Accurate placement of a pelvic binder improves reduction of unstable fractures of the pelvic ring

• Published in: Journal of bone and joint surgery. British volume Vol. 93; no. 11; pp. 1524 - 1528
• Main Authors: BONNER, T. J, EARDLEY, W. G. P, NEWELL, N, MASOUROS, S, MATTHEWS, J. J, GIBB, I, CLASPER, J. C
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 01.11.2011
• Subjects: Biological and medical sciences; Diseases of the osteoarticular system; Fracture Fixation - instrumentation; Fracture Fixation - methods; Fractures, Bone - diagnostic imaging; Fractures, Bone - etiology; Fractures, Bone - surgery; Humans; Injuries of the limb. Injuries of the spine; Medical sciences; Military Personnel; Orthopedic surgery; Orthotic Devices; Pelvic Bones - diagnostic imaging; Pelvic Bones - injuries; Pelvic Bones - surgery; Pubic Symphysis Diastasis - diagnostic imaging; Pubic Symphysis Diastasis - surgery; Radiography; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Traumas. Diseases due to physical agents; Fracture; Orthopedic surgery; Treatment; Trauma; Diseases of the osteoarticular system; Pelvic girdle
• ISSN: 0301-620X; 2044-5377
• DOI: 10.1302/0301-620X.93B11.27023

The aim of this study was to assess the accuracy of placement of pelvic binders and to determine whether circumferential compression at the level of the greater trochanters is the best method of reducing a symphyseal diastasis. Patients were identified by a retrospective review of all pelvic radiographs performed at a military hospital over a period of 30 months. We analysed any pelvic radiograph on which the buckle of the pelvic binder was clearly visible. The patients were divided into groups according to the position of the buckle in relation to the greater trochanters: high, trochanteric or low. Reduction of the symphyseal diastasis was measured in a subgroup of patients with an open-book fracture, which consisted of an injury to the symphysis and disruption of the posterior pelvic arch (AO/OTA 61-B/C). We identified 172 radiographs with a visible pelvic binder. Five cases were excluded due to inadequate radiographs. In 83 (50%) the binder was positioned at the level of the greater trochanters. A high position was the most common site of inaccurate placement, occurring in 65 (39%). Seventeen patients were identified as a subgroup to assess the effect of the position of the binder on reduction of the diastasis. The mean gap was 2.8 times greater (mean difference 22 mm) in the high group compared with the trochanteric group (p < 0.01). Application of a pelvic binder above the level of the greater trochanters is common and is an inadequate method of reducing pelvic fractures and is likely to delay cardiovascular recovery in these seriously injured patients.