A national survey of United Kingdom trauma units on the use of pelvic binders

Jain, Sameer; Bleibleh, Sabri; Marciniak, J.; Pace, Alistair

doi:10.1007/s00264-013-1828-2

Cited by 21 publications

(26 citation statements)

References 15 publications

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“…Although there are several different types of commercially available binders, there is no evidence to show superiority of one particular model even over pelvic sheets, which are commonly used 5. There are complications associated with their use, such as pressure sores, tissue necrosis and nerve palsy,7 especially if they are left on for a prolonged period of time. Pelvic binders may mask the “severity” of the pelvic injury on CTs, particularly APC patterns 17.…”

Section: Discussionmentioning

confidence: 99%

“…The Young and Burgess classification looks at pelvic fractures in terms of the mechanism of injury: anterior posterior compression (APC, open book), lateral compression (LC), vertical shear (VS) or combined mechanism (CM). Stable injuries include APC1 and LC1, while LC2, LC3, APC2, APC3, VS and CM are unstable injures 7,8,9. In the Young and Burgess classification, increasing numbers signify increasing severity of pelvic ring injury (Video 1).…”

Section: Introductionmentioning

confidence: 99%

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Application of Circumferential Compression Device (Binder) in Pelvic Injuries: Room for Improvement

Vaidya¹,

Roth²,

Zarling³

et al. 2016

WestJEM

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IntroductionThe use of a noninvasive pelvic circumferential compression device (PCCD) to achieve pelvic stabilization by both decreasing pelvic volume and limiting inter-fragmentary motion has become commonplace, and is a well-established component of Advanced Trauma Life Support (ATLS) protocol in the treatment of pelvic ring injuries. The purpose of this study was to evaluate the following: 1) how consistently a PCCD was placed on patients who arrived at our hospital with unstable pelvic ring injuries; 2) if they were placed in a timely manner; and 3) if hemodynamic instability influenced their use.MethodsWe performed an institutional review board-approved retrospective study on 112 consecutive unstable pelvic ring injuries, managed over a two-year period at our Level I trauma center. Our hospital electronic medical records were used to review EMT, physician, nurses’, operative notes and radiographic images, to obtain information on the injury and PCCD application. The injuries were classified by an orthopaedic trauma surgeon and a senior orthopaedic resident. Proper application of a pelvic binder using a sheet is demonstrated.ResultsOnly 47% of unstable pelvic fractures received PCCD placement, despite being the standard of care according to ATLS. Lateral compression mechanism pelvic injuries received PCCDs in 33% of cases, while anterior posterior compression (APC) and vertical shear (VS) injuries had applications in 63% of cases. Most of these PCCD devices were applied after imaging (72%). Hemodynamic instability did not influence PCCD application.ConclusionPCCD placement was missed in many (37%) of APC and VS mechanism injuries, where their application could have been critical to providing stability. Furthermore, to provide rapid stability, pelvic circumferential compression devices should be applied after secondary examination, rather than after receiving imaging results. Better education on timing and technique of PCCD placement at our institution is required to improve treatment of pelvic ring injuries.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Application of Circumferential Compression Device (Binder) in Pelvic Injuries: Room for Improvement

Vaidya¹,

Roth²,

Zarling³

et al. 2016

WestJEM

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“…Als Gründe gegen ein Öffnen eines Pelvic Binders in dieser Phase werden eine Zerstörung frisch gebildeter Blutgerinnsel und das erneute Eintreten einer instabilen Kreislaufsituation genannt. Meist wird die Meinung vertreten, dass es besser ist, den Gurt im Rahmen der Ersteinschätzung (primary survey) zu belassen, um die Gerinnselbildung nicht zu beeinträchtigen und erst eine Bildgebung vorzunehmen [5]. Auf der anderen Seite wird beklagt, dass der liegende Gurt die Durchführbarkeit der körperlichen Untersuchung, insbesondere der mechanischen Stabilitätsprüfung, einschränkt bzw.…”

Section: Diskussion !unclassified

“…unmöglich macht. In der gesichteten Literatur finden sich keine Hinweise darauf, dass in der Praxis das Öffnen eines Beckengurts tatsächlich zu einer erneuten hämodynamischen Instabilität geführt hätte [5,6]. Sytematische Studien dazu existieren jedoch nicht.…”

Section: Diskussion !unclassified

“…Es liegen neben den biomechanischen Studien über die optimale Wirksamkeit des Pelvic Binders bei einer Positionierung über der Trochanter-major-Region [10] auch entsprechende klinische Fallberichte vor [9]. Eine Umfrage aus England lässt eine Positionierung eines Pelvic Binders mehrheitlich (zwischen 40 und 79 %) auf Höhe der Trochanteres erwarten [5]. Eine Untersuchung von Wincheringer et al [11] fand bei über 500 präklinisch angelegten Beckengurten in 18 % eine optimale Lage und in 62 % eine Positionierung in einem Korridor von ± 5 cm um den Idealpunkt.…”

Section: Abschnittunclassified

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„Clear-the-Pelvis-Algorithmus“: Handlungsempfehlung zur Freigabe des Beckens nach nicht invasiver Stabilisierung mittels Beckengurt im Rahmen der Schockraumversorgung

et al. 2016

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Severe brain, thoracic and intrapelvic injuries, as well as heavy bleeding, are the main causes of death in patients with major trauma. Unstable pelvic ring fractures can cause this bleeding and the so-called "C problem". This is usually due to haemorrhagic shock caused by the loss of large volumes of blood from the presacral venous plexus, iliac vessels and the fracture surfaces. Many clinical studies have shown that, in the preclinical setting, unstable pelvic ring injuries are often underestimated. The application of a non-invasive external pelvic ring stabilisation (pelvic binder) is therefore recommended if a pelvic fracture is possible. Several circumferential pelvic binders have been developed and their prehospital use is increasing. Clinical and biomechanical studies have demonstrated that there is a favourable haemodynamic effect in unstable fractures, due to rapid closure of the pelvic ring. It is unclear whether the pelvic binder can be safely removed in a presumably haemodynamically stable patient. A correctly placed pelvic binder leads to anatomical closure of the pelvic ring. Therefore unstable pelvic ring fractures may be clinically and radiologically overlooked. This is a particular problem in unconscious patients. Furthermore, the real severity of the injury may then be underestimated in the diagnostic evaluation. Unconsidered opening of the pelvic binder can thus provoke renewed deterioration of the circulatory situation, especially if the injury was adequately treated by the binder and the C problem was controlled. The aim of this article is to describe procedures for handling pelvic binders, particularly as to how to deal with an already applied pelvic binder and how to "clear the pelvic region" while reducing the risk of haemodynamic instability. A detailed analysis of the literature and a Delphi-like discussion among several experts were performed. The following points were raised: 1) Assessment of the clinical situation, including trauma kinematics. 2) Assessment of the haemodynamic status. 3) Check of the need to open the pelvic binder for diagnostic/therapeutic measures before completing all diagnostic tests. 4) Assessment of the radiology diagnostic testing and release of the pelvic region. The result is a so-called "clear the pelvis algorithm" which describes a structured approach according to specific criteria and which specifies the circumstances under which the pelvic binder can be opened. Additional studies are necessary to analyse the applicability and safety of this algorithm in a clinical context. Our advice is not to "clear" the pelvis if no X-rays or CT scans of the pelvis have been carried out without (or with an opened) pelvic binder.

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