Eur J Trauma Emerg Surg (2012) 38:439–442 DOI 10.1007/s00068-012-0180-3
ORIGINAL ARTICLE
Pelvic circumferential compression devices (PCCDs): a best evidence equipment review D. J. Bryson • R. Davidson • R. Mackenzie
Received: 12 September 2011 / Accepted: 5 February 2012 / Published online: 2 March 2012 Ó Springer-Verlag 2012
Abstract Purpose Traumatic disruption of the pelvis can lead to significant morbidity and mortality. ATLSÒ guidance advocates temporary stabilisation or ‘closure’ of the disrupted pelvis with a compression device or sheet. We undertook a best evidence equipment review to assess the ease and efficacy of the application of two leading commercially available devices, the T-PODÒ and the SAM Pelvic SlingTM II. Methods Fifty health care professionals and medical students participated in pelvic circumferential compression device (PCCD) education and assessment. Participants received a 10-min lecture on the epidemiology and aetiology of pelvic fractures and the principles of circumferential compression, followed by a practical demonstration. Three volunteers acted as trauma victims. Assessment included the time taken to secure the devices and whether
this was achieved correctly. All participants completed a post-assessment survey. Results Both devices were applied correctly 100% of the time. The average time taken to secure the SAM Pelvic SlingTM II was 18 s and for the T-PODÒ, it was 31 s (p B 0.0001). Forty-four participants (88%) agreed or strongly agreed that the SAM Pelvic SlingTM II was easy to use compared to 84% (n = 42) for the T-PODÒ. Thirtynine participants (78%) reported that they preferred and, given the choice in the future, would select the T-PODÒ over the SAM Pelvic SlingTM II (n = 11, 22%). Conclusions The results of this study indicate that both PCCDs are easy and acceptable to use and, once learned, can be applied easily and rapidly. Participants applied both devices correctly 100% of the time, with successful application taking, on average, less than 60 s. Keywords Pelvic trauma Fracture ATLS Circumferential compression Pelvic binders
D. J. Bryson R. Davidson R. Mackenzie Emergency Department, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK D. J. Bryson (&) CT2 Trauma and Orthopaedics, Leicester Royal Infirmary, Leicester, UK e-mail: [email protected] D. J. Bryson Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, UK R. Davidson Emergency Department, Lincoln County Hospital, Lincoln, Lincolnshire, UK R. Mackenzie Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, UK
Introduction Traumatic disruption of the pelvis can precipitate lifethreatening haemorrhage [1] and may be associated with mortality rates exceeding 40% [1–3]. The American College of Surgeons’ Advanced Trauma Life Support Course (ATLSÒ) advocates temporary stabilisation or ‘closure’ of the disrupted pelvis with a compression device to decrease bleeding [4]. Circumferential compression of the pelvis reduces pelvic volume, tamponades venous bleeding, minimises motion at the fracture site and promotes haematoma formation [5, 6]. Evidence suggests that early application of a pelvic circumferential compression device (PCCD) can stabilise pelvic fractures, promoting haemostasis and
123
440
reducing haemorrhage in the haemodynamically unstable patient [1, 6, 7]. A best evidence equipment review was undertaken to determine which of the leading commercially available PCCDs, the T-PODÒ and the SAM Pelvic SlingTM II, should be used in our Emergency Department. Both the T-PODÒ and the SAM Pelvic SlingTM II are commercially available devices that can be applied in the pre-hospital or hospital setting. Positioned at the level of the greater trochanters, they provide rapid compression designed to stabilise the bony pelvis and limit blood loss, and may be used in all pelvic fracture patterns, not just the open-book variety [8]. In cadaveric and clinical trials, PCCDs have been shown to reduce symphyseal diastasis following open-book fracture of the pelvic ring [9, 10] and yielded greater efficacy in haemorrhage control than emergent external pelvic fixation (with an anterior frame) in patients with unstable fractures [1]. Indeed, studies suggest that PCCDs may achieve diastasis reduction 97% as effective as that achieved by definitive stabilisation [5]. The one-piece SAM Pelvic SlingTM II is available in three sizes, though the standard size reportedly fits 98% of the population [11]. Described by the manufacturers as a reusable ‘force-controlled circumferential belt’, the SAM Pelvic SlingTM II offers a low-friction posterior slider, a tapered front to facilitate access for such procedures as urinary catheterisation and a patented Autostop buckle designed to limit the application of compressive forces at 33 lbs [11]. In contrast, the T-PODÒ is a one-size-fits-all, single-use device. A two-piece design, the T-PODÒ comprises a fabric belt that wraps around the pelvis and is secured anteriorly by a Velcro-backed, one-handed pulley system, its patented ‘Mechanical Advantage’, that ‘easily and evenly draws the T-PODÒ closed’ [12]. The T-PODÒ is 100% radiolucent and is licensed for use in children.
