From the Guidelines
Pelvic binders should be used in patients with suspected pelvic fractures, particularly those involving pelvic ring disruption, as soon as possible to reduce bleeding and stabilize the fracture fragments 1. The use of pelvic binders is recommended in the pre-hospital setting to limit life-threatening bleeding in the presence of a suspected pelvic fracture, as stated in the European guideline on management of major bleeding and coagulopathy following trauma: sixth edition 1.
Key Points to Consider
- Pelvic binders work by reducing pelvic volume, stabilizing fracture fragments, and tamponading bleeding from cancellous bone surfaces and venous plexuses 1.
- Application involves positioning the binder at the level of the greater trochanters (not over the iliac crests) and tightening until snug 1.
- Pelvic binders should not be used in isolated acetabular fractures, stable pelvic fractures without displacement, or lateral compression fractures with internal rotation deformity, as they may worsen these injuries 1.
- They should be removed within 24-48 hours to prevent skin complications like pressure ulcers, and regular skin checks beneath the binder are essential, especially in prolonged use 1.
Special Considerations
- In elderly patients, even a minor trauma could cause major pelvic fractures or bleedings due to the bones fragility and the decrease in function of regulation systems as the vasospasm, and angiography seems to have more hemostatic effect than pelvic binders in this population 1.
- In pregnant women, the pelvis can be closed with internal rotation of the legs and pelvic binder positioning, but caution should be exercised when applying the binder in this population 1.
Physiological Benefits
- The use of pelvic binders helps control bleeding and reduces pain during patient transport and positioning by reducing the potential space for hemorrhage and stabilizing bone fragments 1.
- Pelvic binders serve as a crucial bridge to surgical fixation in unstable patients, and their use is recommended as an adjunct to limit life-threatening bleeding in the presence of a suspected pelvic fracture 1.
From the Research
Pelvic Binders for Pelvic Fractures
- Pelvic fractures are severe injuries with frequently associated multi-system trauma and a high mortality rate 2
- The early application of pelvic binders is now recommended to address hemorrhage from pelvic injuries 2
- Pelvic binders can help reduce the risk of serious pelvic bleeding by stabilizing the pelvic ring 3
When to Use Pelvic Binders
- Pelvic binders should be used in patients with suspected pelvic ring fractures, especially those with signs of significant bleeding 3
- Pelvic binders can be used as a prehospital intervention to reduce the risk of hemorrhage 3
- The use of pelvic binders is recommended in patients with Tile C fractures, which are associated with higher transfusion requirements and mortality rates 2
When Not to Use Pelvic Binders
- There is no clear evidence to suggest that pelvic binders should not be used in certain patients with pelvic fractures 2, 3
- However, the use of pelvic binders may not be necessary in patients with stable pelvic fractures or those without signs of significant bleeding 3
Alternative Treatments
- Arterial angio-embolization is a effective intervention for controlling arterial bleeding in patients with pelvic fractures 2, 4, 5
- Preperitoneal pelvic packing is another treatment option for patients with pelvic fractures, especially those with venous bleeding 4, 6
- A multidisciplinary approach, including external pelvic stabilization, angioembolization, and preperitoneal pelvic packing, is recommended for the management of hemodynamically unstable patients with pelvic fractures 6