Pelvic binder

Pelvic binder
Other names: Pelvic immobilization, trochanteric binder, pelvic circumferential compression device, SAM sling
Example of using a sheet and cable ties to bind a pelvis.
SpecialtyEmergency medicine
IndicationsInstability or significant pelvic pain following trauma[1]
Steps1) Place a folded sheet crosswise on the bed at the level of the pelvis before patient arrives[2]
2) Cross the sheet over the upper femurs and apply slight traction[3]
3) Fix the two halves with cable ties[3]
4) Tape the toes together[4]
ComplicationsSkin ulceration[4]

A pelvic binder is a device used to compress the pelvis in people with a pelvic fracture in an effort to stop bleeding.[4] While this fracture generally require significant forces in the young, in the elderly it may occur with low energy forces.[1] Pelvic binding is recommended as soon as the fracture is considered.[1]

Preparation involves placing a folded sheet crosswise on the bed, at the level of the pelvis, before a trauma patient arrives.[2] If concerns of an unstable pelvis is present, the sheet is crossed over the upper femurs, some traction is applied, and cable ties are used to hold the two sides together.[3] Application requires at least two people.[3] The toes are than tapped together.[4]

If the person remains unstable, embolization or damage control surgery with preperitoneal packing may be required.[5] Periodic checking of the skin is recommended to rule out signs of skin ulceration.[6][4] Prolonged use is not recommended.[6] This technique is relatively commonly used.[6]

Medical uses

A pelvic binder is used to reduce bleeding after a pelvic fracture. It is recommended for an open book pelvic fracture.[7] It might not be useful in people with lateral compression pelvic fractures.[7]

A pelvic binder can be applied by paramedic before a person reaches hospital, or in an emergency department.[8] It should only be used short term.[4]

A pelvic binder compresses pelvic structures.[8] This encourages any blood in the pelvic cavity to clot, reducing any further bleeding.[9]

Technique

A bed sheet or commercial devices may be used as a pelvic binder.[4]

The sheet should be thin and folded until 20 cm wide, than placed crosswise at the level of the greater trochanters (lower part of the pelvis).[10][4]

It should than be folded across the person and pulled snugly.[4] The two side are than attached together with either cable ties or clamps.[3] Cable ties are preferred as they will not obscure medical imaging.[11] The toes should also be tapped together.[4]

Complications

Pelvic binders are applied incorrectly in around 50% of cases.[8][12] If it is applied for too long, skin ulceration may occur.[4]

References

  1. 1 2 3 Roberts and Hedges' clinical procedures in emergency medicine and acute care (Seventh ed.). Philadelphia, PA: Elsevier Health Sciences. 2019. pp. 939–940. ISBN 9780323547949.
  2. 1 2 "Emergency Stabilization of Unstable Pelvic Fractures". EMS World. Archived from the original on 19 October 2017. Retrieved 22 March 2021.
  3. 1 2 3 4 5 Shackelford, S; Hammesfahr, R; Morissette, D; Montgomery, HR; Kerr, W; Broussard, M; Bennett, BL; Dorlac, WC; Bree, S; Butler, FK (Spring 2017). "The Use of Pelvic Binders in Tactical Combat Casualty Care: TCCC Guidelines Change 1602 7 November 2016". Journal of special operations medicine : a peer reviewed journal for SOF medical professionals. 17 (1): 135–147. PMID 28285493.
  4. 1 2 3 4 5 6 7 8 9 10 11 ATLS - Advanced Trauma Life Support - Student Course Manual (10 ed.). American College of Surgeons. 2018. p. 96–97, 352. ISBN 9780996826235.
  5. ↑ Boffard, Kenneth David (2019). Manual of Definitive Surgical Trauma Care, Fifth Edition. CRC Press. p. 24. ISBN 978-1-351-01286-7. Archived from the original on 2021-08-28. Retrieved 2021-03-22.
  6. 1 2 3 Bakhshayesh, P; Boutefnouchet, T; Tötterman, A (18 May 2016). "Effectiveness of non invasive external pelvic compression: a systematic review of the literature". Scandinavian journal of trauma, resuscitation and emergency medicine. 24: 73. doi:10.1186/s13049-016-0259-7. PMID 27193135.
  7. 1 2 Walls R, Hockberger R, Gausche-Hill M (2017). Rosen's Emergency Medicine - Concepts and Clinical Practice E-Book. Elsevier Health Sciences. p. 577, 588. ISBN 978-0-323-39016-3. Archived from the original on 2021-08-28. Retrieved 2020-09-20.
  8. 1 2 3 Naseem H, Nesbitt PD, Sprott DC, Clayson A (February 2018). "An assessment of pelvic binder placement at a UK major trauma centre". Annals of the Royal College of Surgeons of England. 100 (2): 101–105. doi:10.1308/rcsann.2017.0159. PMC 5838689. PMID 29022794. Archived from the original on 2021-08-28. Retrieved 2021-02-11.
  9. ↑ White CE, Hsu JR, Holcomb JB (October 2009). "Haemodynamically unstable pelvic fractures". Injury. 40 (10): 1023–30. doi:10.1016/j.injury.2008.11.023. PMID 19371871. Archived from the original on 2021-08-28. Retrieved 2021-02-11.
  10. ↑ International Trauma Life Support for Emergency Care Providers (8 ed.). Pearson Education Limited. 2018. pp. 276–277. ISBN 978-1292-17084-8.
  11. ↑ "Clinical Practice Guidelines : Trauma – Early management of pelvic injuries in children". www.rch.org.au. Archived from the original on 18 April 2021. Retrieved 22 March 2021.
  12. ↑ Vaidya R, Roth M, Zarling B, Zhang S, Walsh C, Macsuga J, Swartz J (November 2016). "Application of Circumferential Compression Device (Binder) in Pelvic Injuries: Room for Improvement". The Western Journal of Emergency Medicine. 17 (6): 766–774. doi:10.5811/westjem.2016.7.30057. PMC 5102606. PMID 27833687. Archived from the original on 2020-11-24. Retrieved 2021-02-11.
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