Describe Pelvic Haemorrhage Control & the Pelvic Binder in detail.

The Problem

An unstable pelvic fracture is a leading cause of preventable death in trauma because of massive haemorrhage. Bleeding is predominantly venous (presacral plexus) and from fracture surfaces, with an arterial source (internal iliac branches) in a minority. Opening the pelvic ring (an open-book injury) increases the volume available for bleeding, so that clot cannot form and tamponade the injury — the rationale for early ring closure.

The Pelvic Binder

The pelvic binder is a simple, immediate, life-saving device applied at the level of the greater trochanters (not the iliac crests). By compressing and closing the ring it reduces pelvic volume, restores bony apposition and promotes tamponade of venous bleeding. It is applied early in the ATLS primary survey in any suspected unstable pelvic injury with haemodynamic compromise.

Escalation of Haemorrhage Control

If bleeding continues despite a binder and resuscitation (massive transfusion protocol, tranexamic acid), escalate to: angiography with embolisation for arterial bleeding; pre-peritoneal pelvic packing for surgical control of venous/bony bleeding; and an external fixator or C-clamp for mechanical stability. These are complementary and chosen by the pattern of bleeding and local resources.

Ongoing Care After the Binder

The binder is a temporising measure, not definitive treatment. After application, the patient is resuscitated to a permissive target while the source of bleeding is addressed, and the pelvis is later stabilised definitively (external or internal fixation). Prolonged binder use risks pressure necrosis of the skin over the trochanters and sacrum, so the binder should be released or repositioned once haemorrhage is controlled. Continuous monitoring of haemodynamics, urine output and distal perfusion guides escalation to embolisation or packing. The binder is combined with, not a substitute for, correction of coagulopathy, warming, and calcium replacement as part of damage-control resuscitation.

Binder goes over the trochanters, not the iliac crests.

• Unstable pelvic fracture → life-threatening (mostly venous) haemorrhage.
• Pelvic binder over the greater trochanters closes the ring & tamponades bleeding.
• Too-high placement (iliac crests) fails — apply at the trochanters.
• Escalate: transfusion/TXA → embolisation (arterial) / pre-peritoneal packing → external fixation.