An assessment of pelvic binder placement at a UK major trauma centre

Abstract

Introduction Pelvic binders are used to reduce the haemorrhage associated with pelvic ring injuries. Application at the level of the greater trochanters is required. We assessed the frequency of their use in patients with pelvic ring injuries and their positioning in patients presenting to a single major trauma centre. Methods A retrospective review of our trauma database was performed to randomly select 1000 patients for study from April 2012 to December 2016. Patients with a pelvic binder or a pelvic ring injury defined by the Young and Burgess classification were included. Computed tomography was used to identify and measure pelvic binder placement. Results 140 patients were identified: 110/140 had a binder placed. Of the total, 54 (49.1%) patients had satisfactory placement and 56 (50.9%) had unsatisfactory placement; 30/67 (44.8%) patients with a pelvic ring injury had no binder applied, of whom 6 (20%) had an unstable injury; 9/67 patients died. Discussion This is the first study assessing pelvic binder placement in patients at a UK major trauma centre. Unsatisfactory positioning of the pelvic binder is a common problem and it was not used in a large proportion of patients with pelvic ring injuries. This demonstrates that there is a need for continuing education for teams dealing with major trauma.

A review of blunt pelvic injuries at a major trauma centre in South Africa

“…A major review of pelvic trauma in Great Britain identified 140 patients with major pelvic trauma. 10 Although this group had a higher rate of binder application (110/140), the authors felt that the binder was applied properly in less than half of patients (54; 49.1%). Of note, they found that 30/67 (44.8%) patients with a pelvic ring injury did not have a binder applied.…”

“…Almost all algorithms for the acute management of pelvic trauma advise the use of a pelvic binder or compression device to realign the pelvic bones and to physically tamponade the bleeding. [6][7][8][9][10][11] Once this has been achieved, the next step depends on the clinical circumstances and the results of advanced imaging. Pre-peritoneal packing of the pelvis may be required, and interventional radiology may be used to embolise any overt source of pelvic bleeding.…”

Application of Pelvic Circumferential Compression Devices in Pelvic Ring Fractures—Are Guidelines Followed in Daily Practice?

“…According to studies that mainly examined external rotation injuries and the reduction of symphyseal diastasis by PCCD, the PCCD needs to be positioned over the greater trochanters for optimal efficiency [ 18 , 19 , 46 ]. Retrospective studies which analysed the position of the PCCD in relation to the trochanters have shown that the position is incorrect in up to 50% [ 18 , 47 , 48 , 49 , 50 ].…”

“…Williamson et al found a similar sub- optimal placing of PCCD in 43.5%, 39.7% were placed superior and 3.8% inferior to the greater trochanter line [ 48 ]. Other studies demonstrate a PCCD misalignment of up to 50% [ 49 , 50 ].…”

“…The correction for other confounders was not possible due to the low sample size, therefore, it was chosen to only stratify for stable and unstable fractures. A low rate of accurate indication and correct PCCD application has been reported by several authors [ 18 , 41 , 42 , 43 , 44 , 45 , 47 , 48 , 49 , 50 ].…”