Pelvic Fracture Stabilization, Kpekpeɖeŋunana, Kple Ʋu si Dona Le Ememe¶

akɔta ƒe asigɛ ƒe gbagbã si ŋu ŋusẽ geɖe le nye abi siwo wua ame wu le atikewɔwɔ si me wowɔa nuvevi ame le me dometɔ ɖeka, eye wòhea ku ƒe agbɔsɔsɔme si nye 15 va ɖo 50 le alafa me ne ʋu ƒe dɔwɔwɔ ƒe malikenyenye kpe ɖe eŋu. To vovo na ƒu didi abe afɔkpodzi alo abɔta ene la, amegbetɔ ƒe akɔta nye ƒu ƒe asigɛ sesẽ aɖe si me ƒu gã eve siwo me womeɖe naneke le o (akɔta) siwo wotsɔ ƒo ƒu ɖe ŋgɔgbe le pubic symphysis eye wotsɔ seke ɖo megbe ɖe sacrum ŋu to lãkusi sesẽtɔ kekeake siwo le ŋutilãa me dzi. Ne ʋu si le du dzi ƒe afɔku, dzokeke ƒe gododo (afisi akɔta ƒo ɖe ŋgɔ le amiɖaka me), afɔzɔla ƒe ƒoƒo, abi si wògbã, alo ge tso kɔkɔƒe gbã asigɛ sia le teƒe eve eye wòvuvu megbeƒu ƒe lãkusiwo la, akɔta ƒe ʋuƒoa ʋuna abe agbalẽ ƒe akpawo ene (an "open-book" pelvic fracture).

Ne ƒu ƒe akɔta ƒe asigɛa le ʋuʋum la, eƒe gogloƒe ƒe lolome si le eme la kekena ɖe enu ŋutɔ, si wɔnɛ be ya si le megbe ƒe akpa gã aɖe si ate ŋu ami ʋu mililita 3,000 va ɖo 5,000 (pint 6 va ɖo 10) (dɔnɔa ƒe ʋu ƒe agbɔsɔsɔ bliboa si le tsatsam) evɔ ʋu ɖeka pɛ hã madze le ŋutigbalẽa godo o. Nusi gavloe wue nye be xɔnametɔ siwo si susu nyui le wua amesiwo ŋu akɔta ƒe abi le enuenu to akɔta ƒe afɔtiwo tutu alo wo ʋuʋu me be "woadoe akpɔ be egbã hã" alo to dɔnɔa ʋuʋu ɖe woƒe axadzi, si gbãa ʋu si le megbe si mebɔbɔ o. Ne ènya nusitae mele be mèʋuʋu akɔta gbeɖe o, nusita wòle be akɔtablanu alo abadzivɔ si wowɔ le wo ɖokui si nanɔ titina tututu ɖe afɔkpodzi ƒe trochanters gãtɔwo dzi (eye mele kɔkɔe ɖe akɔta alo akɔta ƒe ta dzi gbeɖe o), kple alesi nàbla klowo kple afɔkpodziwo le ememe tɔtrɔ me la, etua akɔta ƒe asigɛa eye wòɖea agbe.

