Effectiveness and complications of pelvic circumferential compression devices in patients with unstable pelvic fractures: A systematic review of literature
Accepted 22 June 2009.
Abstract
Background
Pelvic fractures can cause massive haemorrhage. Early stabilisation and compression of unstable fractures is thought to limit blood loss. Reposition of fracture parts and reduction of pelvic volume may provide haemorrhage control. Several non-invasive techniques for early stabilisation have been proposed, like the specifically designed pelvic circumferential compression devices (PCCD). The purpose of this systematic review was to investigate current evidence for the effectiveness and safety of non-invasive PCCDs.
Methods
To investigate current literature the search string: “pelvi* AND fract* AND (bind* OR t-pod OR tpod OR wrap OR circumferential compression OR sling OR sheet)” was entered into EMBASE, PubMed (Medline), PiCarta, WebofScience, Cochrane Online, UptoDate, CINAHL, and Scopus. All scientific publications published in indexed journals were included.
Results
The search resulted in 17 included articles, none of which were level I or II studies. One clinical cohort study (level III) and 1 case–control study (level IV) were found. These showed a significant reduction of pelvic volume after applying a PCCD, without an effect on outcome. Other included literature consisted of 4 case series (level V). Two biomechanical analysis studies of fractures in human cadavers showed pelvic stabilisation and effective volume reduction by PCCD, especially when applied around the greater trochanters. Finally, 7 case reports (level VI) and 3 expert opinions (level VII) were identified. These case reports suggested complications such as pressure sores and nerve palsy.
Conclusion
PCCDs seem to be effective in early stabilisation of unstable pelvic fractures. However, prospective data concerning mortality and complications is lacking. Some complications, like pressure sores have been described.
Erasmus MC, University Medical Center Rotterdam, Department of Surgery-Traumatology, Rotterdam, The Netherlands
Corresponding author at: Erasmus MC, University Medical Center Rotterdam, Department of Surgery-Traumatology, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. Tel.: +31 10 7031050; fax: +31 10 7032396.
1 Current address: University Medical Center Leiden, Department of Surgery-Traumatology, Leiden, The Netherlands.
ABSTRACT