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with reduced efficacy in closing of the symphyseal diastasis. 8. Papakostidis C, Giannoudis PV. Pelvic ring injuries with haemo-
5
It is unclear, however, what effects malpositioning of binders dynamic instability: efficacy of pelvic packing, a systematic re-
would have had on our results, and this consideration is par- view. Injury. 2009;40S4:S53–S61.
ticularly pertinent for the improvised binders. They would po- 9. Pascarella R, Del Torto M, Politano R, et al. Critical review of
tentially be used in combat situations at the point of wounding pelvic fractures associated with external iliac artery lesion: a se-
ries of six cases. Injury. 2014;45(2):374–378.
well away from the expertise of a pelvic surgeon. In these cir- 10. Croce MA, Magnotti LJ, et al. Emergent pelvic fixation in pa-
cumstances, suboptimal binder application may be more likely tients with exsanguinating pelvic fractures. J Am Coll Surg. 2007;
because of the stress of the environment in which many lower 204:935–942.
limb and pelvic injuries occur in an operational theater. 23 11. Morris R, Loftus A, Lygas A, et al. Pelvic pressure changes after
a fracture: a pilot cadaveric study assessing the effect of pelvic
binders and limb bandaging. Injury. 2016;47(2):295.
Conclusion 12. Morris R, Loftus A, Friedmann Y, et al. Intra-pelvic pressure
changes after pelvic fracture: a cadaveric study quantifying the
Overall, this study shows that both the TPOD and the CTB effect of a pelvic binder and limb bandaging over a bolster. Injury.
are effective in significantly increasing intrapelvic pressures to 2017;8(4):833–840.
a clinically relevant level. There was no significant superiority 13. Chesser TJS, Cross AM, Ward AJ. The use of pelvic binders in the
of the TPOD over the CTB. Combat soldiers are exclusively emergent management of potential pelvic trauma. Injury. 2012;
43:667–669.
deployed wearing PCS trousers that can be adapted rapidly 14. Yentis SM, Hirsch NP, Ip JK. Anaesthesia and intensive care. An
into a potentially lifesaving pelvic binder without the need for encyclopaedia of principles and practice. 5th ed. Edinburgh, UK:
specialist devices. The described technique could be used in the Churchill-Livingstone Elsevier.
early management of life-threatening pelvic injuries in opera- 15. DeAngelis NA, Wixted JJ, Drew J, et al. Use of the trauma pelvic
tional theaters where dedicated resources are limited. orthotic device (TPOD) for provisional stabilisation of anterior-
posterior compression type pelvic fractures: a cadaveric study.
Injury. 2008;39:903–936.
Funding 16. Tan ECTH, Van Stigt SFL, Van Vugt AB. Effect of a new pelvic
This work was supported by Prof Vishy Mahadevan, MBBS, stabilizer (TPOD ) on reduction of pelvic volume and haemo-
®
PhD, FRCS, the Royal College of Surgeons, and Stephen D. dynamic stability in unstable pelvic fractures. Injury. 2010;41:
Atherton, medical illustrator, MA, RMIP, MIMI, Morriston 1017–1021.
Hospital, Swansea, UK SA6 6NL. 17. National Institute for Health and Clinical Excellence. Trauma
overview. February 2016. http://pathways.nice.org.uk/pathways
/trauma. Accessed 10 June 2017.
Disclosures 18. Bottlang M, Simpson T, Sigg J, et al. Non-invasive reduction of
The authors have nothing to disclose. open-book pelvic fractures by circumferential compression. J Or-
thop Trauma. 2002;16(6):367–373.
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