Wɔ esia fifia¶

1. Ƒo ka na wò nutoa me ƒe xexlẽdzesi kpata enumake eye nàbia Advanced Life Support (ALS) kpekpeɖeŋunalawo be woana ʋuɖoɖo kpata le Level 1 Trauma Center. Ƒo ka na 911 le United States kple Canada, 112 le Europa Dukɔwo ƒe Habɔbɔ bliboa me, 999 le United Kingdom, 000 le Australia, alo nàlé ŋku ɖe... xexlẽdzesi siwo wozãna kpata.
2. MÈGAKPƆ "spring," ʋuʋu, tutu, alo mimi akɔta ƒe ƒuwo gbeɖe be nàkpɔe ɖa be akɔtaƒu gbã hã. Ne ètutu ɖe anyi alo yi eme le akɔta si meli ke o dzi la, etutu ƒu kakɛ siwo ɖa abe lãgbalẽŋudɔwɔnu ene to sacral venous plexus kple internal iliac arteries me, si wɔnɛ be ʋu ƒe sisi gbãtɔ siwo mebɔbɔ o siwo le dɔnɔa lém ɖe te la ɖa. Ne abi ƒe mɔnu alo dzesiwo ɖee fia be akɔta gbã la, tsɔe be akɔta gbã eye nàblae.
3. MÈGAŊLƆ amesi wosusu be eƒe akɔta gbã la ɖe woƒe axadzi GBEÐE o negbe ɖe woƒe yaƒoƒomɔ̃a xe mɔ na wo vevie to ʋuʋudedi alo ʋu me. Ne woƒo amesi ŋu wògblẽ nu le ɖe akɔta si gbã ƒe axadzi la, egbãa akɔta ƒe aʋala la ɖe eme eye wòlãa megbeƒu ƒe ʋukawo. Na dɔnɔa nanɔ gbadzaa le woƒe akɔta (si le akɔta) eye nàzã xɔnametɔ geɖe ƒe ʋuƒo gbadza si le tsitrenu ("bridge lift") alo scoop stretcher ne womate ŋu aƒo asa na ʋuʋu o.
4. Tsɔ Pelvic Binder si wodzrana (SAM Pelvic Sling, T-POD, alo Prometheus) alo Bedsheet Binder si woxatsa si le titina ɖe GREATER TROCHANTERS (ƒu ƒe ʋuʋudedi siwo le gotagome ata/akɔta) dzi pɛpɛpɛ, MENYE ɖe akɔta alo akɔta ƒe tame ƒe ta dzi o. Tsɔ agbalẽ si woxatsa la ƒu gbe ɖe klowo ƒe do te nyuie eye hehe yi dzi va ɖo trochanters gãwo kple pubic symphysis ƒe seƒe la, ewɔa femur ƒe tawo ŋudɔ yia eme tsɔ tua "agbalẽ si woʋu" ƒe akɔta.
5. Trɔ afɔ eveawo blewuu yi eme ("akpakpa ƒe afɔbidɛ") eye nàbla aŋe alo pad-and-strap si ƒe nɔnɔme le abe enyi ene ɖe klowo kple afɔkpodziwo ŋu. Esi wònye be ataƒu ƒe bɔl (afɔkpodzi ƒe ta) nɔa akɔta ƒe ʋuƒo (acetabulum) me ta la, afɔwo kple klowo tɔtrɔ yi eme zãa afɔkpodzi siwo me gblẽ o abe afɔtiwo ene tsɔ hea afɔkpodzi siwo mã la akɔtaƒua ƒo ƒu eye wòxea mɔ na wo be woagaʋuʋu ake o.
6. Na dɔnɔa nanɔ NPO (nane me to nu me) pɛpɛpɛ eye nàxatsa wo tso ta vaseɖe afɔ gbɔ le avɔ dzodzoewo me be woaxe mɔ ɖe dzoxɔxɔ si nu sẽ kple ʋu ƒe sisi nu. Ʋu si dona le akɔta koŋ nye ʋu si dona le ʋuka me kple ƒu si me ʋu sina tona si me ʋu sina tona si nɔa te ɖe dɔnɔa ŋutɔ ƒe ʋuka me ʋu ƒe sisi dzi be wòaxe mɔ ɖe enu; ne vuvɔ le dɔnɔa ŋu le mɔdodoa dzi la, ʋumenugbagbeviɣidɔlékuiwo nu tsona eye ʋu si dona le ememe la megate ŋu tɔa te o.

