Immobilization in pelvic injury

1. Immobilization in Pelvic Injury

2. Pelvic Fracture/Injury
• High mortality
• 5-30% overall mortality rate
• Increased mortality rate to 10-42% in closed fx with hypotension
• 50% mortality rate in open pelvic fx
• Associated with multiple trauma and soft tissue injuries (GI tract, genitourinary, vascular, nerve)
• Usually occur in high energy trauma:
• Motor vehicle/motorcycle crash
• Pedestrian-vehicle collision
• Direct crush injury
• Fall from height

3. Pelvic Fracture/Injury
• Disruption of the posterior osseous ligamentous complex (i.e.,
sacroiliac, sacrospinous, sacrotuberous, and fibromuscular pelvic
floor)
• Dislocation of the sacroiliac joint
• Sacral fracture
• Sacroiliac fracture

5. Management
• Hemorrhage control to prevent hypovolemic shock
• Control achieved through:
• Mechanical reduction and stabilization of the pelvic ring (as soon as possible)
• External counter pressure
• Reccomended manuever
• Externally rotate the hemipelvis, internal rotation of the lower limbs  reducing
pelvic volume
• Circumferential wrapping of a sheet around the pelvis as a sling
• Applying a support directly to the patient’s pelvis  splint the disrupted pelvis 
reduce potential pelvic hemorrhage

6. Immobilization Techniques
• Pelvic Binder
• Pelvic Sheet (sheet wrap method)
• Sam Sling
• Vacuum Bean Bags
• Trauma Pelvic Orthotic Device (T-POD)
• Military Anti Shock Trousers

7. Pelvic Binder
• Initial stabilization of choice for the
immediate management of pelvic
ring injuries
• Function/purpose:
• To splint the bony pelvis to reduce
haemorrhage from bone ends and
venous disruption.
• To reduce pain and movement during
transfers.
• To provide some integrity to the pelvis
when operative packing of the pelvis is
necessary.
• To provide stabilization of the pelvis
until definitive stabilization can be
achieved

8. Pelvic Binder
• Suitable for use in the prehospital arena and emergency
department. Light and easily applied, ideally by one
person.
• Allow access to the abdomen for laparotomy, and to the
groins for angioembolization
• Made from soft material that will be comfortable and
not induce pressure ulceration.
• Should not limit access to the perineum and anus for
examination.
• Must fit various sizes of patients (including children), or
different sizes be available.
• Should be washable or cheap enough to be disposable.

10. Military Anti Shock Trousers