The False Security of Pelvic Binders: 2 Cases of Missed Injuries due to Anatomical Reduction

INTRODUCTION: Pelvic injuries are common in high energy trauma. It is now a standard practice to reduce the potential space for haemorrhage with the use of pelvic binders and slings in the resuscitative scenario as this has been shown to reduce mortality. Most trauma centres have CT based trauma protocols so that alongside increased awareness of pelvic injuries, there is a higher detection rate of pelvic fractures. CASE REPORT: We present two cases of high energy pelvic injuries that were missed on initial presentation. In both the instances, pelvic binders were applied with the level of anatomical reduction being achieved meaning that pelvic injuries were missed on the initial CT scan reports. CONCLUSION: CT scans continue to be an essential tool in the management of trauma, especially with regards to pelvic injuries. The increased availability and improvements in imaging techniques has confirmed CT scans as an important tool in the detection of life threatening injuries, resulting in a marked reduction in the overall number of pelvic fractures missed. However, these cases highlight the fact that the orthopaedic surgeon should not reply on an essentially ‘normal’ CT scan report and when possible, one must perform an accurate clinical assessment of the patient with the involvement of a pelvic specialist at an early stage if there is any suspicion of a pelvic injury. Repeated reporting of the initial CT scan additionally reduces the incidence of missed injuries.