Nyametsotso kpata ƒe ati na akɔta ƒe asigɛ si wosusu be wogbã¶

flowchart TD
    Start["High-Energy Blunt Trauma: Motor Vehicle Crash, Motorcycle Impact,<br/>Pedestrian Struck, Fall > 3 m (10 ft), Horse Trampling, or Crush Injury"]
    CallEMS["Call Emergency Medical Services (ALS Paramedics) Immediately<br/>Keep patient strictly flat (supine); DO NOT log-roll onto side;<br/>DO NOT push or rock the hips ('No Pelvic Springing')"]
    AssessSigns{"Are Pelvic Fracture Criteria or Visual Signs Present?<br/>- Severe hip, groin, lower back, or sacroiliac pain<br/>- Unexplained tachycardia / shock after blunt trauma<br/>- One or both legs flopped outward (external rotation) or one leg shorter<br/>- Bruising over scrotum/labia, perineum, flanks, or blood at urethra"}
    NoPelvic["NO PELVIC FRACTURE SUSPECTED<br/>Continue standard trauma assessment, spinal precautions,<br/>and shock warming until EMS arrival"]
    PrepBinder["PREPARE FOR CIRCUMFERENTIAL PELVIC STABILIZATION<br/>1. Empty trouser pockets (remove keys, wallet, phone, belt)<br/>2. Select Commercial Pelvic Binder (SAM Sling / T-POD)<br/>   OR fold a strong cotton bedsheet smoothly to 15-20 cm (6-8 in) width"]
    SlideSheet["SLIDE BINDER UNDER PATIENT WITHOUT LIFTING OR LOG-ROLLING<br/>1. Pass binder under the natural hollow beneath the KNEES<br/>2. Use a smooth 'seesaw' sawing motion to slide sheet up beneath lower thighs/buttocks<br/>3. Center strictly over the GREATER TROCHANTERS & PUBIC SYMPHYSIS<br/>   (NOT high up over the iliac crests / waist)"]
    TightenLeg["CLOSE THE PELVIC RING & INTERNAL-ROTATE LEGS<br/>1. Have assistant gently bring legs together and rotate feet INWARD ('pigeon-toed')<br/>2. Pull binder straps/sheet ends firmly across front of greater trochanters<br/>3. Lock commercial buckle OR twist/clamp/tie sheet ends securely in front<br/>4. Pad between knees/ankles and tie figure-of-eight strap around ankles & knees"]
    ShockCare["PREVENT LETHAL TRAUMA TRIAD & MONITOR<br/>1. Wrap patient in warm blankets / thermal foil<br/>2. Keep strictly NPO (nothing by mouth)<br/>3. Do NOT remove or loosen pelvic binder until inside Trauma Resuscitation Bay"]

    Start --> CallEMS
    CallEMS --> AssessSigns
    AssessSigns -->|No| NoPelvic
    AssessSigns -->|Yes: Any Criterion Present| PrepBinder
    PrepBinder --> SlideSheet
    SlideSheet --> TightenLeg
    TightenLeg --> ShockCare

Comparing the four Young-Burgess types of pelvic ring fractures¶

Ƒumeŋutinunyalawo bua akɔta ƒe asigɛ ƒe gbagbã ɖe hatsotsowo me le ŋusẽ si gbãa nu ƒe mɔfiame nu (Young-Burgess ƒe hatsotso). Alesi akɔta gbãna gɔmesese ɖe nusita "agbalẽ si woʋu" ƒe gbagbã nana afɔawo ƒua du yia gota kple nusita ʋu si dona le ememe nu sẽna alea gbegbe la me.

Anatomy and pathophysiology: Why a broken pelvis can bleed out 5 liters of blood internally¶

1. The Geometry of a Sphere: Nusitae ne woʋu akɔta sentimeta 5 la, ewɔa ʋudzraɖoƒe gã aɖe¶

Inside an intact adult pelvis, the bony ring encloses a compact hemispherical basin of roughly 1.5 liters (3 pints), tightly packed by tough parietal peritoneum and fascia. If a small blood vessel tears inside an intact pelvis, blood quickly fills that small, tight space until the pressure of the trapped blood equals the pressure inside the veins, naturally plugging the leak (self-tamponade).

However, in an open-book (APC) or vertical-shear pelvic fracture, the pubic symphysis rips open in front, the sacroiliac ligaments rip in back, and the tough pelvic floor fascia tears apart: * By the mathematical law of the volume of a sphere (\(V = \frac{4}{3}\pi r^3\)), every small increase in the radius (\(r\)) of the pelvic ring increases its internal volume by the cube of the radius. * If the front of the pelvis opens by just 5 centimeters (2 inches), the internal volume of the pelvic cavity jumps by more than 400 percent. * Even worse, once the fascial floor of the pelvis tears, blood is no longer confined to the pelvis: it tracks freely upward behind the abdominal lining into the vast retroperitoneal space all the way up to the kidneys and diaphragm. The retroperitoneum can hold 4,000 to 5,000 milliliters (8 to 10 pints) of blood before pressure builds high enough to slow down the bleeding, meaning an adult will bleed to death long before self-tamponade ever occurs.

