Pelvic binder

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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 pelvis.[10]

It should than be folded across the person at the level of the greater trochanters 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. 1.0 1.1 1.2 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. 2.0 2.1 "Emergency Stabilization of Unstable Pelvic Fractures". EMS World. Retrieved 22 March 2021. CS1 maint: discouraged parameter (link)
  3. 3.0 3.1 3.2 3.3 3.4 Shackelford, S; Hammesfahr, R; Morissette, D; Montgomery, HR; Kerr, W; Broussard, M; Bennett, BL; Dorlac, WC; Bree, S; Butler, FK (NaN). "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. Check date values in: |date= (help)
  4. 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 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.
  6. 6.0 6.1 6.2 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. 7.0 7.1 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.
  8. 8.0 8.1 8.2 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.
  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.
  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. Retrieved 22 March 2021. CS1 maint: discouraged parameter (link)
  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.