Pelvic Stabilization

Reviewed and revised 6 June 2016

OVERVIEW

Pelvic stabilization is an important simple intervention in the management of severe pelvic trauma, and has 4 main objectives:

  • Prevent re-injury from pathological pelvic motion (most important clinically)
  • Decrease pelvic volume
  • Tamponade bleeding pelvic bones and vessels
  • Decrease pain

METHODS

Methods of  pelvic stabilization include:

  • Pelvic binder (e.g. sheet, SAM sling, T-POD, etc)
  • Anterior external fixation
  • C clamp
  • Pneumatic Anti-Shock Garment (PASG) ­aka Military Anti-Shock Trousers (MAST) — essentially obsolete

PELVIC BINDERS

  • If a pelvic binding device is not available a sheet can be wrapped around the patient’s pelvis, centered on the patient’s greater trochanters.
    • The sheet can be secured by twisting the encircling ends around one another before being tied or clamped
    • Taping the thighs or the feet together also helps maintain the anatomical position of the pelvis
  • There is little evidence than one form of pelvic binding is better than any other
  • Some proprietary pelvic binders may allow better access to the pelvis for surgery or angiography
  • Pelvic binding may exacerbate injury in iliac wing (LC) fractures and injuries with an over-riding pubic symphysis
  • The goal should be to approximate normal anatomic alignment

The 2011 EAST guidelines made the following evidence-based recommendations regarding pelvic binders:

  • they reduce fractures, provide definitive stabilization and decrease pelvic volume
  • they limit hemorrhage
  • They work as well or better than external fixation in controlling hemorrhage

OTHER INFORMATION

  • Cadaver studies suggest that pelvic stabilization methods does not generate sufficient pressures to tamponade bleeding
  • the increase in pelvic volume with widely diastased open book fractures is actually relatively small
  • disruption of the retroperitoneum leads to a non-compressible space for hemorrhage to accumulate

References and Links


CCC 700 6

Critical Care

Compendium

Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and informatics. Asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | vocortex |

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