Review Question - QID 214067

Figure A demonstrates an APC 3 pelvic ring injury. In the setting of hemodynamic instability, they should be treated with a pelvic binder centered over the greater trochanters.

APC pelvic ring injuries are highly associated with intrapelvic hemorrhage, most commonly from bridging veins. The pelvis can hold a significant amount of blood; thus, the purpose of the pelvic binder is to decrease the total intrapelvic volume. It is crucial that the binder be placed in the proper position at the level of the greater trochanter. Alternatively, a sheet can be applied to the pelvis if a binder is not available.

Prasarn et al review the difference between external fixation and pelvic orthotic devices in a cadaveric study. They report that with logrolling the patient and with elevating the head of the bed the orthotic device placed at the level of the greater trochanters provided improved stability in all planes, however, this did not reach statistical significance. They conclude that there were no significant differences in the stability conferred by an external fixator and a binder for unstable pelvic ring injuries.

Beltran et al review resuscitation and the treatment of shock. They report that placement of a pelvic binder over the greater trochanters serves as an immediate maneuver capable of reducing pelvic volume and stabilizing the pelvis, ultimately aiding in clot formation. They conclude that sheets may also be used and are widely available and can be cut for vascular access to allow for emergent laparotomy.

Prasarn et al compare circumferential sheeting and the use of pelvic binders for unstable pelvic ring injuries. They report no difference in the motion of the hemipelvis during application, logroll, or elevating the head of the bed. They conclude that sheets are more readily available, cost less and are more versatile than pelvic binders.

Incorrect Answers:
Answers 1,2,4, & 5: For maximal volume reduction and stability, pelvic binders and circumferential sheets should be placed over the level of the greater trochanter.