Outcomes Associated With Pelvic Binder Use in Hypotensive Patients With Unstable Pelvic Fractures

Background Pelvic binders are employed with the intent to limit hemorrhage and improve outcomes. This study aimed to evaluate whether their use is associated with a reduction in mortality and interventions intended for hemorrhage control, as well as if there is a potential risk of adverse outcomes, in hypotensive patients with unstable pelvic fractures. Methods The ACS TQIP database from 2016-2021 was used to identify all adult patients who suffered an unstable pelvic fracture (Tile B or C) due to blunt trauma and were hypotensive (SBP <90 mmHg) on admission. To compare the effectiveness of pelvic binder use vs non-use, Poisson regression models and a quantile regression model were used to determine the association between pelvic binder use and outcomes. Results A total of 8311 patients were included in the analysis, of whom 5.3% (N = 441) received a pelvic binder. After adjusting for confounders, the use of a pelvic binder was not associated with a reduction in 24-hour or in-hospital mortality, nor the need for laparotomy/pelvic packing for hemorrhage control. Pelvic binder use was associated with a 26% increased probability of pelvic angioembolization ( P = .005), a 59% increased risk of decubitus ulcers ( P = .018), and a 34% increased risk of lower urinary tract injury ( P < .001). Patients who received a pelvic binder also received a median of 1.44 more units of PRBC within the first 4 hours of admission ( P < .001). Conclusion Despite selecting for a population that could be most expected to benefit from their application, the use of pelvic binders in hypotensive patients with unstable pelvic fractures was not associated with a reduction in mortality, units of PRBC transfused, nor the need for surgery and angioembolization for hemorrhage control.