From the Guidelines
Pelvic binders are a crucial temporary stabilization device in patients with suspected pelvic fractures, particularly those with hemodynamic instability, and should be applied as soon as possible, ideally during the primary survey in trauma patients, to reduce morbidity and mortality. The most recent and highest quality study, 1, published in 2023, recommends the adjunct use of a pelvic binder in the pre-hospital setting to limit life-threatening bleeding in the presence of a suspected pelvic fracture.
Key Considerations for Pelvic Binder Application
- Position the binder at the level of the greater trochanters (not the iliac crests), ensuring it encircles the pelvis completely, as recommended by 1.
- Proper application involves placing the patient supine, aligning the lower extremities, and tightening the binder to reduce the pelvic volume without causing excessive pressure (aim for snug but not overly tight).
- Commercial devices like the SAM Pelvic Sling, T-POD, or PelvicBinder are preferred, but in emergency situations, a bedsheet can be used as a temporary alternative, as noted in 1.
Physiological Benefits and Potential Complications
- The binder works by reducing pelvic volume, stabilizing fracture fragments, limiting internal bleeding, and providing pain relief, which can improve quality of life and reduce morbidity.
- However, prolonged use beyond 24 hours increases the risk of skin breakdown, so regular skin checks are necessary, as warned by 1.
- Pelvic binders are contraindicated in lateral compression fractures where the pelvis is already compressed medially, as they may worsen the injury, highlighting the need for careful patient assessment.
Clinical Decision-Making
- The decision to use a pelvic binder should be based on the individual patient's condition, taking into account the risk of pelvic fracture and hemodynamic instability, as emphasized by 1.
- In patients with pelvic ring disruption in hemorrhagic shock, pelvic ring closure and stabilization should be performed as early as possible, as recommended by 1.
- The use of pelvic binders should be part of a comprehensive approach to managing pelvic trauma, including prompt assessment, stabilization, and definitive fixation, to optimize outcomes and reduce morbidity and mortality.
From the Research
Pelvic Binders in Pelvic Trauma
The use of pelvic binders in pelvic trauma with risk of pelvic fracture is a crucial aspect of management. Pelvic fractures can be life-threatening due to the high vascularity of the pelvis and the difficulty in controlling bleeding in this area 2.
Application and Benefits
The application of a pelvic binder is a key step in the initial management of patients with pelvic fractures. It is recommended to apply a circumferential pelvic sheet or binder immediately at the scene of injury or in the trauma resuscitation bay 3. This helps to:
- Provide external stabilization and reduce bleeding
- Improve hemodynamic stability
- Facilitate transportation and imaging
Management Strategies
The management of pelvic trauma involves a multidisciplinary approach, including:
- External stabilization with pelvic binders
- Resuscitative endovascular balloon occlusion of the aorta
- Preperitoneal pelvic packing
- Angiographic intervention
- Surgical fixation of the pelvic ring 4, 5
Resuscitation Strategies
Protocol-based resuscitation strategies are critical in managing patients with pelvic fractures. This includes:
- Initiation of physiologically optimal fluid resuscitation
- Consideration of tranexamic acid (TXA) to treat coagulopathy
- Emergent operative intervention, such as pelvic external fixation and/or pelvic packing, in patients with signs of hemorrhagic shock 3
Key Considerations
The use of pelvic binders is just one aspect of the overall management of pelvic trauma. It is essential to:
- Identify pelvic injuries and associated injuries expediently
- Have a low threshold for emergent operative intervention
- Consider percutaneous vascular intervention and selective angiography in patients with clinical indicators of arterial injury or hemodynamic instability 3