Management of Undisplaced Pubic Rami Fractures

Indications for Pelvic Binder Use

The World Journal of Emergency Surgery guidelines recommend applying a pelvic binder as an early strategy to stabilize the pelvic ring and decrease the amount of pelvic hemorrhage in the early resuscitation phase, with a Grade 1A recommendation, for hemodynamically unstable patients with suspected pelvic ring injury 1, 2, 3
Pelvic binders should be used in hemodynamically unstable patients (systolic BP <90 mmHg or requiring blood product transfusion) with suspected pelvic ring injury, as recommended by the World Journal of Emergency Surgery 1, 4
The World Journal of Emergency Surgery guidelines also recommend using pelvic binders in mechanically unstable pelvic ring fractures (Young-Burgess or Tile classification indicating instability) in the pre-hospital or early resuscitation setting 1, 2
For elderly patients, even minor trauma can cause significant fractures due to bone fragility, and lateral compression fractures may benefit more from angiography than pelvic binding if bleeding occurs, according to the World Journal of Emergency Surgery 4
Pelvic binders should be positioned with extra caution in elderly patients, as recommended by the World Journal of Emergency Surgery 1, 5

If a patient has a systolic BP <90 mmHg or requires transfusion, a pelvic binder should be applied immediately, as recommended by the World Journal of Emergency Surgery 1, 2
If a pelvic binder was applied pre-hospital, it should be removed within 24-48 hours maximum to prevent skin necrosis and pressure ulcers, and the patient should be transferred off the spine board early to reduce pressure-related complications, as recommended by the World Journal of Emergency Surgery 1, 4, 5