Binder use obscures traumatic pelvic injury in a 29-year-old man

A 29-year-old male motorcyclist was brought to a trauma center after colliding with a highway barrier. The prehospital team had applied a pelvic binder, given the patient's hemodynamic instability. The patient's heart rate before admission to hospital was 144 beats/min, respiratory rate was 28 breaths/ min and blood pressure was 100/65 mm Hg. In the emergency department, he was alert and reported lower abdominal discomfort. On examination, his abdomen was soft and he had bilateral open lower-limb fractures with suspected vascular injury. A trauma computed tomography (CT) scan showed no intra-abdominal injury or pelvic fracture, but did show a pelvic hematoma with no signs of active bleeding. Local pre-hospital guidelines state that a binder should be applied if there is suspicion of a pelvic injury after blunt high-energy trauma with hemodynamic instability. Serious pelvic injuries may be missed in the presence of a well-applied pelvic binder, which is particularly true for purely ligamentous anteroposterior compression injuries. Trauma centers should also have a clear protocol for binder removal. This case reminds that a well-applied pelvic binder can sometimes mask ligamentous injuries in open-book pelvic fractures, and a plain radiograph of the pelvis should always be obtained after removing the binder.