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!

Fig.26 Image via RCEMLearning
  • 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.

Image via NG39

When should we apply a pelvic binder?

Select ‘Apply Binder‘ or ‘Do not apply binder‘ for the following scenarios.

Fig. 278

Learning bite

Essentially apply the pelvic binder if in doubt or if pelvic fracture is suspected.

Removal of pelvic binder


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.

Fig. 28 Image via Everyday E(B)M

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 case rID 52597
Fig. 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.