelvic binder

Pelvic binders are effective devices used in the prehospital setting to stabilise polytrauma patients with suspected pelvic injuries. They provide circumferential pressure around the pelvis, reducing intrapelvic volume to tamponade any potential bleeding. This case presents a patient who sustained multiple fractures and soft tissue injuries during a road traffic accident. The CT scan reported mild pubic symphysis diastasis but stated that the bladder wall was intact. A postpelvic binder removal X-ray showed extravasation of contrast from the bladder indicating a bladder tear. In this case, the pelvic binder had masked the bladder wall injury during the CT scan. We suggest that plain X-rays should be taken of the pelvis after the pelvic binder is removed, regardless of the CT report. This X-ray surveillance would reduce not only the chances of missing injuries to the bony pelvis but also injuries to the pelvic viscera.