II. Indications
-
Pelvic Fracture (with separation or diastasis) immediate stabilization (e.g. open book or vertical shear Pelvic Fracture)
- Unstable Pelvis typically identified on pelvic compression in Trauma Evaluation
- Binder is intended to reduce pelvic venous plexus Hemorrhage (low efficacy) and to stabilize Fracture
III. Contraindications
- Ineffective in Fractures that do not disrupt pelvic ring (e.g. Pubic Ramus Fracture, Acetabular Fracture)
- Lateral pelvic compression Fractures
- Binder may worsen the Fracture if binder is too tight
- Vertical shear Fracture
- Stabilize with skeletal traction
IV. Advantages
- Benefit is decreased pain and to prevent further injury
- Likely has similar efficacy to external fixation (without the additional 2 hours required for orthopedics to perform procedure)
V. Disadvantages
- Pelvic binding is unlikely to decrease pelvic bleeding (similar to external fixation)
VI. Technique
- Position binder at the level of the greater trochanters (not over the iliac crests)
- Eliminate underlying gowns and underwear (risk of skin irritation, skin breakdown over bony prominences)
- Leave in place until evaluation by Trauma surgery (unless interfering with critical procedure, abdominal access)
-
Exercise caution in lateral compression Fractures
- Too tight of a Pelvic Binder may worsen the injury
VII. Preparations: Devices
- T-POD is a Pelvic Binder with pulley system
- Caution against applying too much force
- Velcro Pelvic Binder devices
- Bed sheet
- Fold into width of ~20 cm and position as per technique described above
- Rotate the sheet ends together
- When adequate compression, tuck the ends under and secure with a towel clamp
VIII. References
- Inaba and Herbert in Herbert (2014) EM:Rap 14(4): 10-11
- Ringhauser (2019) Crit Dec Emerg Med 33(6): 19-25