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Stabilization of pelvic ring disruptions with a circumferential sheet.

Pelvic ring disruptions in the polytraumatized patient are associated with a mortality rate of up to 25%. 1 Acute uncontrolled hemorrhage and its complications are the leading causes of death in these patients. 2 Treatment algorithms for resuscitation and control of hemorrhage are aimed at reducing morbidity and mortality. Although variations exist among these algorithms, essentially all include the goal of pelvic reduction and stabilization. 3,4 Various means of pelvic reduction and stabilization exist. Each has is own advantages and limitations. Invasive measures include anterior external fixation, open reduction and internal fixation (ORIF), and posterior pelvic clamps. 5 Although each of these interventions can be utilized early in the resuscitation phase, none can be applied acutely outside the hospital setting. The desire to provide early stabilization, at the accident scene or during patient transport, has led to the development of noninvasive measures, such as vacuum bean-bags or pneumatic antishock garments (PASGs). However, each of these methods is limited either by its ability to effect controlled reduction, or by its potential for severe complications. 6 Most recently, wrapping of the pelvic region with a sheet has been advocated. In fact, the American College of Surgeons’ Advanced Trauma Life Support (ATLS) course now includes a protocol for emergent management of pelvic ring disruptions, advising circumferential application of a pelvic sheet. 7 Sheets can be readily applied at the accident scene and may provide better reduction and stabilization of open-book type pelvic fractures when compared with bean-bags or PASGs. Anecdotal accounts of sheet application at time of hospital admission are numerous. However, case reports documenting application and performance of such pelvic sheets are virtually nonexistent. In this report, we present two exemplary cases of open-book type pelvic fractures (OTA classification 61-B/C) temporarily managed with a pelvic sheet. Furthermore, we provide an analysis of the amount of reduction achieved by circumferential pelvic compression.