pelvic binder improves reduction of unstable fractures of the pelvic ring. Bone Joint J [Internet]. 2011 Nov;93âB(11):1524â8. 4. Hsu S, Chen C, Chou Y, Wang S, ...
Paediatric pelvic splint use: A case report J Smith, R Lyon, EC Dickinson, D Preece, MQ Russell Introduction
Presented at RETRIEVAL 2018
Methods
The use of pelvic binders has been internationally recognised as an effective, immediate method for the stabilisation and reduction of potentially life-threatening pelvic fractures. Suspected fractures of the pelvic bones should managed promptly due to risk of mortality related 1,2 haemorrhaging, primarily (85%) originating from venous bleeding. When using pelvic binders, the main focus should be put on the correct 3 placement, pressure and binder size. Therefore, some commercially available pelvic binders are either aimed specifically for adults or children. The Prometheus Pelvic Splint is designed to fit a broad range of sizes and ages, due to its flexible and adjustable design (Figure 1). We present two paediatric cases in which the PPS was used, demonstrating its applicability on children.
Two paediatric cases were identified in Australia and Scotland, in which the PPS was applied for the initial management of a suspected pelvic fracture. Clinical information was gathered and presented non-subjectively in this case report.
Figure 1— Prometheus Pelvic Splint
Results Patient 1 A 22-month old Australian indigenous boy was injured by his mother’s reversing car. Presenting to the emergency department, the patient was fully alert and hemodynamically stable (HR120-130/min; SBP90-100mmHg). On examination there was visible bruising on the lower back and the left leg was held in flexion at the hip and knee. Initial X-ray showed an 'open-book type' pelvic ring disruption with sacral displacement, after which suitable pelvic binder was sought. The Prometheus Pelvic Splint was applied after administration of ketamine (1mg/kg), followed by catheter insertion. Postsplint imaging revealing reduction of the pelvic ring fracture, with a remaining symphyseal diastasis of 7mm (Figure 2a,b). Six days after the injury, the patient was discharged with hip spica cast and the 20-day follow-up revealed no radiographic abnormalities. Patient 2 An 8-year old boy was hit by a 40mph car whilst attempting to cross a road . Trauma team primary survey revealed a fully alert but painful patient with visible bruising across lower abdomen and pelvis (HR140/min, BP84/44mmHg). Due to suspicion of pelvic injury, a PPS was applied and following assessment in ED, a CT scan showed iliac crest fracture and possible bladder injury. Subsequently, the PPS was able to remain in-situ for instillation of radiographic contrast for a CT-urogram.
Figure 2— Case 1 with open book fracture. Before (a) and after (b) application of Prometheus Pelvic splint.
Conclusion Immediate pelvic fracture management with pelvic binders is a crucial step to reduce potentially life-threatening massive haemorrhaging and 4 pain. The Prometheus Pelvic Splint has been designed to fit a wide range of sizes and ages. The intuitive design allows easy application, while maintaining essential procedural access to the groin area. This case report not only demonstrated its suitability in paediatrics, it also showed the practical and essential aspect of maintaining procedural access.
References 1. Giannoudis PV, Grotz MR, Tzioupis C, Dinopoulos H, Wells GE, Bouamra O, Lecky F. Prevalence of pelvic fractures, associated injuries, and mortality: the United Kingdom perspective. Journal of Trauma and Acute Care Surgery. 2007 Oct 1;63(4):875-83 2. Montmany S, Rebasa P, Luna A, Hidalgo JM, Cánovas G, Navarro S. Source of bleeding in trauma patients with pelvic fracture and haemodynamic instability. Cirugía Española (English Edition). 2015 Aug 1;93(7):450-4. 3. Bonner TJ, Eardley WGP, Newell N, Masouros S, Matthews JJ, Gibb I, et al. Accurate placement of a pelvic binder improves reduction of unstable fractures of the pelvic ring. Bone Joint J [Internet]. 2011 Nov;93–B(11):1524–8. 4. Hsu S, Chen C, Chou Y, Wang S, Chan D. Effect of Early Pelvic Binder Use in the Emergency Management of Suspected Pelvic Trauma : A Retrospective Cohort Study. Int J Environ Res Public Health [Internet]. 2017 Oct;14(1217):1–10.
