Positioning for Pelvic Fractures

Initial Positioning and Stabilization

The World Journal of Emergency Surgery recommends that commercial pelvic binders should be positioned around the great trochanters and symphysis pubis to apply pressure that reduces the pelvic fracture and adducts the lower limbs, decreasing pelvic internal volume 1, 3
If commercial binders are unavailable, "home-made" binders can be effectively used in resource-limited settings, though commercial binders are more effective for hemorrhage control, as stated by the World Journal of Emergency Surgery 2, 4
The World Journal of Emergency Surgery suggests that pelvic binders should be applied as an early strategy to stabilize the pelvic ring and decrease hemorrhage in the resuscitation phase 3, 5
When using a pelvic binder, early transfer from the spine board is essential to significantly reduce the risk of skin pressure lesions, according to the World Journal of Emergency Surgery 2, 6

The World Journal of Emergency Surgery recommends that pelvic binders should not be kept in place for more than 24-48 hours to avoid complications 6, 7
Continuous application of pressure above 9.3 kPa for more than 2-3 hours can lead to skin necrosis and pressure ulcerations, as stated by the World Journal of Emergency Surgery 6
The World Journal of Emergency Surgery suggests that pelvic binders should be removed as soon as physiologically justifiable and replaced by external pelvic fixation or definitive pelvic stabilization when indicated 3, 6

In elderly patients, pelvic binders should be positioned with extra caution due to bone fragility, according to the World Journal of Emergency Surgery 6, 7
For pregnant women, the pelvis can be stabilized with internal rotation of the legs and cautious pelvic binder positioning, as stated by the World Journal of Emergency Surgery 2, 6
In patients with lateral compression fracture patterns, angiography may have more hemostatic effect than pelvic binding alone, according to the World Journal of Emergency Surgery 6

Pelvic binders serve as a bridge to definitive mechanical stabilization in hemodynamically stable patients with mechanical instability, as stated by the World Journal of Emergency Surgery 6, 7
For unstable pelvic ring injuries, progression to definitive internal fixation is indicated after initial stabilization, according to the World Journal of Emergency Surgery 8
In cases of severe hemodynamic instability, pre-peritoneal pelvic packing may be considered as a complementary method for temporary hemostasis, as suggested by Anaesthesia 9

For retrograde urethrogram in patients with suspected urethral injuries, position the patient obliquely with the bottom leg flexed at the knee and the top leg kept straight, according to The Journal of Urology 10
If severe pelvic fractures are present, leave the patient supine and place the penis on stretch to acquire the image, as stated by The Journal of Urology 10
For patients requiring external fixation, the fixator must be placed anteriorly and inferiorly to allow for potential laparotomy, according to Anaesthesia 9

Avoid repeated attempts at urethral catheter placement in patients with pelvic fracture associated urethral injury to prevent increasing injury extent, as stated by The Journal of Urology 10
Avoid over-tightening of pelvic binders as this can lead to skin necrosis and pressure ulcerations, according to the World Journal of Emergency Surgery 6
Monitor for potential soft tissue complications from prolonged compression with pelvic binders, as suggested by the World Journal of Emergency Surgery 3, 6
Ensure early transfer from spine boards when pelvic binders are in place to reduce pressure-related complications, according to the World Journal of Emergency Surgery 2, 6