The pelvis has major blood vessels running throug it; fracture or penetrating injury can easily lead to a fatal amount of massive hemorrhage. Pelvic fractures with hemodynamic instability have a 40% mortality. 26% US mil deaths in Afghanistan and Iraq had a pelvic fracture.
Pelvic fractures are generally caused by severe blunt force or blast trauma. Signs and symptoms include:
Pelvic pain and/or crepitus
Deformed or unstable pelvis, unequal leg lengths, or outward rotation of legs (open-book fracture)
Bruising at bony prominences of pelvic ring, anal/vaginal/urethral bruising or bleeding
Neurological deficits in lower extremities
Major lower limb amputation or near amputation
Unconsciousness
Shock
Pelvic binders help return the pelvis to its natural position and lessen bleeding and further damage. There are several purpose-made varieties; an improvised binder may also be made using a sheet or similar object. Pelvic binders should be placed low, at the level of the greater trochanters ("bottom of the patients' pocket openings"). Higher placement can actually leverage open lower-pelvic fractures, increasing damage. One assessment at a major UK trauma center found that 41% of pelvic binders were placed too high. Outward rotation of legs may be observed in displacement pelvic fractures; in these cases legs should also be bound together, in order to prevent further displacement.
An Assessment of Pelvic Binder Placement at a Major UK Trauma Center
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