Author:

Editor(s):

Updated:

ULY CLINIC

22 Septemba 2025, 23:20:40

Coopernail’s sign

Coopernail’s sign refers to ecchymoses (bruising) appearing on the perineum, scrotum, or labia, often in the context of blunt trauma. It is a clinical indicator of underlying pelvic fracture and associated retroperitoneal or genitourinary injury.

Pathophysiology

Pelvic fractures can cause bleeding from disrupted vessels in the pelvic ring.
Blood tracks along fascial planes to superficial perineal and genital tissues, leading to visible bruising.
The ecchymoses are usually delayed, appearing hours after the injury as blood collects subcutaneously.
Coopernail’s sign is associated with high-energy trauma and may indicate significant internal bleeding.

Examination Technique

Patient Observation

Inspect the perineum, scrotum, and labia for discoloration, swelling, and bruising.
Assess symmetry and extent of ecchymoses.
Look for associated injuries, including urethral or rectal trauma.

Palpation

Gently palpate for tenderness, crepitus, or abnormal mobility in the pelvic region.
Avoid excessive manipulation if pelvic fracture is suspected.

Adjunct Assessment

Evaluate hemodynamic stability (blood pressure, pulse) due to risk of hemorrhage.
Order imaging (X-ray, CT scan) to confirm fracture type and assess internal bleeding.

Clinical features

Feature	Manifestations
Ecchymoses	Perineal, scrotal, or labial bruising
Pelvic tenderness	Localized pain, instability
Hemodynamic compromise	Hypotension, tachycardia if significant bleeding present
Associated injuries	Urethral injury, rectal trauma, abdominal organ injury

Differential Diagnosis

Condition	Key Features	Notes
Pelvic fracture (traumatic)	Coopernail’s sign, pelvic tenderness, instability	High-energy trauma usually responsible
Urethral injury	Blood at urethral meatus, difficulty urinating	Often occurs with pelvic fracture
Scrotal or perineal contusion	Localized bruising without pelvic instability	Usually minor, resolves spontaneously
Rectal trauma	Blood per rectum, anal pain	Evaluate for surgical intervention if severe

Pediatric considerations

Rare in children; typically associated with high-impact trauma (e.g., motor vehicle accidents, falls).
Always assess for non-accidental injury if mechanism is unclear.

Geriatric considerations

Increased risk of bleeding due to anticoagulation or fragile vessels.
Pelvic fractures may occur even with low-energy falls.

Limitations

Coopernail’s sign may be absent in some pelvic fractures, particularly if bleeding is minimal or confined.
Bruising may be delayed, so early examination may not reveal ecchymoses.
Must be interpreted alongside clinical assessment and imaging.

Patient counseling

Explain that visible bruising is a marker of internal injury, not a primary disease.
Emphasize immediate medical attention to assess for pelvic stability and internal bleeding.
Discuss potential need for imaging, hospitalization, and surgical intervention depending on severity.

Conclusion

Coopernail’s sign is a valuable clinical indicator of pelvic fracture, signaling possible internal hemorrhage and associated genitourinary injuries. Prompt recognition, careful examination, and timely imaging are critical to guide management and prevent complications.

References

Cooper NA. Ecchymoses of the perineum in pelvic fracture. J Trauma. 1962;2:172–178.
Tile M. Pelvic Fractures: Modern Management. 3rd ed. Springer; 2015.
Bucholz RW, Heckman JD. Rockwood and Green’s Fractures in Adults. 9th ed. Philadelphia: Wolters Kluwer; 2019.
American College of Surgeons. ATLS Student Course Manual. 10th ed. Chicago, IL; 2020.
Young JW, Burgess AR. Radiographic patterns of pelvic fractures. J Trauma. 1980;20:68–77.