Methods We recruited 50 participants—29 doctors across all grades, 11 medical students, and 10 Emergency Department nurses—to participate in PCCD education and application of the two devices. All participants received a 10-min lecture outlining the epidemiology and aetiology of pelvic fractures and the principles and benefits of circumferential compression. This was followed by a demonstration of the two devices and then the assessment. Three volunteers acted as trauma victims with suspected pelvic fractures. For the purposes of standardisation, the volunteers were positioned supine on a standard Emergency Department trolley with the respective device pre-positioned under the pelvis at the appropriate level, thus, reflecting current practice in our Emergency Department. Participants were instructed
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not to cut the T-PODÒ but, instead, fold the ends to create the appropriate gap anteriorly. Participants were assessed on the time taken to secure the devices (in seconds) and whether or not this was achieved correctly. All 50 participants then completed a brief post-assessment survey; this comprised two 6-point Likert scale questions dealing with perceived ease of use and preference. The time taken to secure the devices (apply compression) is reported as mean (s) ± standard deviation (SD) and range. A paired t-test was used to assess for evidence of a significant difference in time taken to secure the devices. Perceived ease-of-use scores were reported as frequencies. A Wilcoxon signed-rank test was used to assess for a significant difference in the perceived ease of use and a Wilcoxon sign test was used for the overall preference. Statistical analysis was performed using the statistical software package SPSS (SPSS Inc., Chicago, IL, USA) version 16. Results Both devices were applied correctly 100% of the time. The average time taken to secure the SAM Pelvic SlingTM II was 18 s and for the T-PODÒ, it was 31 s (p B 0.0001). Forty-four participants (88%) agreed or strongly agreed that the SAM Pelvic SlingTM II was easy to use compared to 84% (n = 42) for the T-PODÒ. Thirty-nine participants (78%) reported that they preferred and, given the choice in the future, would select the T-PODÒ over the SAM Pelvic SlingTM II (n = 11, 22%) (Table 1). Discussion We directly compared two of the leading PCCDs employed in the management of pelvic fractures. The results indicate that both are easy to use and, once learned, can be applied easily and rapidly. Participants applied both devices correctly 100% of the time, with this successful application taking, on average, less than 60 s. Although our participants expressed an overall preference for the T-PODÒ, very little separates these devices from a practical perspective. However, particular features exist which may make one PCCD more or less favourable (Table 2). The SAM Pelvic SlingTM II is the cheaper of the two PCCDs and, given that it is reusable, may be the better option financially. This advantage is tempered somewhat by the fact that the SAM Pelvic SlingTM II comes in three sizes and while the standard size reportedly fits 98% of the population [11], for those patients with a hip circumference \2700 or [5000 , alternative sizes will be needed.
Pelvic circumferential compression devices
441
Table 1 A comparison of the T-PODÒ and the SAM Pelvic SlingTM II Device
Time to secure, mean ± SD (s)
Ease of use
Overall preference
T-PODÒ
31 ± 12
Agree: 40%, n = 20
78% (n = 39)
Strongly agree: 44%, n = 22 SAM Pelvic SlingTM II
18 ± 7
Significance
p B 0.0001
Agree: 50%, n = 25
22% (n = 11)
Strongly agree: 38%, n = 19 p = 0.5877
p B 0.0001
Table 2 The devices: head-to-head comparison T-PODÒ
SAM Pelvic SlingTM II Manufacturer SAM Medical Products, Tualatin, OR, USA
Pyng Medical Corporation, Richmond, BC, Canada
UK distributor Waterjel Technologies, Hertford, Hertfordshire, SG13 7BJ http://www.waterjel.net
Q Medical Technologies Ltd., Northampton, NN5 7EU http://www.qmedical.co.uk
Cost £48.75 (£75 less 35% for medical and rescue services)
£80 per unit
No minimum # per order Size
No minimum # per order
Available in three sizes
One-size fits all––once cut to size
X-small
Hip circumference 2700 –4700
Two-part system: fabric belt and Velcro-backed plastic pulley
Standard
Hip circumference 3200 –5000
145 cm 9 20 cm (= 5700 9 7.900 )
00
00
X-large
Hip circumference 36 –60
Military
Hip circumference 3200 –5000
Weight
9 oz (255 g)
320 g
Unique features Reusable
