Effectiveness and complications of pelvic circumferential compression devices in patients with unstable pelvic fractures: a systematic review of literature.
BACKGROUND
Pelvic fractures can cause massive haemorrhage. Early stabilisation and compression of unstable fractures is thought to limit blood loss. Reposition of fracture parts and reduction of pelvic volume may provide haemorrhage control. Several non-invasive techniques for early stabilisation have been proposed, like the specifically designed pelvic circumferential compression devices (PCCD). The purpose of this systematic review was to investigate current evidence for the effectiveness and safety of non-invasive PCCDs.


METHODS
To investigate current literature the search string: "pelvi* AND fract* AND (bind* OR t-pod OR tpod OR wrap OR circumferential compression OR sling OR sheet)" was entered into EMBASE, PubMed (Medline), PiCarta, WebofScience, Cochrane Online, UptoDate, CINAHL, and Scopus. All scientific publications published in indexed journals were included.


RESULTS
The search resulted in 17 included articles, none of which were level I or II studies. One clinical cohort study (level III) and 1 case-control study (level IV) were found. These showed a significant reduction of pelvic volume after applying a PCCD, without an effect on outcome. Other included literature consisted of 4 case series (level V). Two biomechanical analysis studies of fractures in human cadavers showed pelvic stabilisation and effective volume reduction by PCCD, especially when applied around the greater trochanters. Finally, 7 case reports (level VI) and 3 expert opinions (level VII) were identified. These case reports suggested complications such as pressure sores and nerve palsy.


CONCLUSIONS
PCCDs seem to be effective in early stabilisation of unstable pelvic fractures. However, prospective data concerning mortality and complications is lacking. Some complications, like pressure sores have been described.
Spanjersberg
Willem R
WR
Erasmus MC, University Medical Center Rotterdam, Department of Surgery-Traumatology, 3000 CA Rotterdam, The Netherlands.
Knops
Simon P
SP
Schep
Niels W L
NW
van Lieshout
Esther M M
EM
Patka
Peter
P
Schipper
Inger B
IB
D001458:Bandages / Q000009:adverse effects; D004812:Epidemiologic Methods; D050723:Fractures, Bone / Q000628:therapy*; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D010384:Pelvic Bones / Q000293:injuries*; D026741:Physical Therapy Modalities / Q000009:adverse effects / Q000295:instrumentation*