A 42-year-old male pedestrian is struck by an SUV. Pelvic radiographs demonstrate disruption of the pubic symphysis diastasis > 2.5 cm and widening of the left sacroiliac joint ('open-book' pelvic fracture). Blood pressure is 78/45 mmHg and heart rate is 134 bpm. What is the immediate life-saving mechanical stabilization measure in the trauma bay?

Answer and explanation

Correct answer: A. Application of a commercial pelvic binder centered over greater trochanters

  1. Step 1: In unstable 'open-book' pelvic ring injuries (anteroposterior compression), the disruption of pelvic ligaments expands pelvic retroperitoneal volume, allowing massive arterial and venous plexus hemorrhage (up to several liters).
  2. Step 2: Applying a commercial pelvic binder (or improvised bed sheet) tightly centered directly over the greater trochanters closes the pelvic ring, reduces internal pelvic volume, promotes tamponade of bleeding veins, and stabilizes bone fragments.
  3. Step 3: This must be applied immediately prior to pelvic angiography or surgical stabilization.
Answer
Application of a commercial pelvic binder centered over greater trochanters.
Why not the others: 'Femoral traction with weights' does not close an open-book pelvic ring; 'Manual reduction under sedation' can dislodge forming hematomas and cause lethal exsanguination; 'High Fowler position' worsens pelvic instability and shock.

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