Pelvic circumferential compression devices benefit patients with pelvic fractures who need transfers

Fu, Chih-Yuan; Wu, Yu-Tung; Liao, Chien‐Hung; Kang, Shih‐Ching; Wang, Shang‐Yu; Hsu, Yung‐Heng; Lin, Being-Chuan; Yuan, Kuo-Ching; Kuo, I-Ming; Ouyang, Chun-Hsiang

doi:10.1016/j.ajem.2013.06.044

Cited by 27 publications

(27 citation statements)

References 33 publications

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“…Their benefits include lifesaving hemorrhage control,5,10,11 decreased mortality,10 reduced transfusion requirement,5,10,11 pelvic fracture reduction/stabilization,5,10,11,15, length of hospital stay,5,10,11 pain control, low risk, non invasive, easy to apply and cheap 5,10,11,12,13,14,15. In patients who were transferred to another institution with a pelvic ring injury, applying a PCCD led to significantly decreased transfusion requirements whether they were hemodynamically stable or unstable prior to transfer 5. The drawbacks of using PCCD are few, if any, even with LC mechanisms 10,11,12,13,14,15.…”

Section: Discussionmentioning

confidence: 99%

“…PCCDs are more effective if placed accurately at the level of the greater trochanters and not higher on the abdomen, which is the most common error16 (Figure 3 and Figure 4, Video 2). 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.…”

Section: Discussionmentioning

confidence: 99%

“…We will continue to educate the frontline physicians in this apparatus, how to place it and the timing of application (Video 1,2). Others have also noted variability in knowledge, use and application of PCCDs 5. The authors acknowledge that no formal study of inter-observer agreement was performed for the radiographic classification of the injuries, but diagnosis were discussed when there was a discrepancy and a consensus was reached.…”

Section: Limitationsmentioning

confidence: 99%

“…Our numbers were low for this type of comparison and other groups have studied this, as mentioned in the discussion. 5,10,11,12,13,14,15…”

Section: Limitationsmentioning

confidence: 99%

“…Use of a noninvasive pelvic circumferential compression device (PCCD) to achieve this effect has become commonplace, and has become a well-established component of Advanced Trauma Life Support (ATLS) protocol3 (Figure 1). Both commercial binders and traditional sheeting techniques seem to be effective in reducing pelvic volume4,5 (Figure 2). Pelvic binders are used not only at major trauma centers, but in prehospital and pre-transfer settings 6.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

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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