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Pelvic binding an effective, safe treatment for patients presenting with shock and high-energy pelvic fractures
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Adherence to state and institutional guidelines for urgent, non-invasive pelvic ring stabilization in patients presenting with hemorrhagic shock was not found to be associated with any hazards, according to this study by researchers in Australia.
The authors noted further education and system development would aid guideline adherence.
Using a prospective pelvic fracture database at a level 1 trauma center, the researchers performed a 41-month retrospective analysis that included high-energy pelvic fractures and excluded A-type injuries and patients who were dead on arrival. Data included patient demographics, injury severity score, fracture classification, application and timing of pelvic binding, associated injuries, physiological parameters, resuscitation fluids and outcomes, according to the study abstract.
The authors also investigated pre- and post-pelvic binding radiographs, with pelvic binding’s impact on soft tissue complications determined by independent investigators.
The researchers identified 115 patients with high-energy B- and C-type pelvic ring injuries, with 36 (31%) presenting with hemorrhagic shock upon arrival. Forty-three pelvic bindings were performed, according to the abstract, with 18 performed on shocked patients. The authors reported a rate of adherence to guidelines for these procedures of 50% overall (80% for B1 fracture type, 20% for B2, 20% for B3, 66% for C1, 86% for C2 and 33% for C3).
Sixty-eight percent of post-pelvic binding radiographs revealed improved or perfect pelvic alignment, with 21% of the radiographs displaying no change. Deformity occurred after application in 11% of B2- and B3-type injuries, the researchers noted.
“Although in some lateral compression fracture patterns the deformity increased, no hazards were associated with the use of [pelvic binding],” the authors wrote.
Perspective
Back to TopLisa K. Cannada, MD
There is a protocol in place at the author’s institution for use of the pelvic binder. The authors evaluated 115 patients with high energy Tile B and C type fractures who presented to their center. Despite a protocol being in place, there were 43 patients who had a pelvic binder placed.
What is most concerning about the results is there were only 18 of 31 patients who arrived in hemorrhagic shock who had the binder placed. Overall adherence to the protocol was 50%, with the least adherence in the B2 and B3 fracture patterns. The highest adherence was in B1 fractures. Those fracture patterns, if an isolated injury, do not generally present with hemorrhagic shock. The authors also noted deformity in 11% of fractures that had the binder placed — those B2 and B3 types. There was no adverse sequelae from this noted.
It is better to be safe than sorry in placing the binder. Hopefully, with the authors finding 68% of patients with improved alignment, that would be more helpful information to disperse. Pelvic binders can significantly decrease the pelvic volume and control hemorrhage for certain types of pelvic fractures. They can be life-saving. I hope this article encourages more compliance, especially in the patients with hemorrhagic shock.
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Toth L. Injury. 2012. doi:10.1016/j.injury.2012.05.014
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