title: Kendrick's extrication device and unstable pelvic fractures: Should a trochanteric belt be added? A cadaveric study.
abstract: BACKGROUND
  Pre-hospital pelvic stabilisation is advised to prevent exsanguination in patients with unstable pelvic fractures (UPFs). Kendrick's extrication device (KED) is commonly used to extricate patients from cars or crevasses. However the KED has not been tested for potential adverse effects in patients with pelvic fractures. The aim of this study was to examine the effect of the KED on pubic symphysis diastasis (SyD) with and without the use of a trochanteric belt (TB) during the extraction process following a MVC.
  
  
  METHODS
  Left-sided "open-book" UPFs were created in 18 human cadavers that were placed in seven different positions simulating pre-extraction and extraction positions using the KED with and without a TB in two different positions (through and over the thigh straps). The SyD was measured using anteroposterior radiographs. The effects of the KED with and without TB, on the SyD, were evaluated.
  
  
  RESULTS
  The KED alone resulted in a non-significant increase of the SyD compared to baseline, whereas the addition of a TB to the KED resulted in a significant reduction of the SyD (p<0.001). The TB through the straps provided a significantly better reduction than the TB over the straps in the extracted position (p<0.05).
  
  
  CONCLUSIONS
  Our study demonstrated that a TB in combination with the KED on UPFs is an effective way to achieve early reduction. The addition of the TB in combination with the KED could be considered for Pre-Hospital Trauma Life Support (PHTLS) training protocols.
authors: University of Lyon, Université Lyon 1, Faculté de Médecine Lyon Est, Laboratoire d'Anatomie, UMR T9405, F-69003 Lyon, France.
authors: Floran A
authors: FA
authors: Reynard
authors: University of Lyon, Université Lyon 1, Faculté de Médecine Lyon Est, Laboratoire d'Anatomie, UMR T9405, F-69003 Lyon, France; Hospices Civils de Lyon, Unit of Emergency Surgery, Centre Hospitalier Lyon-Sud, F-69495 Pierre-Bénite, France; Protypon Neurological-Neuromuscular Center, Thessaloniki, Greece.
authors: Alexandros N
authors: AN
authors: Flaris
authors: Hospices Civils de Lyon, Unit of Emergency Surgery, Centre Hospitalier Lyon-Sud, F-69495 Pierre-Bénite, France; Tulane University School of Medicine, New Orleans, LA, USA.
authors: Eric R
authors: ER
authors: Simms
authors: Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Edouard Herriot, F-69437 Lyon, France.
authors: Olivier
authors: O
authors: Rouvière
authors: University of Lyon, Université Lyon 1, CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, F-69622 Villeurbanne, France.
authors: Pascal
authors: P
authors: Roy
authors: Institut de Recherche Biomédicale des Armées, SMCF, F-91223 Brétigny sur Orge, France.
authors: Nicolas J
authors: NJ
authors: Prat
authors: Service de Santé et de Secours Médical, Service d'Incendie et de Secours du Rhône et de la Métropole de Lyon, F-69421 Lyon, France.
authors: Jean-Gabriel
authors: JG
authors: Damizet
authors: Hospices Civils de Lyon, Unit of Emergency Surgery, Centre Hospitalier Lyon-Sud, F-69495 Pierre-Bénite, France.
authors: Jean-Louis
authors: JL
authors: Caillot
authors: University of Lyon, Université Lyon 1, Faculté de Médecine Lyon Est, Laboratoire d'Anatomie, UMR T9405, F-69003 Lyon, France; Hospices Civils de Lyon, Unit of Emergency Surgery, Centre Hospitalier Lyon-Sud, F-69495 Pierre-Bénite, France; Service de Santé et de Secours Médical, Service d'Incendie et de Secours du Rhône et de la Métropole de Lyon, F-69421 Lyon, France. Electronic address: eric.voiglio@chu-lyon.fr.
authors: Eric J
authors: EJ
authors: Voiglio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D002985:Clinical Protocols; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging* / Q000473:pathology; D005592:Fracture Fixation / Q000379:methods; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007103:Immobilization / Q000379:methods; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning / Q000295:instrumentation* / Q000379:methods; D010384:Pelvic Bones / Q000000981:diagnostic imaging* / Q000293:injuries / Q000473:pathology; D010388:Pelvis / Q000000981:diagnostic imaging* / Q000473:pathology; D046548:Pubic Symphysis Diastasis / Q000000981:diagnostic imaging* / Q000473:pathology; D011859:Radiography
keywords: Cadaver; Haemorrhage; Kendrick's extrication device; Open-book; Pelvic belt; Pelvic fracture; Prehospital care; Symphysis diastasis; Trauma; Trochanteric belt