Pelvic Binder Placement

I. Introduction

Pelvic fractures, which typically result from high-force mechanisms, can lead to bone displacement and widening of the pelvic space, and can be a significant source of blood loss. A pelvic fracture should be considered in any patient with blunt trauma and who is hemodynamically unstable. These injuries are often associated with serious retroperitoneal trauma as well as genitourinary, gastrointestinal, or vascular injuries. As such, pelvic fractures can be a significant source of shock and death, with an overall mortality rate of approximately 8%.

Pelvic binders work by stabilizing the pelvis (which helps with pain) and reducing its overall volume, secondarily enabling tamponade of any bleeding and preventing clot dislodgement.

II. Indications

Pelvic binders are indicated for most pelvic injuries where there is concern for hemorrhagic shock from blunt trauma.

A physical exam facilitates the diagnosis of a pelvic fracture. To rapidly assess for pelvic instability, the examiner should place their hands on the anterior iliac spines of the patient, exert gentle pressure toward midline, and then gentle movements laterally, feeling for laxity. The examiner should stop the maneuver immediately if any instability is detected so as to not exacerbate potential bleeding or worsen pain. When available, pelvic X-rays, focused ultrasound, and CT scans are all useful adjuncts to the physical exam findings.

The Young-Burgess classification categorizes pelvic fractures by the direction of injury-inducing force: anterior-posterior compression (APC), lateral compression (LC), and vertical shear. Pelvic binders are indicated for APC fractures, but not for LC fractures as binding an LC fracture can exacerbate bleeding. All pelvic fractures should be stabilized to some extent, but significant compression with a binder should only be used for APC injuries where the goal is to reduce the potential volume of the pelvis.

III. Equipment

While there are several types of pelvic binders, most consist of a wide belt with a string-tightening mechanism: pulling on the strings tightens the binder’s wrap, increasing its compressive capabilities. Of note, these are usually radiolucent to enable X-ray imaging.

In a setting without pelvic binders readily available, a sheet or other large piece of fabric can be used to provide external compression.

IV. Steps

Carefully pass the binder under the patient’s back, and then adjust it to position it over the buttocks. The proper placement is centered around the greater trochanters. A common pitfall is to place the binder over the iliac crests which would be too high to provide adequate compression. Of note, a pelvic binder should not be placed over the greater trochanters if there’s concern for an acetabular fracture or proximal femur fracture.

Next, cut or fold the binder to leave a 15-20 cm gap between the two sides. Attached the velcro strap to the free end of the binder that’s either been cut (as demonstrated in figure 1) or folded over. Pull on the free tab to tighten the laces, before securing the tab in place (Figure 1).

Besides incorrect placement, other common pitfalls with pelvic binder placement are over-tightening the binder, or leaving it in place for too long. Pelvic binders should only serve as temporary (< 24 hours), stabilizing measures to be followed by definitive management. If leaving a binder in place beyond 24 hours, perform frequent skin checks on the patient to ensure there’s no damage to skin or deeper tissues.

In a low-resource setting, without pelvic binder availability, a sheet or other large piece of fabric can serve as a substitute. Place the sheet on a stretcher or other flat surface, lie the patient on top of the sheet, and then cross the sheet over the patients’ hips, with the tails pulled in opposite directions. The tails can then be tied together (Figure 2). Alternatively, the tails of the sheet can be tied together around a rod, which can then be turned to adjust the amount of compression.

V. References

1. Nassar A, Knowlton L, Spain DA. Pelvis. In: Feliciano DV, Mattox KL, Moore EE. eds. Trauma, 9e. McGraw Hill; 2020. Accessed March 20, 2022.
2. https://accesssurgery-mhmedical-com.ezp-prod1.hul.harvard.edu/content.aspx?bookid=2952&sectionid=249125137
3. Scalea TM. The Shock Trauma Manual of Operative Techniques / Thomas M. Scalea, Editor. 2nd ed. 2021. Springer; 2021. doi:10.1007/978-3-030-27596-9