One-size fits all
One-piece design
100% radiolucent
Patented Autostop buckle––limits compressive forces to 33 lbs; click provides feedback on correct application Tapered front
Patented Mechanical AdvantageÒ, a one-handed pulley system providing even circumferential compression Licensed for use in children
Posterior slider
Area for documentation of time/date of application
We observed that the SAM Pelvic SlingTM II could be applied quicker than the T-PODÒ, thanks largely to its onepiece design and loop and buckle system. This buckle limits the application of compressive force at 33 lbs and provides a reassuring click, signalling that the appropriate force has been applied. Housed within this buckle are two stainless steel ferromagnetic springs and, as a consequence, the SAM Pelvic SlingTM II is not 100% radiolucent and, therefore, may interfere with visualisation of the pelvis during radiological investigations. According to the manufacturers, the SAM Pelvic SlingTM II can remain in place during magnetic resonance imaging (at 3 Tesla or less), as long as the sling is firmly secured to the patient. In contrast, the T-PODÒ is a one-size-fits-all, single-use device that is 100% radiolucent. The one-handed ‘Mechanical Advantage’ cable traction system effectively and easily applies circumferential compression. While the Autostop
buckle on the SAM Pelvic SlingTM II ameliorates the guesswork associated with compression, with the T-PODÒ, the appropriate degree of compressive forces and magnitude of pelvic reduction must be determined by those applying the device. The T-PODÒ is the only one of the two devices licensed for use in paediatric patients––though children under 23 kg (50 lbs) may be too small to achieve the 6-in gap needed for closure––and is the only device replete with an area for documentation of the time and date of application. Pelvic circumferential compression is an elemental step in the management of trauma patients with suspected pelvic fractures, with early application representing an important adjunct in the primary resuscitation of the trauma victim. We directly compared two of the leading PCCDs, examining the ease and efficacy of placement. In this trial, participants applied the SAM Pelvic SlingTM II on average
123
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13 s quicker than the T-PODÒ. While this proved to be statistically significant, it is unlikely to be clinically so–– what is important is the fact that both devices were secured correctly 100% of the time. Overall, very little separates these two devices. Both are easy and acceptable to use and a decision to use one device over the other may, thus, be driven by financial considerations or personal preferences. Conflict of interest
None.
References 1. Croce MA, Magnotti LJ, Savage SA, Wood GW 2nd, Fabian TC. Emergent pelvic fixation in patients with exsanguinating pelvic fractures. J Am Coll Surg. 2007;205:935–9. 2. White CE, Hsu JR, Holcomb JB. Haemodynamically unstable pelvic fractures. Injury. 2009;10:1023–30. 3. Eastridge BJ. Butt binder. J Trauma. 2007;62:S32. 4. [No authors listed]. Advanced trauma life support course: student manual. 8th ed. Chicago: American College of Surgeons; 2008.
123
5. Krieg JC, Mohr M, Ellis TJ, Simpson TS, Madey SM, Bottlang M. Emergent stabilization of pelvic ring injuries by controlled circumferential compression: a clinical trial. J Trauma. 2005;59: 659–64. 6. Spanjersberg WR, Knops SP, Schep NW, van Lieshout EM, Patka P, Schipper IB. Effectiveness and complications of pelvic circumferential compression devices in patients with unstable pelvic fractures: a systematic review of literature. Injury. 2009; 40:1031–5. 7. Schaller TM, Sims S, Maxian T. Skin breakdown following circumferential pelvic antishock sheeting: a case report. J Orthop Trauma. 2005;19:661–5. 8. Guthrie HC, Owens RW, Bircher MD. Fractures of the pelvis. J Bone Joint Surg Br. 2010;92:1481–8. 9. DeAngelis NA, Wixted JJ, Drew J, Eskander MS, Eskander JP, French BG. Use of the trauma pelvic orthotic device (T-POD) for provisional stabilisation of anterior–posterior compression type pelvic fractures: a cadaveric study. Injury. 2008;39:903–6. 10. Bottlang M, Krieg JC, Mohr M, Simpson TS, Madey SM. Emergent management of pelvic ring fractures with use of circumferential compression. J Bone Joint Surg Am. 2002;84:43–7. 11. SAM Medical Products. http://www.sammedical.com. Accessed 31 Aug 2011. 12. Pyng Medical. http://www.T-POD.com. Accessed 31 Aug 2011.
