Noninvasive Reduction of Open-Book Pelvic Fractures by Circumferential Compression

Abstract

Objectives: To determine the efficacy and optimal application parameters of circumferential compression to reduce external rotation-type pelvic fractures. Design: Biomechanical investigation on human cadaveric specimens. Setting: Biomechanics laboratory. Intervention: Partially stable and unstable external rotation injuries of the pelvic ring (OTA classification 61-B1 and 61-C1) were created in seven human cadaveric specimens. A prototype pelvic strap was applied subsequently at three distinct transverse levels around the pelvis. Circumferential pelvic compression was induced by gradual tensioning of the strap to attempt complete reduction of the symphysis diastasis. Main Outcome Measurements: Pelvic reduction was evaluated with respect to strap tension and the strap application site. The effect of circumferential compression on intraperitoneal pressure and skin-strap interface pressure was measured.Results: A successive increase in circumferential compression consistently induced a gradual decrease in symphysis diastasis. An optimal strap application site was determined, at which circumferential compression most effectively yielded pelvic reduction. The minimum strap tension required to achieve complete reduction of symphysis diastasis was determined to be 177 ± 44 Newtons and 180 ± 50 Newtons in the partially stable and unstable pelvis, respectively. Conclusions: Application of circumferential compression to the pelvic soft tissue envelope with a pelvic strap was an efficient means to achieve controlled reduction of external rotation-type pelvic fractures. This study derived application parameters with direct clinical implication for noninvasive emergent management of traumatic pelvic ring disruptions.

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

“…Most, but not all, orthopaedic registrars (79.1 %) stated that they would place the binder at the level of the GT. These results show that more adequate training is required, as there is clear evidence that compression around the GT is most effective in reducing unstable open-book fractures [8,16,17]. Importantly, a misplaced binder may make a pelvic injury worse if there is a fracture through the iliac crests.…”

Biomechanical analysis of a transiliac internal fixator

“…Extended softtissue damage and lengthy surgical procedures complicate the decision-making process [5][6][7]. The most frequent reason for a fatal outcome is a pelvic mass haemorrhage, which can only be controlled by compression [8] with a stable pelvic ring as counter-bearing force [9,10].…”

Measurements of the Exerted Pressure by Pelvic Circumferential Compression Devices

“…Also, the exact application location of the PCCD strongly affects the local pressure level and overall effects. Research into the transverse application level of a specific sling showed that the sling should be applied at the area of the greater trochanters and the symphysis pubis [7].…”

“…The applied pulling forces according to manufacturers application instructions differ substantially. A study on human cadaveric specimens showed the minimum strap tension required to achieve complete reduction of symphysis diastasis was 177 ± 44 N and 180 ± 50 N in the partially stable and unstable pelvis, respectively [7]. As opposed to the tension required to achieve complete reduction, there is no data available for the required tension to achieve hemostasis for initial resuscitation.…”