False negative computed tomography scan due to pelvic binder in a patient with pelvic disruption: a case report and review of the literature

Abstract

BackgroundPelvic binders are routinely used in the prehospital setting for stabilization of pelvic injuries in patients with trauma. Emergency department trauma management relies on primary and secondary survey assessment and imaging, most often computed tomography, in hemodynamically stable patients. Maintaining the pelvic binder in situ allows stabilization of pelvic injuries during imaging but may hinder the visualization of some pelvic lesions. We report a very rare case of severe pelvic disruption with an absolutely normal computed tomography scan due to the effective placement of a pelvic binder.Case presentationWe report the case of a 49-year-old Caucasian man referred to our Emergency Department after a high velocity motorcycle accident. Primary assessment revealed a left wrist deformation and pelvic pain, and a pelvic binder was applied by paramedics. A total body computed tomography scan was performed after arrival in our Emergency Department and did not reveal any pelvic injury. The pelvic binder was removed and because of persisting symphyseal pain, pelvic plain radiography was performed revealing a pelvic disruption with an opening of the pubic symphysis and of the left sacroiliac joint (“open book” type pelvic injury) requiring surgical stabilization.ConclusionsPelvic binders may mask pelvic disruption in patients with trauma. Pelvic plain radiography should be repeated after pelvic binder removal in patients with high velocity trauma and pelvic symptoms or neurological alterations limiting the reliability of clinical examination.Electronic supplementary materialThe online version of this article (10.1186/s13256-018-1808-7) contains supplementary material, which is available to authorized users.

Sacroiliac Separation that Can be Diagnosed After Pelvic Fixation During Surgery: A Case Report and Review of Literature

“…Patients can usually be diagnosed with X-ray and CT. However, there are studies reporting that Sacroiliac joint injuries may be overlooked in the presence of minimal separations and pelvic compression device (8,9). In the current study, without any pelvic compression device, sacroiliac joint injury ndings could not be detected with X-ray and BT images of the patient.…”

“…CT is frequently used in the diagnosis and classi cation of pelvic injuries. (6,7) There are case reports in the literature stating that pelvic injuries may be overlooked in patients undergoing pelvic compression device on CT. (8,9) We are reporting a rare case with a pelvic injury who had sacroiliac separation during surgery while the sacroiliac joint was completely normal on X-ray and CT. To our knowledge, this case is the rst case in which sacroiliac separation can be detected during surgery, although the pelvic compression device was not applied to the patient and the X-ray and CT were completely normal.…”

Emergent Comprehensive Imaging of the Major Trauma Patient: A New Paradigm for Improved Clinical Decision-Making

“…Because physical examination for rotational instability due to disruption of the sacroiliac joint can be clinically unreliable when undetected in larger patients, all such patients, irrespective of hemodynamic stability, should have a pelvic binder applied and proceed promptly with CT imaging if able for definitive assessment of pelvic integrity. 13 In the patient with clear mechanical instability of the pelvis, post-binder pelvis X-ray confirms anatomic closure of the pelvic ring which is important to help control ongoing hemorrhage. This should be done prior to CT as ongoing hemorrhage during CT will worsen shock.…”

Pelvic fracture-related hypotension: A review of contemporary adjuncts for hemorrhage control

“…Skin damage appears more common when these binders are used in conjunction with prolonged spinal board immobilization for >2 to 3 hours 40 . False-negative imaging as a result of pelvic compression devices has also been described and represents a potential limitation of these devices 41–44 . In these instances, reduction of the fracture can mask the presence of fracture, particularly when the device was placed in the prehospital environment before the fracture could be radiographically characterized.…”