2. The Three Sources of Pelvic Hemorrhage (and why a binder stops two of them)¶

Where does all that blood come from inside a broken pelvis? 1. The Presacral and Prevesical Venous Plexus (80% to 85% of cases): A dense, cobweb-like network of large, thin-walled, valveless veins plastered directly against the front of the sacrum and behind the pubic bone. When the sacrum or pubic bone cracks, hundreds of these veins are shredded simultaneously. 2. Spongy Cancellous Bone Marrow Surfaces: The flat iliac wings and sacrum are filled with vascular red bone marrow; the raw broken bone surfaces ooze briskly like a wet sponge. 3. Internal Iliac Artery Branches (10% to 15% of cases): High-pressure arterial tears (most commonly the superior gluteal artery where it hooks around the greater sciatic notch, or the internal pudendal and obturator arteries). * How a Pelvic Binder works: Wrapping a tight circumferential binder around the greater trochanters mechanically closes the split pelvic ring back to its normal small radius (restoring the retroperitoneal tamponade compartment), presses the raw bleeding bone surfaces directly against each other to stop marrow oozing, and splints the bone fragments so they cannot move and tear the venous clots during ambulance transport.

How to recognize a pelvic fracture without ever rocking the hips¶

Why "Pelvic Springing / Rocking" is strictly forbidden¶

For decades, old first aid textbooks taught rescuers to place their hands on both hip crests and push forcibly downward and outward ("rocking or springing the pelvis") to feel for grating bone (crepitus) or instability. Modern trauma guidelines (ATLS, PHTLS, CoTCCC, NICE, JRCALC) strictly forbid pelvic springing: * Manually pushing an unstable pelvic ring apart has sensitivity below 60 percent, causes excruciating pain, and actively kills patients by popping off the newly formed fibrin blood clots covering the torn sacral venous plexus. * Even in the hospital trauma bay, if a paramedic has already placed a pelvic binder based on the crash mechanism, trauma surgeons leave the binder closed until a CT scan or pelvic X-ray is taken.

Six safe, hands-off clues that point to a pelvic fracture¶

1. High-Energy Mechanism + Unexplained Shock: Any victim of a high-speed car crash, motorcycle crash, pedestrian strike, horse accident, crush injury, or fall from > 3 meters (10 feet) who has a rapid heart rate (tachycardia > 100 bpm), pale clammy skin, or confusion must be assumed to have a pelvic fracture until proven otherwise.
2. Pain Location (in conscious patients): Spontaneous pain in the hips, groin, pubic area, lower back (sacrum), or buttocks, or inability to lift either leg off the ground.
3. External Rotation or Shortening of the Lower Extremities: Look down at the victim's feet while they lie on their back. In an open-book pelvic fracture, one or both legs flop outward so the outer edge of the foot rests against the ground (external rotation). In a vertical shear fracture (or posterior hip dislocation), one leg looks 2 to 5 centimeters (1 to 2 inches) shorter than the other.
4. Urogenital and Perineal Signs (50% of severe pelvic fractures injure the bladder or urethra):
5. A drop of bright red blood at the tip of the penis or urethral opening (blood at the urethral meatus).
6. Dark purple bruising and swelling of the scrotum, labia, or perineum (Destot's sign).
7. Vaginal bleeding or rectal bleeding (which indicates an open pelvic fracture where a sharp pubic bone shard has punctured the vagina or rectum, carrying a catastrophic risk of both exsanguination and polymicrobial pelvic sepsis).
8. Retroperitoneal Flank Bruising: Bluish-purple bruising appearing along the flanks (Grey Turner's sign) or above the inguinal ligament (Fox's sign).
9. Gentle Single-Touch Palpation (Only if conscious and diagnosis is completely uncertain): If a conscious patient has a minor mechanism and you are unsure if the pelvis is injured, you may gently feel the front pubic bone and back of the hips with flat fingers to ask if it is tender, and if you ever perform a single stability check in a clinical setting, you only gently press inward (compressing toward the midline) once at the trochanters, NEVER pushing outward or downward.

