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This video demonstrates how to place the pelvic binder quickly and correctly, which may be life-saving in cases of pelvic ring fractures with associated potential massive bleeding. Proper pelvic binder placement technique requires attention to some details, including the 5Ps (pulses, penis, pockets, pain and pulses), horizontal force application in opposing vectors and ensuring the pelvic binder is locked.
- Feet are held in slight internal rotation
- The pelvic binder is passed under the popliteal fossa and slided up to the level of the greater trochanter
- The 5 'P' are assessed: pulses (both central and peripheral); penis; pockets; pain; pulses again after the pelvic binder is placed
- The pelvic binder is fastened and an opposing horizontal strength is applied until 2 clicks are heard
High-energy multiple trauma
Suspected unstable pelvic fractures
Local open wounds or burns. Contraindications are relative.
- Patient in dorsal decubitus, feet positioned in slight internal rotation
- Trauma team composed of 1 team leader and at least 1 other element
Emergency handover using the AT-MIST mnemonic
Initial assessment using ABCDE approach
The pelvic binder is advanced until the level of the greater trochanter.
Advantages:
- Provides excellent pelvic stabilization in the emergency context, reducing the pelvic volume and associated bleeding
- Easy to learn usage
- Low risk, allowing use in not confirmed suspicion of pelvic fracture
Disadvantages:
- Temporary treatment, needs to be completed with application of surgery or angioembolization
Risks:
- Suboptimal placement of pelvic binder - making educational videos important to overcome incorrect placement
- Potential to mask the severity of unstable pelvic ring injuries in CT scan
- Interfere with femoral vein or artery access
No financial, consultant, institutional or other existing conflict of interest.
Diana, Rita and Ana, future doctors who participated in the video recording
Bonner T, Eardley W, Newell N et al. Accurate placement of a pelvic binder improves reduction of unstable fractures of the pelvic ring. J Bone Joint Surg Br. 2011;93-B(11):1524-1528. doi:10.1302/0301-620x.93b11.27023
Naseem H, Nesbitt P, Sprott D, Clayson A. An assessment of pelvic binder placement at a UK major trauma centre. The Annals of The Royal College of Surgeons of England. 2018;100(2):101-105. doi:10.1308/rcsann.2017.0159
Williamson F, Coulthard L, Hacking C, Martin-Dines P. Identifying risk factors for suboptimal pelvic binder placement in major trauma. Injury. 2020;51(4):971-977. doi:10.1016/j.injury.2020.02.099
Swartz J, Vaidya R, Hudson I, Oliphant B, Tonnos F. Effect of Pelvic Binder Placement on OTA Classification of Pelvic Ring Injuries Using Computed Tomography. Does It Mask the Injury?. J Orthop Trauma. 2016;30(6):325-330. doi:10.1097/bot.0000000000000515
Chavez M, Weinberg J, Jacobs J et al. Commonly performed pelvic binder modifications for femoral access may hinder binder efficacy. The American Journal of Surgery. 2022. doi:10.1016/j.amjsurg.2022.04.032
Review How to Correctly Place the Pelvic Binder – A Life-Saving Technique.