Application of Pelvic Circumferential Compression Devices in Pelvic Ring Fractures-Are Guidelines Followed in Daily Practice?

Valerie Kuner,Frank J P Beeres,Nicole Van Veelen,Bryan Van De Wall,Matthias Knobe,Reto Babst,Jürgen Fornaro,Michael Stickel,Björn-Christian Link,Stephanie Studer

doi:10.3390/jcm10061297

Valerie Kuner, Frank J P Beeres + Show 8 more

Open Access

https://doi.org/10.3390/jcm10061297

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Abstract

Early administration of a pelvic circumferential compression device (PCCD) is recommended for suspected pelvic trauma. This study was conducted to evaluate the prevalence of PCCD in patients with pelvic fractures assigned to the resuscitation room (RR) of a Level I trauma center. Furthermore, correct application of the PCCD as well as associated injuries with potential clinical sequelae were assessed. All patients with pelvic fractures assigned to the RR of a level one trauma center between 2016 and 2017 were evaluated retrospectively. Presence and position of the PCCD on the initial trauma scan were assessed and rated. Associated injuries with potential adverse effects on clinical outcome were analysed. Seventy-seven patients were included, of which 26 (34%) had a PCCD in place. Eighteen (23%) patients had an unstable fracture pattern of whom ten (56%) had received a PCCD. The PCCD was correctly placed in four (15%) cases, acceptable in 12 (46%) and incorrectly in ten (39%). Of all patients with pelvic fractures (n = 77, 100%) treated in the RR, only one third (n = 26, 34%) had a PCCD. In addition, 39% of PCCDs were positioned incorrectly. Of the patients with unstable pelvic fractures (n = 18, 100%), more than half either did not receive any PCCD (n = 8, 44%) or had one which was inadequately positioned (n = 2, 11 %). These results underline that preclinical and clinical education programs on PCCD indication and application should be critically reassessed.

Highlights

About 20% of polytrauma patients have a pelvic injury [1], with an estimated incidence of about 23 per 100,000 persons per year [2,3]
The examination of pelvic stability is part of the primary survey of trauma patients as an unstable pelvic ring fracture may result in severe intra- or retroperitoneal bleeding [4,5,6]
A further option to reduce anterior diastasis is simple internal rotation of the lower extremities, which can be held by tape as reported by Gardner et al this technique is problematic if the lower limbs are unstable due to long bone fractures [13,14,15]

Summary

Introduction

About 20% of polytrauma patients have a pelvic injury [1], with an estimated incidence of about 23 per 100,000 persons per year [2,3]. A further option to reduce anterior diastasis is simple internal rotation of the lower extremities, which can be held by tape as reported by Gardner et al this technique is problematic if the lower limbs are unstable due to long bone fractures [13,14,15]. The PCCD is applied in the preclinical setting directly at the site of the accident. It is left in place until either the injury is ruled out or treatment is initiated [16,17]. The PCCD should be positioned over the greater trochanters to allow for optimal transmission of forces via the proximal femur to the pelvis to reduce anterior diastasis [18,19]. Potential disadvantages of PCCDs such as skin necrosis and nerve lesions have been described in case reports [20,21,22,23,24,25,26]

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