1b Use of pelvic binder
A range of pelvic binders are available which aim to reduce and stabilise pelvic fractures. Currently there is insufficient evidence to support one device over the other. If no device is available, use a bed sheet to wrap around the pelvis. Pelvic binders also help with:
- Prevention of re-injury from pelvic motion
- Decreasing pelvic volume
- Decreasing pain
- Controling bleeding
Application of pelvic binder: SPLINT TO SKIN!
- Straighten both legs
- Apply to skin directly
- At the level of greater trochanter
- Sam’s Sling is commonly found in most EDs – 3 sizes available (small, standard and large. If in doubt, use the standard size which is designed to fit 95% of the population)
- Pelvic binders are compatible with CT and MRI
- If appropriately applied the feet should be internally rotated
- Video for application of pelvic binder
Learning bite
It is important to identify the correct landmark of the greater trochanters to apply the pelvic binder, otherwise it is ineffective. Only 50% were positioned correctly according to a survey done in 20186.
When to put the pelvic binder on?
See guidance below from NICE Pathway and Royal College of Surgeons of Edinburgh on when to apply the pelvic binder3.
When should we apply a pelvic binder?
Select ‘Apply Binder‘ or ‘Do not apply binder‘ for the following scenarios.
Learning bite
Essentially apply the pelvic binder if in doubt or if pelvic fracture is suspected.
Removal of pelvic binder
Question
It is important to closely monitor the patient’s haemodynamic status and repeat the pelvic x-ray post binder removal because a well-applied pelvic binder can mask fracture. See example below of pelvic x-ray with and without binder.
Sometimes even the CT will appear normal with the pelvic binder on.
Learning bite
Monitor the patient’s status closely and repeat the pelvic x-ray post pelvic binder removal.