Step-by-step technique: Applying a Commercial Pelvic Binder or Improvised Bedsheet Binder¶

Step 1: Prepare the patient and empty all pockets¶

1. Keep the patient lying completely flat on their back (supine).
2. Empty all pockets and remove belts: Before wrapping anything tightly around the hips, use trauma shears to cut away or empty everything inside the front, side, and back trouser pockets (smartphones, keys, thick wallets, coins, belt buckles, or tools). Tightening a pelvic binder over a set of keys or a phone in a pocket will drive the metal object into the skin over the bone, causing a full-thickness necrotic pressure ulcer within 60 minutes.

Step 2: Find the exact anatomical landmark: The Greater Trochanters¶

To find the greater trochanters on any patient: 1. Mègase le ɖokuiwò me le akɔta alo akɔtaƒu ƒe go si le etame si woƒo xlãe o (emae nye iliac crest, si kɔkɔ sentimeta 10 va ɖo 15 / sentimeta 4 va ɖo 6 akpa). 2. Ke boŋ, tsɔ wò asi siwo ŋu asigɛ le la ƒu gbe ɖe dɔnɔa ƒe ata si le etame ƒe gota gome va ɖo akɔta ƒe ƒu (akɔta) si le ŋgɔgbe kple akɔta ƒe akpa si keke wu le megbe. Àse le ɖokuiwò me be ƒu sesẽ aɖe si le abe abɔta ene la dze le afɔkpodzi ƒe akpa ɖesiaɖe si le etame ƒe gota gome: emae nye trochanter gãtɔ. 3. Wò akɔta ƒe nublanu alo agbalẽ si woxatsa ƒe titina ele be wòato trochanters gãwo siaa dzi tẽ eye wòato pubic symphysis la dzi.

Afɔɖeɖe 3A: Akɔtaɖonu si Wodzrana (SAM Pelvic Sling II, T-POD, alo Prometheus) Zazã .¶

1. Gbugbɔ klowo te gbã (No-Lift Technique): Klo agbalẽblanu la gbadzaa eye nàtsɔe aƒu gbe to dzɔdzɔme do si le dɔnɔa ƒe klowo te la me (mègakɔ akɔta alo log-rolle gbeɖe o).
2. Seesaw yi dzi va ɖo eƒe nɔƒe: Ne èlé agbalẽblamɔ̃a ƒe nugbɔ ɖeka ɖe dɔnɔa ƒe akpa ɖesiaɖe la, zã aŋenu blewuu tso axa ɖeka yi axadzi nàtsɔ abla nu la yi dzi nyuie le ata kple akɔta te vaseɖe esime wòaɖo titina tẽ ɖe trochanters gãwo dzi.
3. Trɔ afɔawo le ememe: Na xɔnametɔ evelia nalé dɔnɔa ƒe afɔkpodziwo eye wòatsɔ afɔawo aƒo ƒu blewuu esime wòle afɔawo trɔm ɖe eme ("pigeon-toed").
4. Hee eye nàxe mɔ:
5. Le SAM Pelvic Sling gome la, he ka yibɔa sesĩe to Autostop ƒe akɔtaɖonu la me esime nèle asiléƒe si tsi tre ɖe eŋu hem le mɔ si tsi tre ɖe eŋu nu vaseɖe esime ka la naƒo eye gakpo ƒe asike eveawo naxe ɖe doawo me (wotrɔ asi le wo ŋu be woaxe le wo ɖokui si le 150 Newtons / 33 pounds of circumferential tension tututu me ale be màte ŋu aƒo akɔta la wòagbɔ eme o), emegbe te Velcro-ka la ɖe anyi.
6. Le T-POD gome la, lã alidziblanua nàgblẽ dometsotso si didi sentimeta 15 va ɖo 20 (inch 6 va ɖo 8) ɖe akɔta ƒe ŋgɔgbe, tsɔ mɔ̃a ƒe ʋuƒoa ƒe mɔ̃a de dometsotsoa me, eye nàhe ka si wotsɔna hea ka la vaseɖe esime dometsotsoa natsi eye akɔta nasẽ, emegbe nàtu ka la.

