Effect of Pelvic Binder Placement on OTA Classification of Pelvic Ring Injuries Using Computed Tomography. Does It Mask the Injury?

Swartz, John; Vaidya, Rahul; Hudson, Ian; Oliphant, Bryant W.; Tonnos, Fred

doi:10.1097/bot.0000000000000515

Cited by 18 publications

(19 citation statements)

References 28 publications

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“…Bonner et al [ 41 ] have shown that correctly placed pelvic binders could effectively reduce unstable pelvic ring injuries. This is supported by a recently published study by Swartz et al [ 42 ], who have shown that pelvic binders could mask the true nature of the fracture pattern and in particular made Tile C and B3 fractures look like B2 fractures. Since in the present series about half of the fractures were classified based on imaging with pelvic binders in place, it can be hypothesized that some B1 fractures may have been classified as B2 fractures.…”

Section: Discussionsupporting

confidence: 56%

Association of pelvic fracture patterns, pelvic binder use and arterial angio-embolization with transfusion requirements and mortality rates; a 7-year retrospective cohort study

et al. 2017

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BackgroundPelvic fractures are severe injuries with frequently associated multi-system trauma and a high mortality rate. The value of the pelvic fracture pattern for predicting transfusion requirements and mortality is not entirely clear. To address hemorrhage from pelvic injuries, the early application of pelvic binders is now recommended and arterial angio-embolization is widely used for controlling arterial bleeding. Our aim was to assess the association of the pelvic fracture pattern according to the Tile classification system with transfusion requirements and mortality rates, and to evaluate the correlation between the use of pelvic binders and arterial angio-embolization and the mortality of patients with pelvic fractures.MethodsSingle-center retrospective cohort study including all consecutive patients with a pelvic fracture from January 2008 to June 2015. All radiological fracture patterns were independently reviewed and grouped according to the Tile classification system. Data on patient demographics, use of pelvic binders and arterial angio-embolization, transfusion requirements and mortality were extracted from the institutional trauma registry and analyzed.ResultsThe present study included 228 patients. Median patient age was 43.5 years and 68.9% were male. The two independent observers identified 105 Tile C (46.1%), 71 Tile B (31.1%) and 52 Tile A (22.8%) fractures, with substantial to almost perfect interobserver agreement (Kappa 0.70-0.83). Tile C fractures were associated with a higher mortality rate (p = 0.001) and higher transfusion requirements (p < 0.0001) than Tile A or B fractures. Arterial angio-embolization for pelvic bleeding (p = 0.05) and prehospital pelvic binder placement (p = 0.5) were not associated with differences in mortality rates.ConclusionsTile C pelvic fractures are associated with higher transfusion requirements and a higher mortality rate than Tile A or B fractures. No association between the use of pelvic binders or arterial angio-embolization and survival was observed in this cohort of patients with pelvic fractures.

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Section: Discussionsupporting

confidence: 56%

Association of pelvic fracture patterns, pelvic binder use and arterial angio-embolization with transfusion requirements and mortality rates; a 7-year retrospective cohort study

et al. 2017

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“…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. It is rare to completely hide any injury, but it does happen 17,18.…”

Section: Discussionmentioning

confidence: 99%

“…Pelvic binders may mask the “severity” of the pelvic injury on CTs, particularly APC patterns 17. It is rare to completely hide any injury, but it does happen 17,18. This is not a reason to avoid PCCD usage but an example of how efficient they are at accomplishing their goal.…”

Section: Discussionmentioning

confidence: 99%

“…This is not a reason to avoid PCCD usage but an example of how efficient they are at accomplishing their goal. For the trauma team, one should be aware that a CT with a PCCD placed without prior imaging may not be diagnostic of the injury 17. For the treating surgeon, a fluoroscopic exam under anesthesia in a controlled environment (the operating room) is an important adjunct in this situation 17.…”

Section: Discussionmentioning

confidence: 99%

“…For the trauma team, one should be aware that a CT with a PCCD placed without prior imaging may not be diagnostic of the injury 17. For the treating surgeon, a fluoroscopic exam under anesthesia in a controlled environment (the operating room) is an important adjunct in this situation 17. We don’t recommend removing the PCCD to do a radiograph in a hemodynamically unstable patient.…”

Section: Discussionmentioning

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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Ergebnisse nach Plattenstabilisierung der Symphysensprengung

et al. 2020

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Effect of Pelvic Binder Placement on OTA Classification of Pelvic Ring Injuries Using Computed Tomography. Does It Mask the Injury?

Abstract: Diagnostic level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 18 publications

References 28 publications

Association of pelvic fracture patterns, pelvic binder use and arterial angio-embolization with transfusion requirements and mortality rates; a 7-year retrospective cohort study

Association of pelvic fracture patterns, pelvic binder use and arterial angio-embolization with transfusion requirements and mortality rates; a 7-year retrospective cohort study

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

Ergebnisse nach Plattenstabilisierung der Symphysensprengung

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