EMERGENCY DEPARTMENT · WALL POSTER

Pelvic Binder Application

DECIDEUnstable blunt trauma with a suspected pelvic ring injury. · Assess pelvic stability once. · Apply empirically in the undifferentiated unstable patient. · Apply over an open pelvic fracture too. Give early antibiotics.

STEPS · ◆ KEY STEP — LOGGED WITH ITS TIME

TECHNIQUE — STEP BY STEP

Expose the pelvis/hips; bring the legs together.
Slide it under at the GREATER TROCHANTERS — not the iliac crests.
One clinician reduces the pelvis while a second tightens the device.
Tighten until it clicks or the belt edges meet. Two fingers must still fit. ◆ BINDER APPLIED
Bind ankles/knees together to maintain internal rotation. Document time of application.
No device: folded bedsheet ~18 in wide at the trochanters, pulled tight, clipped.

EQUIPMENT

Commercial pelvic binder (e.g. SAM Pelvic Sling II or T-POD) — primary device.
Backup: a folded bedsheet plus 2 towel clips.
Trauma shears to expose the pelvis and hips · tape or bandage to bind ankles/knees together.

FIGURE

The commonest binder error is placing it on the iliac crests, where it looks correct but has no effect — the band has to sit over the greater trochanters, level with the hip joints, to reduce pelvic volume. Cut clothing away and apply to skin.

GREATER TROCHANTERS, NOT ILIAC CRESTS

ASSESS PELVIC STABILITY ONCE ONLY

SKIN CHECK BY ~4H · REMOVE BY 24H IF FEASIBLE

MOSTLY VENOUS BLEEDING — BINDER ≠ DEFINITIVE CONTROL

PITFALLS & PEARLS

Placing it over the iliac crests/abdomen — the single most common error, and it does not work there.

Overtightening — increases skin-injury risk without added hemostatic benefit.

Treating the binder as definitive control.

Leaving it on indefinitely — skin necrosis can start within 2–4 hours.