title: Effectiveness of non invasive external pelvic compression: a systematic review of the literature.
abstract: BACKGROUND
  Pelvic fractures might carry a significant risk of bleeding. A wide variety of pelvic binders together with pelvic sheets are available and offer an adjunct to the initial management of poly-trauma patients with pelvic injuries. These devices are collectively referred to as pelvic circumferential compression devices (PCCDs). The aim of this study was to review the literature for evidence pertinent to the efficacy and safety of PCCDs.
  
  
  METHODS
  Using the PRISMA guidelines a systematic search on PubMed, Web of Science, CINAHL, Embase and Scopus was carried out. Articles included were in English language and published between 1999 and 2015. Studies included were appraised with narrative data synthesis.
  
  
  RESULTS
  Seven articles addressed mechanical properties of non-invasive external mechanical devices, six articles focused on physiological aspects, and three studies evaluated the pressure characteristics of these devices. We found 4 case reports regarding adverse effects. None of the studies identified addressed the cost effectiveness or pain relief issues related to the use of PCCDs.
  
  
  CONCLUSIONS
  Based on available literature, PCCDs are widely used in the initial management of patients with suspected pelvic bleeding. There is evidence to suggest that external compression reduces disrupted pelvic rings. There are some complications reported following application of PCCDs. Hemorrhagic source and physiological effectiveness of PCCDs needs to be addressed in future studies. In the meantime judicious application of PCCDs will continue to be recommended.
authors.affiliation: Department of Orthopaedics, Karolinska University Hospital, Karolinksa vägen, 17176, Solna, Stockholm, Sweden. peyman.bakhshayesh@karolinska.se.
authors.forename: Peyman
authors.initials: P
authors.lastname: Bakhshayesh
authors.affiliation: University Hospital Coventry and Warwickshire, Clifford bridge road, Coventry, CV2 2DX, UK.
authors.forename: Tarek
authors.initials: T
authors.lastname: Boutefnouchet
authors.affiliation: Department of Orthopaedics, Karolinska University Hospital, Karolinksa vägen, 17176, Solna, Stockholm, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Tötterman
mesh_terms: D005592:Fracture Fixation / Q000379:methods*; D050723:Fractures, Bone / Q000628:therapy*; D006801:Humans; D010384:Pelvic Bones / Q000293:injuries*; D011312:Pressure
keywords: Binder; Damage control; External compression; Haemorrhage; Pelvic fracture