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:
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
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.
Select ‘Apply Binder‘ or ‘Do not apply binder‘ for the following scenarios.
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1. Question
A 80-year-old male with a fall from standing and a heart rate of 110.
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A 20-year-old pedestrian hit by a car at 30mph. Heart rate 80, Blood Pressure 120/80, GCS 15/15. No distracting injury and the primary survey shows no abnormality detected.
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A 40-year-old with a fall from a roof. Heart rate 90, Blood Pressure 110/85, smells of alcohol and appeared confused, no obvious injury.
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A 25-year-old motorcyclist hit a lamp post at 55mph. Heart rate 80, blood pressure 130/85, GCS 15/15, and an obvious open displaced lower right leg fracture.
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A 30-year-old playing football, slipped on wet grass. Complaining of right hip pain but able to partially weight bear.
Fig. 278
Learning bite
Essentially apply the pelvic binder if in doubt or if pelvic fracture is suspected.
Removal of pelvic binder
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All pelvic binder should be removed within:
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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.
Fig. 29 CT can be normal with pelvic binder in-situ. Radiopaedia.org. From the caserID 52597Fig. 30 X-ray after pelvic binder removal showing pubic symphysis diastasis. By Nevit Dilmen via Wikimedia Commons
Learning bite
Monitor the patient’s status closely and repeat the pelvic x-ray post pelvic binder removal.