Comparison of circumferential pelvic sheeting versus the T-POD on unstable pelvic injuries: A cadaveric study of stability

Prasarn, Mark L.; Conrad, Bryan P.; Small, John; Horodyski, MaryBeth; Rechtine, Glenn R.

doi:10.1016/j.injury.2013.05.016

Cited by 24 publications

(16 citation statements)

References 35 publications

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“…PCCDs seem effective to reduce a pelvic ring fracture, however this reduction might reasonably be considered for AP-type of injuries in haemodynamically unstable patients [ 19 – 23 ]. Literature is in favour of PCCDs physiological effect during early phase of resuscitation [ 28 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness of non invasive external pelvic compression: a systematic review of the literature

Bakhshayesh

Boutefnouchet

Tötterman

2016

Scand J Trauma Resusc Emerg Med

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IntroductionPelvic fractures might carry a significant risk of bleeding. A wide variety of pelvic binders together with pelvic sheets are available and offer an adjunct to the initial management of poly-trauma patients with pelvic injuries. These devices are collectively referred to as pelvic circumferential compression devices (PCCDs). The aim of this study was to review the literature for evidence pertinent to the efficacy and safety of PCCDs.MethodsUsing the PRISMA guidelines a systematic search on PubMed, Web of Science, CINAHL, Embase and Scopus was carried out. Articles included were in English language and published between 1999 and 2015. Studies included were appraised with narrative data synthesis.ResultsSeven articles addressed mechanical properties of non-invasive external mechanical devices, six articles focused on physiological aspects, and three studies evaluated the pressure characteristics of these devices. We found 4 case reports regarding adverse effects. None of the studies identified addressed the cost effectiveness or pain relief issues related to the use of PCCDs.ConclusionsBased on available literature, PCCDs are widely used in the initial management of patients with suspected pelvic bleeding. There is evidence to suggest that external compression reduces disrupted pelvic rings. There are some complications reported following application of PCCDs. Hemorrhagic source and physiological effectiveness of PCCDs needs to be addressed in future studies. In the meantime judicious application of PCCDs will continue to be recommended.

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Section: Discussionmentioning

confidence: 99%

“…In a similar approach to the previous studies, motion analysis was performed during application of the device, logrolling, bed transfer and elevation of head end of the bed. The results demonstrated no differences in stability conferred by either device during application or motion [ 23 ].…”

Section: Mechanical Effectsmentioning

confidence: 99%

Effectiveness of non invasive external pelvic compression: a systematic review of the literature

Bakhshayesh

Boutefnouchet

Tötterman

2016

Scand J Trauma Resusc Emerg Med

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“…Its application is quick and easy and therefore this should be done in the emergency room before the patient is transferred for CT-scan [ 30 ]. As an alternative to binders, a conventional sheet can be applied [ 31 ], and this method is apparently more cost effective [ 32 ]. In a study conducted using embalmed whole human cadavers, electromagnetic sensors were applied to each hemipelvis in order to record sagittal, coronal and axial rotation during application of the device, simulating bed transfer, log-rolling and head of bed elevation.…”

Section: Ring Closurementioning

confidence: 99%

“…In a study conducted using embalmed whole human cadavers, electromagnetic sensors were applied to each hemipelvis in order to record sagittal, coronal and axial rotation during application of the device, simulating bed transfer, log-rolling and head of bed elevation. The authors observed no significant differences in displacements when the pelvis was immobilised with either a sheet or a pelvic binder [ 32 ]. In another study, the same authors found no differences, either, when external fixation was used [ 33 ].…”

Section: Ring Closurementioning

confidence: 99%

Resuscitation of Polytrauma Patients: The Management of Massive Skeletal Bleeding

Guerado¹,

Bertrand²,

Valdés³

et al. 2015

TOORTHJ

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The term ‘severely injured patient’ is often synonymous of polytrauma patient, multiply-injured patient or, in some settings, polyfractured patient. Together with brain trauma, copious bleeding is the most severe complication of polytrauma. Consequently hypotension develop. Then, the perfusion of organs may be compromised, with the risk of organ failure. Treatment of chest bleeding after trauma is essential and is mainly addressed via surgical manoeuvres. As in the case of lesions to the pelvis, abdomen or extremities, this approach demonstrates the application of damage control (DC). The introduction of sonography has dramatically changed the diagnosis and prognosis of abdominal bleeding. In stable patients, a contrast CT-scan should be performed before any x-ray projection, because, in an emergency situation, spinal or pelvic fractures be missed by conventional radiological studies. Fractures or dislocation of the pelvis causing enlargement of the pelvic cavity, provoked by an anteroposterior trauma, and in particular cases presenting vertical instability, are the most severe types and require fast stabilisation by closing the pelvic ring diameter to normal dimensions and by stabilising the vertical shear. Controversy still exists about whether angiography or packing should be used as the first choice to address active bleeding after pelvic ring closure. Pelvic angiography plays a significant complementary role to pelvic packing for final haemorrhage control. Apart from pelvic trauma, fracture of the femur is the only fracture provoking acute life-threatening bleeding. If possible, femur fractures should be immobilised immediately, either by external fixation or by a sheet wrap around both extremities.

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“…Biomechanical studies also show that PCCDs are a safe and effective method of temporary stabilisation of pelvic injuries. 16,17 ATLS guidelines are the accepted and taught basic standard of trauma care around the world. 18,19 The ATLS protocol for emergent management of pelvic ring disruptions includes advising circumferential application of a bed sheet.…”

Section: Introductionmentioning

confidence: 99%

A bed sheet is not as effective as a pelvic circumferential compression device in generating pelvic compression in patients with a suspected pelvic fracture

Sinha

Ellicott

Gee

et al. 2015

Trauma

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IntroductionThe Advanced Trauma Life Support protocol for emergent management of pelvic ring disruptions includes advising circumferential application of a bed sheet. A number of purpose-designed pelvic circumferential compression devices are commercially available. We assessed whether the Advanced Trauma Life Support-recommended simple bed sheet was able to generate the same pelvic pressure as provided by a pelvic circumferential compression device. MethodsA healthy volunteer was laid supine on an examination trolley and a pressure transducer was placed overlying the volunteer’s greater trochanters. Two pelvic compression devices, a commercially available SAM Pelvic Sling II™ and a standard hospital bed sheet, were applied single handedly. The SAM Sling was applied according to the manufacturer’s instructions and the bed sheet was applied in the way the participant felt best. The pressures generated at the level of the greater trochanters were measured at 2 min. The mean of the left and right pressures was recorded. Following removal of the first device, the second device was then placed and the pressures were again recorded at 2 min. ResultsTwelve participants completed the study. The mean (standard deviation) pressure generated by the SAM sling was 107 (28.4) mmHg and by the bed sheet 54 (26.3) mmHg; the SAM sling generated significantly greater pressure (p < 0.0001). A variety of different methods for applying the bed sheet were observed. ConclusionIn patients with a suspected pelvic fracture, a bed sheet is unable to reliably generate pressures approaching those of a commercially available pelvic circumferential compression device.

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Comparison of circumferential pelvic sheeting versus the T-POD on unstable pelvic injuries: A cadaveric study of stability

Cited by 24 publications

References 35 publications

Effectiveness of non invasive external pelvic compression: a systematic review of the literature

Effectiveness of non invasive external pelvic compression: a systematic review of the literature

Resuscitation of Polytrauma Patients: The Management of Massive Skeletal Bleeding

A bed sheet is not as effective as a pelvic circumferential compression device in generating pelvic compression in patients with a suspected pelvic fracture

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