A national survey of United Kingdom trauma units on the use of pelvic binders

Abstract

Major pelvic injuries resulting from high-energy trauma require emergency hospital treatment, and part of the initial management includes mechanical stabilisation of the pelvis. Controversies include binder position, use in lateral compression injuries and application during radiological assessment. We present the results of a survey of both emergency department and orthopaedic specialties. A telephone survey of all 144 trauma units in the UK accepting adult pelvic trauma patients was carried out in July 2012. The duty registrar for the emergency and orthopaedic departments was contacted and asked to complete a questionnaire. A response rate of 100% was achieved. Pelvic binders were available for use in approximately three quarters of the trauma units surveyed. Eight-five emergency department (59%) and 79 orthopaedic (54.9%) registrars had been given training on pelvic binder application. Fifty-six emergency department (38.9%) and 114 orthopaedic (79.1%) registrars identified the level of the greater trochanters as the most suitable position for the binder. Forty-five emergency department (31.3%) and 58 orthopaedic (40.3%) registrars used pelvic binders in suspected lateral compression injuries. One hundred and twenty-six emergency department (87.5%) and 113 orthopaedic (78.5%) registrars would not release the binder during radiological assessment of the pelvis in a haemodynamically stable patient. There is great variability in practice amongst trauma units in the UK. Training must be formalised and provided as a mandatory part of departmental induction. The use of standardised treatment algorithms in trauma units and the Advanced Trauma and Life Support (ATLS) framework may help decision making and improve patient survival rates.