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 – Pelvic Trauma
• CCC – Pelvic Arterial Injury
• CCC – Pelvic Fracture Classification
• CCC – Pelvic Trauma: Angiography And Embolisation