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Efficacy and safety of emergency non-invasive pelvic ring stabilisation
Laszlo Toth1, Kate L King, Benjamin McGrath
1Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Newcastle, NSW 2310, Australia.
Insights
Pelvic binding (PB) is recommended for shocked patients with pelvic fractures, but adherence to guidelines is only 50%. While PB improves pelvic alignment in most cases, further education is needed to enhance its application in trauma care.
Area of Science:
- Trauma Surgery
- Orthopedic Surgery
- Emergency Medicine
Background:
- Urgent non-invasive pelvic ring stabilization (pelvic binding, PB) is guideline-recommended for shocked patients with pelvic fractures.
- Current adherence to these guidelines and the efficacy of PB require evaluation.
- Potential adverse effects of PB also need to be identified.
Purpose of the Study:
- To determine adherence to pelvic binding guidelines in shocked patients.
- To assess the efficacy of pelvic binding in stabilizing pelvic ring injuries.
- To identify potential adverse effects associated with pelvic binding.
Main Methods:
- Retrospective analysis of a prospective pelvic fracture database (41 months) at a Level 1 trauma center.
- Inclusion of high-energy pelvic fractures (B and C types, AO/OTA classification), excluding type A and DOA patients.
- Data collected: demographics, ISS, fracture type, PB application/timing, injuries, physiology, resuscitation, outcomes; pre/post-PB radiographs reviewed; soft tissue complications assessed by experts.
Main Results:
- 115 patients with high-energy B/C pelvic injuries included; 36 (31%) in hemorrhagic shock.
- Pelvic binding performed in 43 patients (18 shocked); guideline adherence was 50% overall (18/36).
- PB improved/perfected pelvic alignment in 68% of cases; deformity increased in 11% (B2/B3 types). 10 deaths (8.7%), 4 from pelvic bleeding (2 with PB). No clear association between PB and soft tissue injuries (femoral vessel, bladder, rectum).
Conclusions:
- Adherence to pelvic binding guidelines requires improvement through education and system development.
- Pelvic binding demonstrates good radiographic efficacy in stabilizing pelvic ring injuries.
- Despite rare instances of increased deformity in specific fracture patterns, pelvic binding is not associated with significant hazards.
Background:
Urgent non-invasive pelvic ring stabilisation (pelvic binding, PB) in shocked patients is recommended by state and institutional guidelines regardless of the fracture pattern. The purpose of this study was to determine the adherence to the guidelines, efficacy of the technique and identification of potential adverse effects associated with PB.
Patients And Methods:
A 41-month retrospective analysis of the prospective pelvic fracture database was undertaken at a level 1 trauma centre. High-energy pelvic fractures were included in the analysis with exclusion of the A type injuries (AO/OTA classification) and patients who were dead on arrival. Collected data included patient demographics, injury severity score, fracture classification, application and timing of PB, associated injuries, physiological parameters, resuscitation fluids and outcomes. Pre and post-PB radiographs were reviewed. The potential effects of the PB on soft tissue (femoral vessel, bladder and rectal injury) complications were assessed by independent experts.
Results:
115 patients with high-energy B and C type pelvic ring injuries were included. Thirty-six (31%) patients presented in haemorrhagic shock on arrival. A total of 43 pelvic bindings were performed, 18 of them on shocked patients. The adherence to the guidelines was 50% (18/36) overall. Analysing fracture types of shocked patients the adherence was: B1 80%, B2 20%, B3 20%, C1 66%, C2 86%, C3 33%. The alignment of the pelvis was improved or perfect on post-PB radiographs in 68% and had not changed in 21%. In some cases of B2 and B3 type injuries the PB increased the deformity after application (11%). There were 10 deaths (8.7%) in the study group, with 4 deaths attributed to acute pelvic bleeding. Two of these had PB applied and two were identified as potential for improvement. One femoral artery injury, four bladder injuries and three rectum injuries were identified in patients who had PB applied. Association between the PB and these injuries is unlikely.
Conclusion:
The adherence to the guidelines should be improved with further education and system development. The good effect of the technique was evident on radiographs. Although in some lateral compression fracture patterns the deformity increased, no hazards were associated with the use of PB.
