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

BACKGROUND: 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. CASE REPORT: 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.