Afɔɖeɖe 3B: Improvised Bedsheet Pelvic Binder (Ne asitsamɔ̃ aɖeke meli o) .¶

Woɖo kpe edzi le atikewɔnyawo me be abadzivɔ sesẽ si wotsɔ kotoklobo wɔ, avɔ si keke, alo avɔ si woxatsa nyuie ɖea akɔta ƒe lolome dzi kpɔtɔna nyuie abe alesi wotsɔa atike si wodzrana blaa nu ene ne wotsɔe de akɔtaɖonuawo dzi: 1. Klo agbalẽvia nyuie: Klo abadzivɔ gbadzaa ɖe eƒe didime nu vaseɖe esime wòazu ka si le gbadzaa, si me fli mele o si keke abe sentimeta 15 va ɖo 20 (inch 6 va ɖo 8) ene. 2. Tsɔ klowo te eye nàsesaw vaseɖe Greater Trochanters: To agbalẽ si woxatsa la ɖe kloawo ƒe doa te eye nàtsɔe aƒu gbe nyuie yi dzi le akɔta te vaseɖe esime wòaɖo titina ɖe greater trochanters kple pubic symphysis dzi. 3. Bring the legs together in internal rotation: Have a helper hold the knees and ankles together with the toes pointed slightly inward. 4. Tso, he sesĩe, eye nàde dedie: * Trɔ agbalẽa ƒe nugbɔ didi eveawo ɖe akɔta ƒe ŋgɔgbekpa dzi. * Ne xɔnametɔ ɖeka le miame eye ɖeka le ɖusime la, bɔbɔ ɖe megbe eye nàhe agbalẽa ƒe nugbɔ eveawo nyuie eye nàhe sesĩe ɖe mɔ siwo tsi tre ɖe wo nɔewo ŋu nu vaseɖe esime woaxɔ slack la eye agbalẽa nakpla asi kɔ na trochanters la nyuie. * Secure the sheet without losing tension: Either twist the two crossed ends together over the front of the pelvis and clamp them with heavy trauma clamps/hemostats (or twist them around a short stick/baton and tape the stick down, or tie a flat Reef/Square knot over a folded towel pad so the knot does not dig into the belly).

Step 4: Tie the Knees and Ankles in Internal Rotation ("The Figure-of-Eight Leg Tie")¶

Even with a binder around the hips, the heavy weight of two unconscious legs flopping outward acts as a mechanical lever that tries to pry the pubic symphysis back open. 1. Place a folded towel, jacket, or foam pad between the patient's knees and between their ankles to prevent bone-on-bone skin pressure sores. 2. Wrap a triangular cravat bandage, roller bandage, or wide strap around both knees, and wrap a figure-of-eight bandage around both ankles and feet to hold the legs comfortably rotated inward.

Step 5: Safe Lifting, Warming, and Transport Rules¶

1. Never log-roll a pelvic fracture patient: When paramedics arrive to move the patient onto a stretcher, they will use an orthopedic scoop stretcher (which splits in half lengthwise and slides under the left and right sides with minimal movement) or a 4-to-6-person vertical bridge lift.
2. Never remove or loosen a pelvic binder prematurely: Once a pelvic binder is applied, it stays locked in place until the patient is inside a hospital trauma center with blood transfusion running and orthopedic/interventional radiology teams ready. Loosening a pelvic binder in the field to "check the skin" lets the pelvic ring spring back open and triggers immediate re-bleeding.
3. Aggressive warming: Cover the patient completely with warm blankets and an insulating barrier underneath them to prevent the Lethal Trauma Triad (hypothermia, acidosis, and coagulopathy).

