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The pelvic belt: A cautionary tale of pressure necrosis

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Abstract

Prehospital emergency care for suspected pelvic injuries involves the use of a pelvic belt. The pressure exerted by the belt will cause necrosis of the soft tissues after a short period of time (see figure 1 …
The pelvic belt: a cautionary tale of
pressure necrosis
Prehospital emergency care for suspected pelvic injuries involves
the use of a pelvic belt. The pressure exerted by the belt will
cause necrosis of the soft tissues after a short period of time (see
gure 1).
1
If the area of pressure necrosis involves the operative
eldthen open reduction and internal xation will not be
possible due to the increased risk of infection. As a consequence,
the patient may develop a pelvic mal-union, which is associated
with a poor outcome, disabling symptoms and has major
socioeconomic implications. Therefore, the need for the pelvic
belt should be reviewed as soon as possible. The absolute indi-
cation for a pelvic belt is an unstable patient with an unstable
pelvic injury. In this scenario the pelvic belt should be exchanged
for more denitive stabilisation, usually with an external xator.
Once stable all patients with pelvic injuries should be discussed
with the local pelvic unit regarding further management.
Simon Ball, Nirav K Patel, Angus Lewis
Department of Trauma and Orthopaedic Surgery, Charing Cross Hospital, Imperial
College Healthcare NHS Trust, London, UK
Correspondence to Dr Simon Ball, 26 Albert Road, Teddington, Middlesex, London
TW11 0BD, UK; si_ball@hotmail.com
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; not externally peer reviewed.
Accepted 22 July 2010
Emerg Med J 2010;-:1. doi:10.1136/emj.2010.102160
REFERENCE
1. Knops SP, van Reil MP, Goossens RH, et al. Measurements of the exerted pressure
by pelvic circumferential compression devices. Open Orthop J 2010;17:101e6.
Figure 1 Pressure necrosis caused by a pelvic belt.
Ball S, Patel NK, Lewis A. Emerg Med J (2010). doi:10.1136/emj.2010.102160 1of1
Images in emergency medicine
EMJ Online First, published on March 25, 2011 as 10.1136/emj.2010.102160
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doi: 10.1136/emj.2010.102160
published online March 25, 2011Emerg Med J
Simon Ball, Nirav K Patel and Angus Lewis
necrosis
The pelvic belt: a cautionary tale of pressure
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Article
This method is particularly suited to resource poor areas where the loss of items as simple as hospital laundry may be costly and unwanted. The case illustrated is a lady who presented to a small hospital in remote far western Nepal, after being recovered from a landslide, with a disrupted pelvis and fractured femur.
Article
Background Data on the efficacy and safety of non-invasive Pelvic Circumferential Compression Devices (PCCDs) is limited. Tissue damage may occur if a continuous pressure on the skin exceeding 9.3 kPa is sustained for more than two or three hours. The aim of this study was to gain insight into the pressure build-up at the interface, by measuring the PCCD-induced pressure when applying pulling forces to three different PCCDs (Pelvic Binder ® , SAM-Sling ® and T-POD ® ) in a simplified model. Methods The resulting exerted pressures were measured at four ‘anatomical’ locations (right, left, posterior and anterior) in a model using a pressure measurement system consisting of pressure cuffs. Results The exerted pressure varied substantially between the locations as well as between the PCCDs. Maximum pressures ranged from 18.9-23.3 kPa and from 19.2-27.5 kPa at the right location and left location, respectively. Pressures at the posterior location stayed below 18 kPa. At the anterior location pressures varied markedly between the different PCCDs. Conclusion The circmferential compression by the different PCCDs showed high pressures measured at the four locations using a simplified model. Difference in design and functional characteristics of the PCCDs resulted in different pressure build-up at the four locations. When following the manufacturer’s instructions, the exerted pressure of all three PCCDs tested exceeded the tissue damaging level (9.3 kPa). In case of prolonged use in a clinical situation this might put patients at risk for developing tissue damage.