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Occult bladder wall injury with pelvic binder.
Cameron Heathcote1, Chandan Noel Vincent2, Joseph Alsousou2
1Trauma and Orthopaedics, Manchester University NHS Foundation Trust, Manchester, UK cameron.heathcote@doctors.org.uk.
BMJ Case Reports
|February 3, 2025
Summary
Pelvic binders stabilize trauma patients but can mask bladder injuries. A follow-up X-ray after binder removal is crucial for detecting hidden pelvic visceral damage.
Area of Science:
- Traumatology
- Emergency Medicine
- Radiology
Background:
- Pelvic binders are vital prehospital tools for stabilizing patients with suspected pelvic injuries.
- They reduce intrapelvic volume to control bleeding by applying circumferential pressure.
Purpose of the Study:
- To highlight a case where a pelvic binder masked a bladder injury during CT imaging.
- To recommend a specific imaging protocol to prevent missed diagnoses.
Main Methods:
- Case report of a polytrauma patient with pelvic fractures and soft tissue injuries.
- CT scan performed with pelvic binder in situ.
- Post-binder removal X-ray to assess for missed injuries.
Main Results:
- CT scan showed mild pubic symphysis diastasis with an intact bladder wall.
- A subsequent X-ray after pelvic binder removal revealed bladder wall injury (extravasation of contrast).
- The pelvic binder obscured the bladder tear on the initial CT scan.
Conclusions:
- Pelvic binders can mask visceral injuries, including bladder tears, during CT scans.
- Plain X-rays of the pelvis should be performed after pelvic binder removal, irrespective of CT findings.
- This imaging strategy can prevent missed injuries to the bony pelvis and pelvic viscera.
