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We would like to thank the authors for their case presentation and images to highlight the importance of x-rays in the diagnosis of traumatic pelvic fractures (Seah & MacKay, 2021). It also provides an opportunity to highlight key principles of blunt trauma patient management.
As per the 10th edition Advanced Trauma Life Support (ATLS®) guidelines, any blunt trauma patient with hemodynamic instability, pelvic instability, or pelvic pain should undergo pelvic x-ray. This is consistent with many Canadian pre-hospital guidelines for binder application by Emergency Health Services. A pelvic binder is a core component of our University of Alberta protocol for shock and pelvis fractures (Menon et al, 2017). Thus, blunt trauma patients presenting to emergency departments in Canada with a pelvic binder in situ have an indication for a pelvic x-ray. This is also consistent with pelvic trauma guidelines from the Western Trauma Association (Tran et al, 2016), and the World Society of Emergency Surgery (Cocclioni et al, 2017).
The patient in the case presented was hemodynamically unstable, but there was no mention of a pelvic x-ray prior to CT scan. While the authors are using this case to highlight the potential to miss a ligamentous injury with a binder in situ, this example is still the vast minority of pelvic fracture cases (Clements et al, 2015). Thus, it is also a good case to highlight two key concepts:
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1. a pelvic binder is a powerful resuscitative to...Competing Interests: None declared.References
- K.T. Matthew Seah, James W. MacKay. Binder use obscures traumatic pelvic injury in a 29-year-old man. CMAJ 2021;193:E216-E216.
- Menon M, Petretta R, Domke C et al. Introduction and virtual validation of a universally applicable decision tree for the treatment of pelvic fracture - associated shock. CJS 2017; 60 (Suppl 2): S39.
- Tran TLN, Brasel KJ, Karmy-Jones R, Western Trauma Association Critical Decisions in Trauma: Management of pelvic fracture with hemodynamic instability—2016 updates. JTACS 2016; 89:1171-74.
- Coccolini, F., Stahel, P.F., Montori, G. et al. Pelvic trauma: WSES classification and guidelines. WJES 2017;12(5). https://doi.org/10.1186/s13017-017-0117-6
- Clements J, Jeavons R, White C, et al. The concealment of significant pelvic injuries on computed tomography evaluation by pelvic compression devices. J Emerg Med 2015;49:675–8