ORIGINAL ARTICLE
Pelvic circumferential compression devices (PCCDs): a best evidence equipment review D. J. Bryson • R. Davidson • R. Mackenzie
Received: 12 September 2011 / Accepted: 5 February 2012 / Published online: 2 March 2012 Ó Springer-Verlag 2012
Abstract Purpose Traumatic disruption of the pelvis can lead to significant morbidity and mortality. ATLSÒ guidance advocates temporary stabilisation or ‘closure’ of the disrupted pelvis with a compression device or sheet. We undertook a best evidence equipment review to assess the ease and efficacy of the application of two leading commercially available devices, the T-PODÒ and the SAM Pelvic SlingTM II. Methods Fifty health care professionals and medical students participated in pelvic circumferential compression device (PCCD) education and assessment. Participants received a 10-min lecture on the epidemiology and aetiology of pelvic fractures and the principles of circumferential compression, followed by a practical demonstration. Three volunteers acted as trauma victims. Assessment included the time taken to secure the devices and whether
this was achieved correctly. All participants completed a post-assessment survey. Results Both devices were applied correctly 100% of the time. The average time taken to secure the SAM Pelvic SlingTM II was 18 s and for the T-PODÒ, it was 31 s (p B 0.0001). Forty-four participants (88%) agreed or strongly agreed that the SAM Pelvic SlingTM II was easy to use compared to 84% (n = 42) for the T-PODÒ. Thirtynine participants (78%) reported that they preferred and, given the choice in the future, would select the T-PODÒ over the SAM Pelvic SlingTM II (n = 11, 22%). Conclusions The results of this study indicate that both PCCDs are easy and acceptable to use and, once learned, can be applied easily and rapidly. Participants applied both devices correctly 100% of the time, with successful application taking, on average, less than 60 s. Keywords Pelvic trauma Fracture ATLS Circumferential compression Pelvic binders
D. J. Bryson R. Davidson R. Mackenzie Emergency Department, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK D. J. Bryson (&) CT2 Trauma and Orthopaedics, Leicester Royal Infirmary, Leicester, UK e-mail: [email protected] D. J. Bryson Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, UK R. Davidson Emergency Department, Lincoln County Hospital, Lincoln, Lincolnshire, UK R. Mackenzie Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, UK
Introduction Traumatic disruption of the pelvis can precipitate lifethreatening haemorrhage [1] and may be associated with mortality rates exceeding 40% [1–3]. The American College of Surgeons’ Advanced Trauma Life Support Course (ATLSÒ) advocates temporary stabilisation or ‘closure’ of the disrupted pelvis with a compression device to decrease bleeding [4]. Circumferential compression of the pelvis reduces pelvic volume, tamponades venous bleeding, minimises motion at the fracture site and promotes haematoma formation [5, 6]. Evidence suggests that early application of a pelvic circumferential compression device (PCCD) can stabilise pelvic fractures, promoting haemostasis and
123
440
reducing haemorrhage in the haemodynamically unstable patient [1, 6, 7]. A best evidence equipment review was undertaken to determine which of the leading commercially available PCCDs, the T-PODÒ and the SAM Pelvic SlingTM II, should be used in our Emergency Department. Both the T-PODÒ and the SAM Pelvic SlingTM II are commercially available devices that can be applied in the pre-hospital or hospital setting. Positioned at the level of the greater trochanters, they provide rapid compression designed to stabilise the bony pelvis and limit blood loss, and may be used in all pelvic fracture patterns, not just the open-book variety [8]. In cadaveric and clinical trials, PCCDs have been shown to reduce symphyseal diastasis following open-book fracture of the pelvic ring [9, 10] and yielded greater efficacy in haemorrhage control than emergent external pelvic fixation (with an anterior frame) in patients with unstable fractures [1]. Indeed, studies suggest that PCCDs may achieve diastasis reduction 97% as effective as that achieved by definitive stabilisation [5]. The one-piece SAM Pelvic SlingTM II is available in three sizes, though the standard size reportedly fits 98% of the population [11]. Described by the manufacturers as a reusable ‘force-controlled circumferential belt’, the SAM Pelvic SlingTM II offers a low-friction posterior slider, a tapered front to facilitate access for such procedures as urinary catheterisation and a patented Autostop buckle designed to limit the application of compressive forces at 33 lbs [11]. In contrast, the T-PODÒ is a one-size-fits-all, single-use device. A two-piece design, the T-PODÒ comprises a fabric belt that wraps around the pelvis and is secured anteriorly by a Velcro-backed, one-handed pulley system, its patented ‘Mechanical Advantage’, that ‘easily and evenly draws the T-PODÒ closed’ [12]. The T-PODÒ is 100% radiolucent and is licensed for use in children.
