Application of Circumferential Compression Device (Binder) in Pelvic Injuries: Room for Improvement
Introduction The use of a noninvasive pelvic circumferential compression device (PCCD) to achieve pelvic stabilization by both decreasing pelvic volume and limiting inter-fragmentary motion has become commonplace, and is a well-established component of Advanced Trauma Life Support (ATLS) protocol...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
eScholarship Publishing, University of California
2016-11-01
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| Series: | Western Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | http://escholarship.org/uc/item/91d6g9wn |
| _version_ | 1818541175120855040 |
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| author | Matthew Roth Rahul Vaidya John Swartz Bradley Zarling Sarah Zhang Christopher Walsh Jessica Macsuga John Swartz |
| author_facet | Matthew Roth Rahul Vaidya John Swartz Bradley Zarling Sarah Zhang Christopher Walsh Jessica Macsuga John Swartz |
| author_sort | Matthew Roth |
| collection | DOAJ |
| description | Introduction
The use of a noninvasive pelvic circumferential compression device (PCCD) to achieve pelvic stabilization by both decreasing pelvic volume and limiting inter-fragmentary motion has become commonplace, and is a well-established component of Advanced Trauma Life Support (ATLS) protocol in the treatment of pelvic ring injuries. The purpose of this study was to evaluate the following: 1) how consistently a PCCD was placed on patients who arrived at our hospital with unstable pelvic ring injuries; 2) if they were placed in a timely manner; and 3) if hemodynamic instability influenced their use.
Methods
We performed an institutional review board-approved retrospective study on 112 consecutive unstable pelvic ring injuries, managed over a two-year period at our Level I trauma center. Our hospital electronic medical records were used to review EMT, physician, nurses’, operative notes and radiographic images, to obtain information on the injury and PCCD application. The injuries were classified by an orthopaedic trauma surgeon and a senior orthopaedic resident. Proper application of a pelvic binder using a sheet is demonstrated.
Results
Only 47% of unstable pelvic fractures received PCCD placement, despite being the standard of care according to ATLS. Lateral compression mechanism pelvic injuries received PCCDs in 33% of cases, while anterior posterior compression (APC) and vertical shear (VS) injuries had applications in 63% of cases. Most of these PCCD devices were applied after imaging (72%). Hemodynamic instability did not influence PCCD application.
Conclusion
PCCD placement was missed in many (37%) of APC and VS mechanism injuries, where their application could have been critical to providing stability. Furthermore, to provide rapid stability, pelvic circumferential compression devices should be applied after secondary examination, rather than after receiving imaging results. Better education on timing and technique of PCCD placement at our institution is required to improve treatment of pelvic ring injuries. |
| first_indexed | 2024-12-11T22:05:08Z |
| format | Article |
| id | doaj.art-44fd41c5ca774da796d403b44beb48e9 |
| institution | Directory Open Access Journal |
| issn | 1936-900X 1936-9018 |
| language | English |
| last_indexed | 2024-12-11T22:05:08Z |
| publishDate | 2016-11-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj.art-44fd41c5ca774da796d403b44beb48e92022-12-22T00:48:58ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182016-11-0117676677410.5811/westjem.2016.7.30057Application of Circumferential Compression Device (Binder) in Pelvic Injuries: Room for ImprovementMatthew Roth0Rahul Vaidya1John Swartz2Bradley Zarling3Sarah Zhang4Christopher Walsh5Jessica Macsuga6John Swartz7Wayne State School of MedicineDetroit Medical CenterDetroit Medical CenterDetroit Medical CenterDetroit Medical CenterDetroit Medical CenterDetroit Medical CenterDetroit Medical CenterIntroduction The use of a noninvasive pelvic circumferential compression device (PCCD) to achieve pelvic stabilization by both decreasing pelvic volume and limiting inter-fragmentary motion has become commonplace, and is a well-established component of Advanced Trauma Life Support (ATLS) protocol in the treatment of pelvic ring injuries. The purpose of this study was to evaluate the following: 1) how consistently a PCCD was placed on patients who arrived at our hospital with unstable pelvic ring injuries; 2) if they were placed in a timely manner; and 3) if hemodynamic instability influenced their use. Methods We performed an institutional review board-approved retrospective study on 112 consecutive unstable pelvic ring injuries, managed over a two-year period at our Level I trauma center. Our hospital electronic medical records were used to review EMT, physician, nurses’, operative notes and radiographic images, to obtain information on the injury and PCCD application. The injuries were classified by an orthopaedic trauma surgeon and a senior orthopaedic resident. Proper application of a pelvic binder using a sheet is demonstrated. Results Only 47% of unstable pelvic fractures received PCCD placement, despite being the standard of care according to ATLS. Lateral compression mechanism pelvic injuries received PCCDs in 33% of cases, while anterior posterior compression (APC) and vertical shear (VS) injuries had applications in 63% of cases. Most of these PCCD devices were applied after imaging (72%). Hemodynamic instability did not influence PCCD application. Conclusion PCCD placement was missed in many (37%) of APC and VS mechanism injuries, where their application could have been critical to providing stability. Furthermore, to provide rapid stability, pelvic circumferential compression devices should be applied after secondary examination, rather than after receiving imaging results. Better education on timing and technique of PCCD placement at our institution is required to improve treatment of pelvic ring injuries.http://escholarship.org/uc/item/91d6g9wnMedicineOrthopedicsEmergency MedicinePelvic InjuriesPelvic Circumferential Compression Devices |
| spellingShingle | Matthew Roth Rahul Vaidya John Swartz Bradley Zarling Sarah Zhang Christopher Walsh Jessica Macsuga John Swartz Application of Circumferential Compression Device (Binder) in Pelvic Injuries: Room for Improvement Western Journal of Emergency Medicine Medicine Orthopedics Emergency Medicine Pelvic Injuries Pelvic Circumferential Compression Devices |
| title | Application of Circumferential Compression Device (Binder) in Pelvic Injuries: Room for Improvement |
| title_full | Application of Circumferential Compression Device (Binder) in Pelvic Injuries: Room for Improvement |
| title_fullStr | Application of Circumferential Compression Device (Binder) in Pelvic Injuries: Room for Improvement |
| title_full_unstemmed | Application of Circumferential Compression Device (Binder) in Pelvic Injuries: Room for Improvement |
| title_short | Application of Circumferential Compression Device (Binder) in Pelvic Injuries: Room for Improvement |
| title_sort | application of circumferential compression device binder in pelvic injuries room for improvement |
| topic | Medicine Orthopedics Emergency Medicine Pelvic Injuries Pelvic Circumferential Compression Devices |
| url | http://escholarship.org/uc/item/91d6g9wn |
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