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Pelvic Fracture algorithm

Pelvic Fracture Notes:

Annotation for Point D

If the patient remains unstable and has a negative FAST or DPA, in selected circumstances, external pelvis stabilization may be beneficial. If the pelvis is clinically unstable to manual compression or the radiograph shows widening of the posterior pelvic ring or pubic symphysis diastasis, noninvasive pelvic stabilization should be done. Level II evidence demonstrates that external compression of the pelvis can reduce the volume by 10%.^24,25 There is some Level III data suggesting clinical and hemodynamic benefit in these patients.^26,27 If there is no widening of the pelvic ring, or pubic symphysis diastasis (i.e., lateral compression type injuries, or pubic rami fractures), external pelvic stabilization is not likely to be helpful, and may exacerbate the injury. The pelvis can be stabilized with a tightly wrapped sheet, secured with towel clips or with a proprietary device (T-pod; Bio Cybernetics, La Verne, CA). The device (or sheet) should be centered over the greater trochanters, covering the buttocks in most patients. The device should not be left in place longer than 24 to 36 hours as skin necrosis can occur over injured areas and boney prominences.²⁸