BET 2: Stabilisation of pelvic fractures
Institution: Stepping Hill Hospital, Stockport, UK and Blackpool Victoria Hospital, Blackpool, UK
A short-cut review was carried out to establish whether pelvic immobilisation with a T-POD, or similar device, or pelvic immobilisation with a wrapped sheet is better at fracture stabilisation. Three papers were relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are shown in table 2. The clinical bottom line is that these devices/techniques do reduce and stabilise some fractures, whether one device is better than another is unclear.
In (trauma patients with unstable pelvic fractures) is (pelvic immobilisation with a T-POD, or similar device, or pelvic immobilisation with a wrapped sheet) better (at fracture stabilisation)?
A patient is bought to the emergency department with pelvic trauma. One of the members of the trauma team mentions that the new T-POD pelvic binder is better than the traditional wrapped sheet for fracture stabilisation. You wonder if there is any evidence to support this.
Medline 1980–May 2011 using the NHS library interface. [[Pelvis ti.ab OR Pelvic ti.ab] AND [Splint ti.ab. OR immobilisation ti.ab.] AND [Trauma ti.ab]] OR [Tpod ti.ab] Medline 1980-February 7th 2013 using NHS Evidence (TPOD ti,ab OR T-POD.ti,ab OR trauma pelvic orthotic device.ti, ab)=13 records Embase 1980-Feb 7th 2013 15 records no new relevancies The Cochrane Library issue 1 of 12 Jan 2013 TPOD ti,ab OR T-POD.ti,ab OR trauma pelvic orthotic device.ti, ab 2 records no new relevancies.
This search yielded 19 papers. No paper directly answered the question. A systematic review and two subsequent studies seemed relevant to the question and their results are presented.
Historically, patients with unstable pelvic fractures and haemodynamic instability have had mortality rates of 40–80% (Geeraerts et al, 2007). The application of external fixators or C clamps may stabilise the fracture(s), but this requires appropriate equipment and training and has prompted the development of alternative non-invasive techniques such as wrapping a circumferential sheet around the pelvis and pelvic circumferential compression devices. The studies cited suggest that these can achieve reduction of horizontal displacement. However, there is a suggestion that pressure on the skin is sufficient to cause tissue damage if the devices are left on for more than 2–3 h (Jowett and Bower, 2007).
Clinical bottom line
Non-invasive pelvic stabilisation measures are widely advocated in the resuscitation of patients with unstable pelvic fractures. Cadaver and clinical studies do suggest that they can reduce pubic symphysis diastasis. Local guidelines should be followed about which technique/device to use.
▸ Spanjersberg WR, Knops SP, Schep NWL, et al. Effectiveness and complications of pelvic circumferential compression devices in patients with unstable pelvic fractures: a systematic review of literature. Injury 2009;40:1031–5.
▸ Tan ECTH, van Stight SFL, van Vught AB. Effect of a new pelvic stabilizer (T-POD) on reduction of pelvic volume and haemodynamic stability in unstable pelvic fractures. Injury 2010;41:1239–43.
▸ Geeraerts T, Chhor V, Cheissong, et al. Clinical review: initial management of blunt pelvic trauma patients with haemodynamic instability. Critical Care 2007;11:204.
▸ Knops SP, Schep NWL, Spoor CW, et al. Comparison of three different pelvic circumferential compression devices: a biomechanical cadaver study. J Bone Joint Surg Am 2011;93:230–40.
▸ Jowett AJ, Bower GW. Pressure characteristics of pelvic binders. Injury 2007;38:118–21.