UMEM Educational Pearls

Category: Trauma

Title: Pelvic fractures, compression and the need for education

Keywords: Pelvic Trauma, education, pelvic binder, hemorrhage control, pelvic compression (PubMed Search)

Posted: 1/1/2023 by Robert Flint, MD (Updated: 4/17/2024)
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Pelvic fractures caused by large force compression (open book) and vertical sheer injuries can lead to life threatening massive hemorrhage from arterial injury, venous injury (most common), bone bleeding or muscle hemorrhage. Advanced Trauma Life Support and many other trauma organizations recommend pelvic binding be applied after the secondary survey is complete. This should preferentially happen in the pre-hospital envirnonment. The literature has not shown a mortality benefit to pelvic binding. One reason that external compression has not been shown to be of benefit is the high percentage of incorrectly applied compression devices. Commercial pelvic compression devices are superior to the old sheet method. If the device is not applied with maxim compression over the greater trochanters the benefit of pelvic compression is lost.

 

Beser et al. demonstrated in their recent study in the Journal of Trauma Nursing that it takes about 8 attempts to learn to properly place the binder over the greater trochanters. This adds to the literature that appropriate education and continuing education is needed to assure that these devices are appropriately applied.

 

It is this pearl author’s recommendation that new EMS, nursing and ED and trauma provider staff receive training on these devices with repetitive application until proficient and that yearly competency be performed to maintain our skills in this low frequency potentially high yield procedure.

 

Open to thoughts and comments.

Happy New Year!

References

Pelvic Compression Device (Binder) Application Training in Medical Students: A Manikin Study Be?er, Zafer MD; O?uz, Ahmet Burak MD; Koca, Ayça MD; Genç, Sinan MD; Erdurmu?, Ömer Yusuf MD; Polat, Onur MD Journal of Trauma Nursing 29(6):p 298-304, November/December 2022. | DOI: 10.1097/JTN.0000000000000682

Application of Circumferential Compression Device (Binder) in Pelvic Injuries: Room for Improvement Rahul Vaidya, MD et al. Western Journal of Emergency Medicine ARTICLES , CRITICAL CARE , CURRENT ISSUE: VOLUME 17 ISSUE 6 , ORIGINAL RESEARCH PUBLISHED: OCTOBER 20, 2016 DOI: 10.5811/WESTJEM.2016.7.30057

 

Pelvic circumferential compression devices for prehospital management of suspected pelvic fractures: a rapid review and evidence summary for quality indicator evaluation Robin PapRachel McKeownCraig LockwoodMatthew Stephenson, Paul Simpson Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine volume 28, Article number: 65 (2020)

Application of Pelvic Circumferential Compression Devices in Pelvic Ring Fractures—Are Guidelines Followed in Daily Practice? Valerie Kuner,,* Nicole van VeelenStephanie StuderBryan Van de WallJürgen FornaroMichael StickelMatthias KnobeReto BabstFrank J.P. Beeres, and Björn-Christian Link   J Clin Med. 2021 Mar; 10(6): 1297.

Published online 2021 Mar 21. doi: 10.3390/jcm10061297