LAS VEGAS — The incidence of pelvic fractures from blunt trauma and blast injury and evidence for treatment with a pelvic splint were discussed at the World Trauma Symposium. Col. Stacey Shackelford, MD, USAF, MC, Chief of Performance Improvement, Joint Trauma System, reviewed pelvic fracture epidemiology on the battlefield and non-combat, civilian mechanisms before describing relevant anatomy and pathophysiology.
Shackelford discussed a set of questions answered through literature review of research on application of a pelvic sling. The process led to an update of the Tactical Combat Casualty Care guideline review recommending pelvic sling as part of circulation care along with tourniquet application.
Memorable quotes on pelvic binder
Here are three memorable quotes from Shackelford on pelvic fractures.
“Hemodynamic instability from pelvic fracture has 40 percent mortality.”
“Complex network of blood vessels surrounds entire pelvis.”
“There is evidence in cadaver studies that fracture motion is reduced” with a pelvic splint.”
Top takeaways on prehospital pelvic fracture treatment
Combat and civilian injury mechanisms can lead to a pelvic fracture. Here are four top takeaways from Shackelford’s update of the Tactical Combat Casualty Care guidelines.
1. Pelvic fracture can lead to rapid blood loss
Any fracture pattern to the pelvis can lead to life-threatening hemorrhage. Blunt trauma and blast injury forces to the pelvis, major vessels and surrounding vasculature can lead to rapid blood loss and shock.
2. Pelvic fracture is associated with other trauma
Because of the high amount of force required to fracture the pelvis, the patient is likely to have other major traumatic injuries. For example, soldiers with traumatic lower limb amputation had a high incidence of pelvic fracture.
3. Pelvic splint is treatment for a pelvic fracture
The top treatment goals for a patient with a suspected pelvic fracture are reducing blood loss and rapid transport to definitive care. A pelvic splint or sling is the only treatment available for non-invasive prehospital care of a pelvis fracture. Devices are known by different names, including commercial products – PelvicBinder, T-PODResponder, SAM Pelvic Sling II, orthopedic compression device, pelvic sling and pelvic splint. Shackelford described all devices as a pelvic splint and that there is weak clinical evidence to select a commercial compression device over an improvised sheet.
Shackelford reviewed available research to answer a number of questions about the impact of a pelvic splint to control severe bleeding and improve patient survival. There is weak clinical evidence that a pelvic splint may reduce pelvic fracture bleeding and improve survival, but all of the research is based on pelvic compression being applied after patient arrival at the hospital.
Since the evidence of efficacy is weak Shackelford described research about the potential for harm by applying a pelvic splint. A case review of 115 patients with pelvic ring injuries found no increase in hazards associated with placement of the compression device.
4. Pelvic splint indications
Indications for a pelvic splint after severe blunt or blast injury include one or more of the following:
- Pelvic pain
- Any major limb amputation or near amputation
- Physical exam findings suggestive of a pelvic fracture
- Unconscious
- Shock
In addition to applying the pelvic sling, Shackelford reminded attendees to secure the patient’s legs to prevent external leg rotation during patient lifting, moving and transport.
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