From the Guidelines
A pelvic wrap should be applied for suspected pelvic fractures based on the mechanism of injury alone, even without obvious clinical signs, as it can help reduce pelvic volume, stabilize potential fractures, and limit internal bleeding 1.
Indication for Pelvic Wrap
The indication for a pelvic wrap is based solely on the mechanism of injury, and it should be applied pre-hospital or during initial assessment for patients with high-energy trauma mechanisms such as:
- Motor vehicle collisions
- Falls from height
- Crush injuries
- Pedestrians struck by vehicles The proper technique involves placing the binder at the level of the greater trochanters (not the iliac crests), ensuring it's snug but not overly tight 1.
Key Considerations
- Commercial devices like the T-POD or SAM Pelvic Sling are preferred, but in their absence, a folded sheet secured with clamps can be used temporarily 1.
- The binder should remain in place until definitive imaging confirms or rules out pelvic fracture, and should only be removed after consultation with orthopedic or trauma specialists.
- Pelvic binders should be positioned cautiously in pregnant women and elderly patients, as they may be at higher risk of complications 1.
- The binder should not be kept for more than 24-48 hours, as prolonged compression can increase the risk of skin necrosis and pressure ulcerations 1.
Benefits of Pelvic Wrap
The use of a pelvic wrap can help reduce the risk of hemorrhage and improve outcomes in patients with unstable pelvic fractures, with studies showing a decrease in transfusion needs and mortality rates 1. The application of a pelvic binder is a cost-effective and non-invasive tool that can be used by physicians and volunteers during the maneuvers aiming to stabilize a trauma patient, particularly in the immediate resuscitative period and the pre-hospital setting 1.
From the Research
Indication for Pelvic Wrap
The indication for a pelvic wrap based solely on the mechanism of injury is not clearly defined in the provided studies. However, some studies suggest that a pelvic binder may be applied due to the trauma mechanism alone, especially in cases of high-energy trauma [ 2, 3 ].
Mechanism of Injury
The mechanism of injury is an important factor in determining the need for a pelvic wrap. High-energy trauma, such as motor vehicle accidents or falls from height, may increase the risk of pelvic fractures and hemorrhage 2, 3, 4. In such cases, a pelvic binder may be applied as a precautionary measure to reduce the risk of hemorrhage and improve outcomes.
Key Points to Consider
- High-energy trauma may increase the risk of pelvic fractures and hemorrhage 2, 3, 4
- A pelvic binder may be applied due to the trauma mechanism alone, especially in cases of high-energy trauma 2, 3
- The application of a pelvic binder should be based on a thorough assessment of the patient's clinical situation, including trauma kinematics and haemodynamic status 5
- The use of a pelvic binder may not always prevent hemorrhage or improve outcomes, and its application should be carefully considered on a case-by-case basis 3