Dɔdaƒe ƒe nɔnɔme tɔxɛwo le akɔta ƒe nuveviwɔame me¶

1. Open Pelvic Fractures and Perineal / Rectal / Vaginal Lacerations¶

Roughly 5 percent of pelvic ring fractures are open pelvic fractures, in which a razor-sharp fragment of the pubic rami or ischium slices through the skin of the groin, perineum, buttocks, vagina, or rectum. Open pelvic fractures carry a mortality rate approaching 40 to 50 percent because external skin tamponade is lost and fecal bacteria contaminate the retroperitoneal hematoma: * Never pull apart the legs or hips to inspect a perineal wound if it means opening the pelvic ring. * Control external groin or perineal bleeding with firm direct pressure and hemostatic gauze wound packing (or a junctional inguinal compression device if available), then apply the circumferential pelvic binder over the greater trochanters right over the packed wound dressing. * Never insert a urinary catheter, rectal thermometer, or vaginal pack in the field if blood is visible at the urethral meatus or perineum, as the urethra or rectum may be partially transected.

2. Pelvic Fractures in Pregnancy and in Children¶

• During Pregnancy: In the second and third trimesters, the gravid uterus rises out of the bony pelvis into the abdomen, and maternal uterine blood flow reaches 600 to 800 milliliters per minute. You can and should still apply a pelvic binder to an unstable pelvic fracture in a pregnant patient because the binder sits low over the greater trochanters and pubic symphysis (below the main fundus of the uterus). After applying the trochanteric binder, manually displace the pregnant uterus 15 to 20 degrees to the LEFT (or tilt the rigid scoop stretcher 15 to 30 degrees to the left) so the heavy uterus does not crush the maternal inferior vena cava (supine hypotensive syndrome).
• In Children: Pediatric pelvic bones are flexible and lined with thick cartilage, so it takes extreme kinetic energy (such as being run over by a vehicle) to break a child's pelvic ring. Fold a smaller sheet or pediatric binder to match the width of the child's trochanters and monitor closely for concurrent spleen or liver hemorrhage.

3. Prehospital Handoff Checklist for EMS and Trauma Resuscitation¶

• Mechanism of injury: High-speed crash, motorcycle fuel-tank impact, fall height, or crush weight.
• Exact time and anatomical level of binder placement: Confirm the binder is centered over the greater trochanters and that pockets were emptied before tightening.
• Distal neurovascular (PMS) status in both feet: Dorsalis pedis and posterior tibial pulses, skin warmth, and foot movement before and after binding.
• Urogenital signs observed: Presence of blood at the urethral tip, scrotal/labial hematoma, or perineal lacerations.

Knowing how to recognize a hidden pelvic fracture and apply a trochanteric binder turns an otherwise fatal internal bleed into a survivable injury. Consider taking a certified first aid, Stop the Bleed, or prehospital trauma course through your national Red Cross or Red Crescent society, St John Ambulance, or the National Association of Emergency Medical Technicians (NAEMT).

Nya siwo wobiaa amewo enuenu¶

Wolé ŋku ɖe dzɔtsoƒewo ŋu¶

• American College of Surgeons (ACS, United States): Advanced Trauma Life Support (ATLS) Student Course Manual: Abdominal and Pelvic Trauma, Circumferential Pelvic Compression, and Hemorrhagic Shock.
• Committee on Tactical Combat Casualty Care (CoTCCC / Joint Trauma System, United States): TCCC Guidelines for Medical Personnel: Pelvic Binder Indications and Trochanteric Placement.
• National Institute for Health and Care Excellence (NICE, United Kingdom): Guideline NG37: Major Trauma and Complex Fractures, Prehospital Application of Pelvic Binders, and Non-Log-Roll Handling.
• Joint Royal Colleges Ambulance Liaison Committee (JRCALC, United Kingdom): Clinical Practice Guidelines: Pelvic Trauma Assessment ("No Springing" Rule) and Pelvic Splinting.
• World Society of Emergency Surgery (WSES, International): Pelvic Trauma Classification and Management Guidelines.

Mɔfiame siwo do ƒome kplii¶

• Dzidziƒoame ƒe dzesidede kple beléle kpata
• Spinal injuries and immobilization
• Open (compound) fractures and splinting
• Ƒodo ƒe ʋuʋudedi kple ƒodo ƒe abi si le ʋuʋu ɖi dzi kpɔkpɔ
• Crush injury kple compartment syndrome ƒe dzesidede
• Xexlẽdzesi siwo woxɔna le nudzɔdzɔ kpatawo me kple dukɔwo dome dɔdɔ