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Reduction of Pelvic Volume from Pelvic Fractures

- Discussion: 
          -see AP injuries
and vascular injuries from pelvic fracture
          - anatomic reduction and stabilization of pelvic frx prevents continued blood loss by reducing bleeding from fracture fragments
                    and from and injured sacral venous plexus which has the effect of reducing pelvic volume;
          - pelvic volume can be closed down by wrapping sheet around pelvis, and then sequentially twisting a "broom stick" to tied
                    ends until sheet tightens; 
          - taping the knees and ankles together;
                    - may correct lower extremity external rotation and improve the pelvic reduction;
          - antishock ("C") clamps;
          - careful not to overtighten the clamp; 
          - pressure on the skin is clinically the limiting factor
          - straps should be pulled until two fingers just fit between the binder and the patient
          - tension of about 180 N (40 lbs) is maximally effective;
          - synthesis C clamp
          - references:
                 - Circumferential pelvic antishock sheeting: a temporary resuscitation aid.
                 - Pelvic emergency clamps: anatomic landmarks for a safe primary application.
                 - Clinical experience with two types of pelvic C-clamps for unstable pelvic ring injuries.
                 - [Biomechanical comparison of various emergency stabilization measures of the pelvic ring.]
                 - Emergent treatment of pelvic fractures. Comparison of methods for stabilization.
                 - Institutional practice guidelines on management of pelvic fracture-related hemodynamic instability: do they make a difference?
                 - Skin breakdown following circumferential pelvic antishock sheeting: a case report.
                 - Innominosacral dissociation: mechanism of injury as a predictor of resuscitation requirements, morbidity, and mortality.
                 - The trochanteric C-clamp for provisional pelvic stability. 
                 - Internal rotation and taping of the lower extremities for closed pelvic reduction.
                 - Emergent Management of Pelvic Ring Fractures with Use of Circumferential Compression
                 - Stabilization of Pelvic Ring Disruptions with a Circumferential Sheet
                 - Comparison of Three Different Pelvic Circumferential Compression Devices: A Biomechanical Cadaver Study
                 - Haemorrhage control in pelvic fractures-A survey of surgical capabilities
                 - Effect of a new pelvic stabilizer (T-POD®) on reduction of pelvic volume and haemodynamic stability in unstable pelvic fractures
                 - Efficacy and safety of emergency non-invasive pelvic ring stabilisation
                 - Videos in clinical medicine. Technique for temporary pelvic stabilization after trauma.
                 - Comparison of skin pressure measurements with the use of pelvic circumferential compression devices on pelvic ring injuries.

- Cautions:
       - The Effect of Pelvic Binder Placement on OTA Classification of Pelvic Ring Injuries using Computed Tomography. Does it Mask the Injury?

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