Application of Circumferential Compression Device (Binder) in Pelvic Injuries: Room for Improvement
Abstract
ABSTRACT
INTRODUCTION
The use of a noninvasive pelvic circumferential compression device (PCCD) to achieve pelvic stabilization by both decreasing pelvic volume and limiting inter-fragmentary motion, has become commonplace and is a well-established component of ATLS protocol in the treatment of pelvic ring injuries. The Purpose of this study was to evaluate 1) how consistently a PCCD was placed on patients who arrived at our Hospital with unstable pelvic ring injuries 2) if they were placed in a timely manner and 3) if hemodynamic instability influenced their use .
METHODS
An IRB approved retrospective study was preformed on 112 consecutive unstable pelvic ring injuries, managed over a 2 year period at our Level 1 Trauma center. Our Hospital Electronic Medical Record was used to review EMT, Physician , Nurse’s , Operative notes and radiographic images in order to obtain information on the injury and PCCD application. The injuries were classified by an Orthopaedic Trauma Surgeon and a senior Orthopaedic Resident. Proper application of a pelvic binder using a sheet is demonstrated.
RESULTS
Only 47% of unstable pelvic fractures received PCCD placement, despite being the standard of care according to ATLS. Lateral Compression mechanism pelvic injuries received PCCDs in 33% of cases, while AP Compression and Vertical sheer injuries had applications in 63% of cases. Most of these PCCD devices were applied after imaging (72%) Hemodynamic instability did not influence PCCD application.
CONCLUSION
PCCD placement was missed in many (37%) of APC and VS mechanism injuries, where their application can be critical to providing stability. Furthermore, in order to provide rapid stability, Pelvic circumferential compression devices should be applied after secondary examination, rather than after waiting for imaging results. Better education on, exam of the pelvis during the secondary survey, timing and technique of PCCD placement at our institution is required in order to improve treatment of pelvic ring injuries.