Pelvic binding

[shelvpower]

Good day guys. I would like some input from you guys about two questions regarding pelvic binding/splinting especially when using a sheet.

1. When assessing the pelvis (palpating etc) and a "instability"/ fracture is noticed will you then hold the pelvis in that position and then let your partner splint it in that position or is it acceptable to let go of the pelvis and then splint it.

2. Is there any evidence to substantiate your answer in question 1?

3. Is there any evidence to prove that pelvic splinting in the pre-hospital environment is effective at reducing the mortality rate in patients?

Regards

 

[Underoath87]

Pelvic splinting is used to treat an open book Fx. So you definitely don't want to splint it with downward pressure (like you'll get when pressing on the pelvis) but rather the opposite. And I think its more of a comfort thing than a lifesaving intervention (like a traction splint).

 

[EpiEMS]

1. When assessing the pelvis (palpating etc) and a "instability"/ fracture is noticed will you then hold the pelvis in that position and then let your partner splint it in that position or is it acceptable to let go of the pelvis and then splint it.

I'm unaware of any protocols or research suggesting that you manually stabilize the pelvis prior to splinting (which I understand to mean using a sheet wrap or commercial pelvic stabilization device). I've never heard of applying manual stabilization in any anecdotal context, either. However, I am aware of some evidence that it may be harmful to compress the pelvis for assessment purposes.

2. Is there any evidence to substantiate your answer in question 1?

A quick PubMed/Medline search evinced some research that this practice of compression (in an assessment setting) could be harmful, so I would imagine that compression that is not circumferential could be harmful.

3. Is there any evidence to prove that pelvic splinting in the pre-hospital environment is effective at reducing the mortality rate in patients?

There seems to be some to the contrary: A 2007 study, "Effects of early use of external pelvic compression on transfusion requirements and mortality in pelvic fractures" published in the American Journal of Surgery found that "[external mechanical compression] had no effect on mortality (23% vs 23%, P = .92)".

I wasn't able to find anything in the quick search I did, but there is some evidence that external compression does effectively splint the fracture. There's not high-quality research, though.

Some useful references:
"Diagnosis and Management of Pelvic Fractures" (2010), published in the Bulletin of the NYU Hospital for Joint Diseases (yes, it is peer-reviewed)
"The prehospital management of pelvic fractures: initial consensus statement" (2013), published in the Emergency Medicine Journal, which is a solid British journal
"The prehospital management of pelvic fractures" (2007), also published in EMJ
"Haemodynamically unstable pelvic fractures" (2008), published in Injury (downloadable at: http://www.dtic.mil/cgi-bin/GetTRDoc? Location=U2&doc=GetTRDoc.pdf&AD=ADA627601)

 

[Tigger]

Good day guys. I would like some input from you guys about two questions regarding pelvic binding/splinting especially when using a sheet.

1. When assessing the pelvis (palpating etc) and a "instability"/ fracture is noticed will you then hold the pelvis in that position and then let your partner splint it in that position or is it acceptable to let go of the pelvis and then splint it.

2. Is there any evidence to substantiate your answer in question 1?

3. Is there any evidence to prove that pelvic splinting in the pre-hospital environment is effective at reducing the mortality rate in patients?

Regards

Of note:

At present, the only evidence available on the efficacy of pelvic binders is anecdotal. Nevertheless this safe, noninvasive method seems to be a logical first resuscitative step with a serious pelvic fracture, to provide early hemorrhage control before considering invasive methods.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3211576/

 

[EpiEMS]

Of note:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3211576/

No doubt that the use of pelvic binders is primarily based on anecdote and biological/clinical plausibility -- however, I'd be very surprised if anybody has done an RCT.

Here's a good note demonstrating how pelvic binders promote hemodynamic stabilization (see Table 1).