PELVIC SPLINTAGE, SOME EVIDENCE EXISTS

We splint the pelvis because it makes sense. When we teach it we say it makes sense to splint the pelvis as it reduces diastasis and by doing that we reduce the volume into which fractures can bleed. 

Then we normally go on to say there are no studies to support pelvic splintage. That might not be entirely true. There are actually some small studies suggesting we are doing the right thing.

There’s a cadaveric study from 2008  an anterior-posterior compression fractures (APC) fractures that demonstrate how one of the commercially available binders reduce diastasis to normal in 75% patients. The classical circumferential sheet was tested too. It worked, but not as good as the commercial device.

Then there was the study by Tan et al (2010) demonstrated how patients with unstable pelvic fractures had their symphysis pubis diastasis reduced by 60% on x-rays. Furthermore their systolic pressures increase by 20mmHg on average.

Finally there’s the 2007 study from Croce et al that tell us that all this might translate into clinical benefit. They retrospectively looked at patients with life threatening pelvic fracture over 10 years. They could demonstrate significant reduction of transfusion needs and hospital stay. They also recorded reduced mortality but that data wasn’t statistically conclusive.

So it seems there are at least some studies supporting our use of pelvic splints. As for the old sheet around the pelvis i remain unsure. I you get the pressure points right, over the trochanters, sure, it should work just as well. Problem is that most of the time you don’t and if you do its likely to slide or spontaneously slack anyway. So go for the commercial made-for splints.

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