Skip to main content

How effective are different models of pelvic binders: results of a study using a Pelvic Emergency Simulator

European Journal of Trauma and Emergency Surgery (2020)Cite this article

Abstract

Background

The application of pelvic binders in the preclinical and early clinical phase is advisable to avoid or treat C-problems in unstable and potential bleeding pelvic ring fractures, even if the clinical effectivity is not completely proved. The use for pathologies in the posterior pelvic ring is still debatable.

Questions/purposes

We determined if there is a difference in achievable compression in the dorsal pelvic ring depending on position and pelvic binder model. Can this effect be tested with a simplified artificial model?

Methods

We simulated a Tile type C fracture within the established pelvic emergency trainer and measured in a test series the effectivity of reduction with a non-invasive stabilization technique using 3 different pelvic binders.

Results

Any therapeutic effect of a pelvic binder with compression to the posterior pelvic ring requires at first a reduction maneuver. While the compression effect in the symphysis depends only on positioning of the binder, in the posterior pelvic ring, the result varies with the used model. The achievable pressure in the SI joint with a pelvic binder is only 20–25% (33.5–47 N) compared to the C-Clamp values (156 N).

Conclusions

The use of pelvic binders for non-invasive pelvic ring stabilization, even with a posterior pathology, could be proven in a simplified fracture model. A proper fracture reduction and an adequate device positioning influence the effectiveness.

Clinical relevance

The use of an emergency pelvic trainer even for a non-invasive maneuver is advisable.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Manson T, O'Toole RV, Whitney A, Duggan B, Sciadini M, Nascone J. Young-Burgess classification of pelvic ring fractures: does it predict mortality, transfusion requirements, and non-orthopaedic injuries? J Orthop Trauma. 2010;24(10):603–9. https://doi.org/10.1097/BOT.0b013e3181d3cb6b.

    Article  PubMed  Google Scholar 

  2. Mucha P Jr, Welch TJ. Hemorrhage in major pelvic fractures. Surg Clin North Am. 1988;68(4):757–73.

    Article  Google Scholar 

  3. Blackmore CC, Cummings P, Jurkovich GJ, Linnau KF, Hoffer EK, Rivara FP. Predicting major hemorrhage in patients with pelvic fracture. J Trauma. 2006;61(2):346–52. https://doi.org/10.1097/01.ta.0000226151.88369.c9.

    Article  PubMed  Google Scholar 

  4. Gabbe BJ, de Steiger R, Esser M, Bucknill A, Russ MK, Cameron PA. Predictors of mortality following severe pelvic ring fracture: results of a population-based study. Injury. 2011;42(10):985–91. https://doi.org/10.1016/j.injury.2011.06.003.

    Article  PubMed  Google Scholar 

  5. Pehle B, Nast-Kolb D, Oberbeck R, Waydhas C, Ruchholtz S. Significance of physical examination and radiography of the pelvis during treatment in the shock emergency room. Unfallchirurg. 2003;106(8):642–8. https://doi.org/10.1007/s00113-003-0629-2.

    CAS  Article  PubMed  Google Scholar 

  6. Knops SP, Schep NW, Spoor CW, van Riel MP, Spanjersberg WR, Kleinrensink GJ, et al. Comparison of three different pelvic circumferential compression devices: a biomechanical cadaver study. J Bone Joint Surg Am. 2011;93(3):230–40. https://doi.org/10.2106/jbjs.J.00084.

    CAS  Article  PubMed  Google Scholar 

  7. Tan ECTH, van Stigt SFL, van Vugt AB. Effect of a new pelvic stabilizer (T-POD®) on reduction of pelvic volume and haemodynamic stability in unstable pelvic fractures. Injury. 2010;41(12):1239–43. https://doi.org/10.1016/j.injury.2010.03.013.

    Article  PubMed  Google Scholar 

  8. Spanjersberg WR, Knops SP, Schep NW, van Lieshout EM, Patka P, Schipper IB. Effectiveness and complications of pelvic circumferential compression devices in patients with unstable pelvic fractures: a systematic review of literature. Injury. 2009;40(10):1031–5. https://doi.org/10.1016/j.injury.2009.06.164.

    Article  PubMed  Google Scholar 

  9. Bakhshayesh P, Boutefnouchet T, Tötterman A. Effectiveness of non invasive external pelvic compression: a systematic review of the literature. Scandinavian J Trauma Resusc Emerg Med. 2016;24:73. https://doi.org/10.1186/s13049-016-0259-7.

    Article  Google Scholar 

  10. Vermeulen B, Peter R, Hoffmeyer P, Unger PF. Prehospital stabilization of pelvic dislocations: a new strap belt to provide temporary hemodynamic stabilization. Swiss Surg. 1999;5(2):43–6. https://doi.org/10.1024/1023-9332.5.2.43.

    CAS  Article  PubMed  Google Scholar 

  11. Cullinane DC, Schiller HJ, Zielinski MD, Bilaniuk JW, Collier BR, Como J, et al. Eastern association for the surgery of trauma practice management guidelines for hemorrhage in pelvic fracture—update and systematic review. J Trauma. 2011;71(6):1850–68. https://doi.org/10.1097/TA.0b013e31823dca9a.

