II. Indications

  1. Pelvic Fracture (with separation or diastasis) immediate stabilization (e.g. open book or vertical shear Pelvic Fracture)
    1. Unstable Pelvis typically identified on pelvic compression in Trauma Evaluation
    2. Binder is intended to reduce pelvic venous plexus Hemorrhage (low efficacy) and to stabilize Fracture

III. Contraindications

  1. Ineffective in Fractures that do not disrupt pelvic ring (e.g. pubic ramus Fracture, acetabular Fracture)
  2. Lateral pelvic compression Fractures
    1. Binder may worsen the Fracture

IV. Advantages

  1. Benefit is decreased pain and to prevent further injury
  2. Likely has similar efficacy to external fixation (without the additional 2 hours required for orthopedics to perform procedure)

V. Disadvantages

  1. Pelvic binding is unlikely to decrease pelvic bleeding (similar to external fixation)

VI. Technique

  1. Position binder at the level of the greater trochanters (not over the iliac crests)
  2. Eliminate underlying gowns and underwear (risk of skin irritation, skin breakdown over bony prominences)
  3. Leave in place until evaluation by Trauma surgery (unless interfering with critical procedure, abdominal access)

VII. Preparations: Devices

  1. T-POD is a Pelvic Binder with pulley system
    1. Caution against applying too much force
  2. Velcro Pelvic Binder devices
  3. Bed sheet
    1. Fold into width of ~20 cm and position as per technique described above
    2. Rotate the sheet ends together
    3. When adequate compression, tuck the ends under and secure with a towel clamp

VIII. References

  1. Inaba and Herbert in Herbert (2014) EM:Rap 14(4): 10-11
  2. Ringhauser (2019) Crit Dec Emerg Med 33(6): 19-25

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