Methods We recruited 50 participants—29 doctors across all grades, 11 medical students, and 10 Emergency Department nurses—to participate in PCCD education and application of the two devices. All participants received a 10-min lecture outlining the epidemiology and aetiology of pelvic fractures and the principles and benefits of circumferential compression. This was followed by a demonstration of the two devices and then the assessment. Three volunteers acted as trauma victims with suspected pelvic fractures. For the purposes of standardisation, the volunteers were positioned supine on a standard Emergency Department trolley with the respective device pre-positioned under the pelvis at the appropriate level, thus, reflecting current practice in our Emergency Department. Participants were instructed
123
D. J. Bryson et al.
not to cut the T-PODÒ but, instead, fold the ends to create the appropriate gap anteriorly. Participants were assessed on the time taken to secure the devices (in seconds) and whether or not this was achieved correctly. All 50 participants then completed a brief post-assessment survey; this comprised two 6-point Likert scale questions dealing with perceived ease of use and preference. The time taken to secure the devices (apply compression) is reported as mean (s) ± standard deviation (SD) and range. A paired t-test was used to assess for evidence of a significant difference in time taken to secure the devices. Perceived ease-of-use scores were reported as frequencies. A Wilcoxon signed-rank test was used to assess for a significant difference in the perceived ease of use and a Wilcoxon sign test was used for the overall preference. Statistical analysis was performed using the statistical software package SPSS (SPSS Inc., Chicago, IL, USA) version 16. Results Both devices were applied correctly 100% of the time. The average time taken to secure the SAM Pelvic SlingTM II was 18 s and for the T-PODÒ, it was 31 s (p B 0.0001). Forty-four participants (88%) agreed or strongly agreed that the SAM Pelvic SlingTM II was easy to use compared to 84% (n = 42) for the T-PODÒ. Thirty-nine participants (78%) reported that they preferred and, given the choice in the future, would select the T-PODÒ over the SAM Pelvic SlingTM II (n = 11, 22%) (Table 1). Discussion We directly compared two of the leading PCCDs employed in the management of pelvic fractures. The results indicate that both are easy to use and, once learned, can be applied easily and rapidly. Participants applied both devices correctly 100% of the time, with this successful application taking, on average, less than 60 s. Although our participants expressed an overall preference for the T-PODÒ, very little separates these devices from a practical perspective. However, particular features exist which may make one PCCD more or less favourable (Table 2). The SAM Pelvic SlingTM II is the cheaper of the two PCCDs and, given that it is reusable, may be the better option financially. This advantage is tempered somewhat by the fact that the SAM Pelvic SlingTM II comes in three sizes and while the standard size reportedly fits 98% of the population [11], for those patients with a hip circumference \2700 or [5000 , alternative sizes will be needed.
Pelvic circumferential compression devices
441
Table 1 A comparison of the T-PODÒ and the SAM Pelvic SlingTM II Device
Time to secure, mean ± SD (s)
Ease of use
Overall preference
T-PODÒ
31 ± 12
Agree: 40%, n = 20
78% (n = 39)
Strongly agree: 44%, n = 22 SAM Pelvic SlingTM II
18 ± 7
Significance
p B 0.0001
Agree: 50%, n = 25
22% (n = 11)
Strongly agree: 38%, n = 19 p = 0.5877
p B 0.0001
Table 2 The devices: head-to-head comparison T-PODÒ
SAM Pelvic SlingTM II Manufacturer SAM Medical Products, Tualatin, OR, USA
Pyng Medical Corporation, Richmond, BC, Canada
UK distributor Waterjel Technologies, Hertford, Hertfordshire, SG13 7BJ http://www.waterjel.net
Q Medical Technologies Ltd., Northampton, NN5 7EU http://www.qmedical.co.uk
Cost £48.75 (£75 less 35% for medical and rescue services)
£80 per unit
No minimum # per order Size
No minimum # per order
Available in three sizes
One-size fits all––once cut to size
X-small
Hip circumference 2700 –4700
Two-part system: fabric belt and Velcro-backed plastic pulley
Standard
Hip circumference 3200 –5000
145 cm 9 20 cm (= 5700 9 7.900 )
00
00
X-large
Hip circumference 36 –60
Military
Hip circumference 3200 –5000
Weight
9 oz (255 g)
320 g
Unique features Reusable
