The primary role of a pelvic binder is to control bleeding in shocked patients with suspected or known pelvic injury.
Clinical features which indicate a pelvic injury include:
- abnormal pelvic examination, including suspected femur fracture
- bruising, wounds, asymmetry or obvious deformity of pelvis or lower limbs
- tenderness on gentle palpation of iliac crests, pubic symphysis, sacroiliac joints, ischial tuberosities and lumbar-sacral spine
- pelvic instability on gentle compression of the iliac crest. Note: this should only be assessed once and by the most senior clinician available, or avoided altogether if there is obvious pelvic instability (risk of dislodging a clot and worsening bleeding).
How do I apply a pelvic binder to the patient?
1. Place folded bed sheet underneath the patient between iliac crests and greater trochanters.
2. With two trauma team members, cross the sheet across the symphysis and pull the sheet firmly so it tightly fits around and stabilises the pelvis.
3. A third person should clamp the sheet at the four points shown (away from laparotomy/angiograph access points).
- The binder should be placed at the level of the greater trochanters (not iliac crests).
- A misplaced binder may exacerbate a pelvic fracture if there is an injury through the iliac crest. When placed too high, it will also obstruct access for laparotomy.
- Tying the feet together will help maintain the anatomical position of the pelvis (unless there are also lower limb fractures) via internal rotation of the femurs.
- The binder will not control arterial haemorrhage. Patients who do not improve haemodynamically after applying the pelvic binder may require urgent angioembolisation or operative intervention.
- The binder should remain in place until the definitive stabilisation procedure.
What if I do not have a bespoke pelvic binder or the patient is too young?
Circumferential pelvic sheeting is an option for all patients, especially younger patients:
- Place a folded sheet underneath the patient – between the iliac crests and greater trochanters.
- Two team members should cross the sheet across the pubic symphysis and pull the sheet firmly.
- Twist the ends together and secure them with a plastic clamp where possible. Metal artery clips can obscure plain x-rays and CT imaging.
This section was adapted, with permission, from: The Royal Children's Hospital Melbourne, Clinical Practice Guidelines: Trauma – Early management of pelvic injuries in children.
Accessed from the Emergency Care Institute website at https://aci.health.nsw.gov.au/ecat/appendices/pelvic-binder