Comparison of external fixation versus the trauma pelvic orthotic device on unstable pelvic injuries

Prasarn, Mark L.; Horodyski, Mary Beth; Conrad, Bryan P.; Rubery, Paul T.; Dubose, Dewayne; Small, John; Rechtine, Glenn R.

doi:10.1097/ta.0b013e31824526a7

Cited by 33 publications

(20 citation statements)

References 21 publications

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“…Cadaveric studies have shown that circumferential sheets and trauma pelvic orthotic devices (PODs) are able to reduce symphyseal diastasis consistently and reduce the symphyseal diastasis to normal in the majority of patients with anterior-posterior compression (APC) type injuries [ 17 ]. Moreover, external stabilization using a POD has been shown to be as efficient as external fixation using a pelvic clamp in preventing pelvic displacements in a cadaveric comparative study [ 18 ]. Among patients with unstable pelvic fractures, the use of a circumferential external compression device has been shown to reduce transfusion requirements, hospital length of stay, and mortality in a retrospective study [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

False negative computed tomography scan due to pelvic binder in a patient with pelvic disruption: a case report and review of the literature

et al. 2018

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BackgroundPelvic binders are routinely used in the prehospital setting for stabilization of pelvic injuries in patients with trauma. Emergency department trauma management relies on primary and secondary survey assessment and imaging, most often computed tomography, in hemodynamically stable patients. Maintaining the pelvic binder in situ allows stabilization of pelvic injuries during imaging but may hinder the visualization of some pelvic lesions. We report a very rare case of severe pelvic disruption with an absolutely normal computed tomography scan due to the effective placement of a pelvic binder.Case presentationWe report the case of a 49-year-old Caucasian man referred to our Emergency Department after a high velocity motorcycle accident. Primary assessment revealed a left wrist deformation and pelvic pain, and a pelvic binder was applied by paramedics. A total body computed tomography scan was performed after arrival in our Emergency Department and did not reveal any pelvic injury. The pelvic binder was removed and because of persisting symphyseal pain, pelvic plain radiography was performed revealing a pelvic disruption with an opening of the pubic symphysis and of the left sacroiliac joint (“open book” type pelvic injury) requiring surgical stabilization.ConclusionsPelvic binders may mask pelvic disruption in patients with trauma. Pelvic plain radiography should be repeated after pelvic binder removal in patients with high velocity trauma and pelvic symptoms or neurological alterations limiting the reliability of clinical examination.Electronic supplementary materialThe online version of this article (10.1186/s13256-018-1808-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

False negative computed tomography scan due to pelvic binder in a patient with pelvic disruption: a case report and review of the literature

et al. 2018

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“…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 ]. Although some studies have reported that binders present a statistically better control of symphisis pubis diastasis than sheets, in Burgess and Young anterior-posterior compression type II pelvic injuries (Tile types B-1 and C) [ 34 ] both binders and sheets obtain comparable results [ 30 , 31 ], without overreduction [ 30 ].…”

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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“…It is important to note that cadaveric studies have demonstrated that there is no significant difference in pelvic stability achieved with properly placed pelvic binders and external fixators. 20 Therefore, at institutions that do not have readily available expertise in placing external fixators in the emergency room setting, pelvic binders should be used as a bridge to placement of external fixators and/or definitive treatment with internal fixation. With regards to patients who need surgical or invasive radiologic intervention, there are data that suggest that patients who undergo laparotomy or angiography before external fixation had higher mortality 19 than those who underwent external fixation alone or external fixation followed by angiography or laparotomy.…”

Section: Pelvic Hemorrhagementioning

confidence: 99%

Pelvic Trauma

Desai

Gonzalez

Juang

2015

J Pediatr Intensive Care

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The leading cause of death in the pediatric population is trauma, of which pelvic injuries make up a very small percentage. Trauma to the pelvis can result in multiple injuries to the bony pelvis, rectum, bladder, and or the urethra. Although mortality in the pediatric population is typically secondary to associated injuries, pelvic hemorrhage can be a life-threatening event. The management of patients with complex pelvic injuries requires a multidisciplinary approach in order to achieve the best possible outcomes.

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Comparison of external fixation versus the trauma pelvic orthotic device on unstable pelvic injuries

Cited by 33 publications

References 21 publications

False negative computed tomography scan due to pelvic binder in a patient with pelvic disruption: a case report and review of the literature

False negative computed tomography scan due to pelvic binder in a patient with pelvic disruption: a case report and review of the literature

Resuscitation of Polytrauma Patients: The Management of Massive Skeletal Bleeding

Pelvic Trauma

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