One-size fits all
One-piece design
100% radiolucent
Patented Autostop buckle––limits compressive forces to 33 lbs; click provides feedback on correct application Tapered front
Patented Mechanical AdvantageÒ, a one-handed pulley system providing even circumferential compression Licensed for use in children
Posterior slider
Area for documentation of time/date of application
We observed that the SAM Pelvic SlingTM II could be applied quicker than the T-PODÒ, thanks largely to its onepiece design and loop and buckle system. This buckle limits the application of compressive force at 33 lbs and provides a reassuring click, signalling that the appropriate force has been applied. Housed within this buckle are two stainless steel ferromagnetic springs and, as a consequence, the SAM Pelvic SlingTM II is not 100% radiolucent and, therefore, may interfere with visualisation of the pelvis during radiological investigations. According to the manufacturers, the SAM Pelvic SlingTM II can remain in place during magnetic resonance imaging (at 3 Tesla or less), as long as the sling is firmly secured to the patient. In contrast, the T-PODÒ is a one-size-fits-all, single-use device that is 100% radiolucent. The one-handed ‘Mechanical Advantage’ cable traction system effectively and easily applies circumferential compression. While the Autostop
buckle on the SAM Pelvic SlingTM II ameliorates the guesswork associated with compression, with the T-PODÒ, the appropriate degree of compressive forces and magnitude of pelvic reduction must be determined by those applying the device. The T-PODÒ is the only one of the two devices licensed for use in paediatric patients––though children under 23 kg (50 lbs) may be too small to achieve the 6-in gap needed for closure––and is the only device replete with an area for documentation of the time and date of application. Pelvic circumferential compression is an elemental step in the management of trauma patients with suspected pelvic fractures, with early application representing an important adjunct in the primary resuscitation of the trauma victim. We directly compared two of the leading PCCDs, examining the ease and efficacy of placement. In this trial, participants applied the SAM Pelvic SlingTM II on average
123
442
D. J. Bryson et al.
13 s quicker than the T-PODÒ. While this proved to be statistically significant, it is unlikely to be clinically so–– what is important is the fact that both devices were secured correctly 100% of the time. Overall, very little separates these two devices. Both are easy and acceptable to use and a decision to use one device over the other may, thus, be driven by financial considerations or personal preferences. Conflict of interest
None.
References 1. Croce MA, Magnotti LJ, Savage SA, Wood GW 2nd, Fabian TC. Emergent pelvic fixation in patients with exsanguinating pelvic fractures. J Am Coll Surg. 2007;205:935–9. 2. White CE, Hsu JR, Holcomb JB. Haemodynamically unstable pelvic fractures. Injury. 2009;10:1023–30. 3. Eastridge BJ. Butt binder. J Trauma. 2007;62:S32. 4. [No authors listed]. Advanced trauma life support course: student manual. 8th ed. Chicago: American College of Surgeons; 2008.
123
5. Krieg JC, Mohr M, Ellis TJ, Simpson TS, Madey SM, Bottlang M. Emergent stabilization of pelvic ring injuries by controlled circumferential compression: a clinical trial. J Trauma. 2005;59: 659–64. 6. Spanjersberg WR, Knops SP, Schep NW, van Lieshout EM, Patka P, Schipper IB. Effectiveness and complications of pelvic circumferential compression devices in patients with unstable pelvic fractures: a systematic review of literature. Injury. 2009; 40:1031–5. 7. Schaller TM, Sims S, Maxian T. Skin breakdown following circumferential pelvic antishock sheeting: a case report. J Orthop Trauma. 2005;19:661–5. 8. Guthrie HC, Owens RW, Bircher MD. Fractures of the pelvis. J Bone Joint Surg Br. 2010;92:1481–8. 9. DeAngelis NA, Wixted JJ, Drew J, Eskander MS, Eskander JP, French BG. Use of the trauma pelvic orthotic device (T-POD) for provisional stabilisation of anterior–posterior compression type pelvic fractures: a cadaveric study. Injury. 2008;39:903–6. 10. Bottlang M, Krieg JC, Mohr M, Simpson TS, Madey SM. Emergent management of pelvic ring fractures with use of circumferential compression. J Bone Joint Surg Am. 2002;84:43–7. 11. SAM Medical Products. http://www.sammedical.com. Accessed 31 Aug 2011. 12. Pyng Medical. http://www.T-POD.com. Accessed 31 Aug 2011.
