Pelvic Binders in Pelvic Ring Trauma: Reassessing Mortality as an Endpoint in a Systematic Review and Meta-Analysis

Pelvic binders are widely used in the prehospital and early trauma setting with the goal of fracture stabilization and limiting hemorrhage. Despite their widespread adoption, their clinical impact when assessed using traditional outcome measures such as mortality remains uncertain. Accordingly, this systematic review was undertaken to evaluate the association between pelvic binder use and mortality in patients with pelvic fractures. PubMed, Scopus, MEDLINE, and the Cochrane Central Register of Controlled Trials were methodically queried for articles from January 1, 2000, to September 30, 2025. These databases were searched for studies evaluating the association between pelvic binder use and mortality in patients with pelvic fractures. A meta-analysis was subsequently performed. Out of a total of 364 studies, 16 studies (6591 participants) addressing the association between pelvic binder use and mortality in patients with pelvic fractures were identified and included in the analysis. When pooling the 5 studies that adjusted for confounding (4264 participants), there was no significant association between pelvic binder use and a reduction in mortality [OR (95% CI): 0.90 (0.73-1.10)]. This also remained true when pooling the unadjusted analyses (2327 participants) [OR (95% CI): 1.31 (0.86-1.99)] or all analyses [OR (95% CI): 1.20 (0.86-1.67)]. The use of pelvic binders was not associated with a reduction in mortality in pooled analyses of adjusted, unadjusted, or all available studies. These findings should be interpreted in the context of pelvic binders as temporizing interventions in damage-control trauma care, suggesting that mortality alone may be an insufficient endpoint for evaluating their clinical utility.