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Hello again from the Emergency Procedures team

Today we are at pelvic binders and how to apply them

Detailed written instructions and explanation are available in our Free App (iOS and Android). This video is hot off the press and we want your help improving it. Drop us a line with any suggestions

So, without further ado…here is the video


Q&A

When do I put on a pelvic binder?

Pelvic binders should be applied to patients following blunt trauma if there is any suspicion of pelvic fracture.

This may be indicated by mechanism of injury, pain, leg or pelvic deformity, hypotension, or cardiac arrest.

How do pelvic binders work?

Binders decrease pelvic volume following pelvic fracture and may improve biomechanical stability reducing mortality and transfusion requirements.

Pelvic binders aid in controlling small venous and cancellous bone bleeding. It does this by reducing the volume of the pelvis thereby promoting pelvic tamponade and clot formation. Binders do not control arterial bleeding.

Tying the legs together in internal rotation also reduces pelvic volume

How do I manage a pelvic binder which has already been applied?

This is our usual role in the emergency department.

You should first check binder position as part of your primary survey. The binder should be positioned over the greater trochanters. If this is not the case, it should be loosened, moved and re-tightened.

The binder should then stay on until definitive management of a pelvic injury, or removed when a pelvic injury has been excluded. Hemodynamically stable patients without pelvic pain, reduced GCS or distracting injury can have binders placed by emergency medical service removed without imaging.

Patients with possible pelvic injury should only have the binder removed after CT scan excludes pelvic injury. In centres without CT scanners, or in low-risk cases pelvic X-ray can be used remaining aware that this is a less sensitive tool, and some fractures may be missed.

If in doubt, leave the binder on throughout initial assessment and management, and closely observe the patient with your trauma team once it is removed.

Could a binder worsen bleeding?

This is possible, and a reason we do not overtighten binders.

A pelvic binder works best for an open book pelvic fracture and might worsen position of some lateral compression or shear fractures, dislodging clots and worsening bleeding.

It is identified as unreliable to identify pelvic fracture pattern off the mechanism alone, prior to any imaging. Consensus expert opinion is to apply binders to all suspected unstable pelvic injuries.

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Emergency Procedures

Dr Chris McLenachan MBChB FACEM CCPU DipPHRM. Staff Specialist Emergency Medicine, Prince of Wales Hospital, Randwick. Staff Specialist, ANSW Aeromedical and Medical Retrieval Unit

Dr John Mackenzie MBChB FACEM Dip MSM. Staff Specialist Emergency Prince of Wales Hospital; Consultant Hyperbaric Therapy POW HBU. Lead author of Emergency Procedures App | Twitter | | YouTube |

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