    Article  PubMed  Google Scholar 

  12. Agri F, Bourgeat M, Becce F, Moerenhout K, Pasquier M, Borens O, et al. Association of pelvic fracture patterns, pelvic binder use and arterial angio-embolization with transfusion requirements and mortality rates; a 7-year retrospective cohort study. BMC surgery. 2017;17(1):104. https://doi.org/10.1186/s12893-017-0299-6.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ghaemmaghami V, Sperry J, Gunst M, Friese R, Starr A, Frankel H, et al. Effects of early use of external pelvic compression on transfusion requirements and mortality in pelvic fractures. Am J Surg. 2007;194(6):720–3. https://doi.org/10.1016/j.amjsurg.2007.08.040

    Article  PubMed  Google Scholar 

  14. Schweigkofler U, Wohlrath B, Trentzsch H, Horas K, Hoffmann R, Wincheringer D. Is there any benefit in the pre-hospital application of pelvic binders in patients with suspected pelvic injuries? Eur J Trauma Emerg Surg. 2019. https://doi.org/10.1007/s00068-019-01239-6.

    Article  PubMed  Google Scholar 

  15. Höch A, Zeidler S, Pieroh P, Josten C, Stuby FM, Herath SC, et al. Trends and efficacy of external emergency stabilization of pelvic ring fractures: results from the German Pelvic Trauma Registry. Eur J Trauma Emerg Surg. 2019. https://doi.org/10.1007/s00068-019-01155-9.

    Article  PubMed  Google Scholar 

  16. Pohlemann T, Culemann U, Holstein JH. Initial experience using a pelvic emergency simulator to train reduction in blood loss. Clin Orthop Relat Res®. 2012;470(8):2098–103. https://doi.org/10.1007/s11999-012-2272-0.

    Article  Google Scholar 

  17. Gardner MJ, Kendoff D, Ostermeier S, Citak M, Hüfner T, Krettek C, et al. Sacroiliac joint compression using an anterior pelvic compressor: a mechanical study in synthetic bone. J Orthop Trauma. 2007;21(7):435–41. https://doi.org/10.1097/BOT.0b013e318126bb8e.

    Article  PubMed  Google Scholar 

  18. Brimacombe JM, Wilson DR, Hodgson AJ, Ho KCT, Anglin C. Effect of calibration method on Tekscan sensor accuracy. J Biomech Eng. 2008. https://doi.org/10.1115/1.3005165.

    Article  Google Scholar 

  19. Sellei R, Schandelmaier P, Kobbe P, Knobe M, Pape H. Can a modified anterior external fixator provide posterior compression of AP compression type III pelvic injuries? Clin Orthop Relat Res. 2013. https://doi.org/10.1007/s11999-013-2993-8.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Lee C, Porter K. The prehospital management of pelvic fractures. Emerg Med J. 2007;24(2):130–3. https://doi.org/10.1136/emj.2006.041384.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Fleiter N, Reimertz C, Lustenberger T, Schweigkofler U, Marzi I, Hoffmann R, et al. Importance of the correct placement of the pelvic binder for stabilisation of haemodynamically compromised patients. Z Orthop Unfall. 2012;150(6):627–9. https://doi.org/10.1055/s-0032-1327796.

    CAS  Article  PubMed  Google Scholar 

  22. Bottlang M, Simpson T, Sigg J, Krieg J, Madey S, Long W. Noninvasive reduction of open-book pelvic fractures by circumferential compression. J Orthop Trauma. 2002;16:367–73. https://doi.org/10.1097/00005131-200207000-00001.

    Article  PubMed  Google Scholar 

  23. Qureshi A, McGee A, Cooper JP, Porter KM. Reduction of the posterior pelvic ring by non-invasive stabilisation: a report of two cases. Emerg Med J. 2005;22(12):885–6. https://doi.org/10.1136/emj.2004.015891.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  24. Gardner M, Parada S, Routt M. Internal rotation and taping of the lower extremities for closed pelvic reduction. J Orthop Trauma. 2009;23:361–4. https://doi.org/10.1097/BOT.0b013e31819c4a3f.

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Uwe Schweigkofler and Dennis Wincheringer had the same amount writing this article, Shared First Authorship

Affiliations

  1. Department of Orthopedic and Trauma Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt, Friedberger Landstraße 430, 60389, Frankfurt, Germany

    Uwe Schweigkofler & Reinhard Hoffmann

  2. Orthopaedicum Wiesbaden, Friedrichstraße 29, 65185, Wiesbaden, Germany

    Dennis Wincheringer

  3. ETHIANUM Heidelberg, Voßstr. 6, 69115, Heidelberg, Germany

    Jörg Holstein

  4. Department of Trauma, Hand, and Reconstructive Surgery, University of Saarland, Kirrberger Strasse 1, 66421, Homburg, Germany

    Tobias Fritz, Tim Pohlemann & Steven C. Herath

Authors
  1. Uwe Schweigkofler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dennis Wincheringer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jörg Holstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tobias Fritz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Reinhard Hoffmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tim Pohlemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Steven C. Herath
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Uwe Schweigkofler.

Ethics declarations

Conflict of interest

All authors declare no conflict of interest; there was no funding or financial support.

Ethical approval

The study was carried out at the Institute for Clinical Research of the University Medical Centre of the Saarland, D 66421 Homburg/Saar. All ethical regulations are fullfiled.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Schweigkofler, U., Wincheringer, D., Holstein, J. et al. How effective are different models of pelvic binders: results of a study using a Pelvic Emergency Simulator. Eur J Trauma Emerg Surg (2020). https://doi.org/10.1007/s00068-020-01406-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00068-020-01406-0

Keywords

  • Pelvic binder
  • Pelvic ring fracture
  • Pelvic emergency trainer