Category Archives: Equipment

Don’t Have A Pelvic Binder? Make Your Own! (Video)

During the past two posts, I’ve reviewed the various pelvic binders available and how much they cost. But what can you do if you find yourself in a situation where you need a binder but don’t have one?

It’s time to go MacGyver!

You need three things:

Yes, that’s right. A simple and cheap SAM splint, a tourniquet, and some kind of blade to cut the SAM splint with. Essentially, the SAM splint is the binder and the tourniquet is used to cinch it down in the correct position.

Here’s a video that demonstrates how to do it. Enjoy!

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What’s The Best Pelvic Binder? Part 2

Yesterday, I detailed some pelvic binders commonly available in the US. Today, I’ll go through the (little) science there is regarding which are better than others.

And remember, tomorrow I’ll show you how to make a free pelvic binder out of stuff that all medics have in their rig.

There are a number of factors to consider when choosing one of these products. They are:

  • Does it work?
  • Does it hurt or cause skin damage?
  • Is it easy to use?
  • How much does it cost?

It’s difficult to determine how well binders work in the live, clinical setting. But biomechanical studies can serve as a surrogate to try to answer this question. One such cadaver study was carried out in the Netherlands a few years ago. They created one of three different fracture types in pelvis specimens. Special locator wires were placed initially so they could measure bone movement before and after binder placement. All three of the previously discussed commercial binders were used.

Here are the factoids:

  • In fracture patterns that were partially stable or unstable, all binders successfully closed the pelvic ring.
  • None of the binders caused adverse displacements of fracture fragments.
  • Pulling force to achieve complete reduction was lowest with the T-POD (40 Newtons) and highest with the SAM pelvic sling (120 Newtons). The SAM sling limits compression to 150 Newtons, which was more than adequate to close the pelvis.

So what about harm? A healthy volunteer study was used to test each binder for tissue pressure levels. The 80 volunteers were outfitted with a pressure sensing mat around their pelvis, and readings were taken with each binder in place.

Here are the additional factoids:

  • The tissue damage threshold was assumed to be 9.3 kPa sustained for more than 2-3 hours based on the 1994 paper cited below.
  • All binders exceeded the tissue damage threshold at the greater trochanters and sacrum while lying on a backboard. It was highest with the Pelvic Binder and lowest with the SAM sling.
  • Pressures over the trochanters decreased significantly after transfer to a hospital bed, but the Pelvic Binder pressures remained at the tissue damage level.
  • Pressures over the sacrum far exceeded the tissue damage pressure with all binders on a backboard and it remained at or above this level even after transfer to a bed. Once again, the Pelvic Binder pressures were higher. The other splints had similar pressures.

And finally, the price! Although your results may vary due to your buying power, the SAM sling is about $50-$70, the Pelvic Binder $140, and the T-POD $125.

Bottom line: The binder that performed the best (equivalent biomechanical testing, better tissue pressure profile) was the SAM sling. It also happens to be the least expensive, although it takes a little more elbow grease to apply. In my mind, that’s a winning combo. Plus, it’s narrow, which allows easy access to the abdomen and groins for procedures. But remember, whichever one you choose, get them off as soon as possible to avoid skin complications.

References:

  • Comparison of three different pelvic circumferential compression devices: a biomechanical cadaver study. JBJS 93:230-240, 2011.
  • Randomised clinical trial comparing pressure characteristics of pelvic circumferential compression devices in healthy volunteers. Injury 42:1020-1026, 2011.
  • Pressure sores. BMJ 309(6959):853-857, 1994.
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What’s The Best Pelvic Binder? Part 1

Several products for compressing the fractured pelvis are available. They range from free and simple (a sheet), to a bit more complicated and expensive. How to decide which product to use? Today, I’ll discuss the four commonly used products. Tomorrow, I’ll look at the science. And on Wednesday, I’ll show you a creative way to make your own free pelvic binder.

First, let’s dispense with the sheet. Yes, it’s very cheap. But it’s not easy to use correctly, and more difficult to secure. Click here to see my post on its use.

There are three commercial products that are commonly used. First is the Pelvic Binder from the company of the same name (www.pelvicbinder.com). It consists of a relatively wide belt with a tensioning mechanism that attaches to the belt using velcro. One size fits all, so you may have to cut down the belt for smaller patients. Proper tension is gauged by being able to insert two fingers under the binder.

Next is the SAM Pelvic Sling from SAM Medical Products (http://www.sammedical.com). This device is a bit fancier, is slimmer, and the inside is more padded. It uses a belt mechanism to tighten and secure the sling. This mechanism automatically limits the amount of force applied to avoid problems with excessive compression. It comes in three sizes, and the standard size fits 98% of the population, they say.

Finally, there is the T-POD from Pyng Medical (http://www.pyng.com/products/t-podresponder). This one looks similar to the Pelvic Binder in terms of width and tensioning. It is also a cut to fit, one size fits all device. It has a pull tab that uses a pulley system to apply tension. Again, two fingers must be inserted to gauge proper tension.

So those are the choices. Tomorrow, I’ll go over some of the data and pricing so you can make intelligent choices about selecting the right device for you.

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So You Want Your Own Hybrid Room?!

You’re hooked! You are thinking back to a number of cases that you think might have done better with a hybrid room. And now let’s assume you already have one in your OR suite. Now what do you do?

The key is to avoid jumping right in and sending your next eligible patient straight to that room. You absolutely must take some time to develop policies and guidelines to make sure things go smoothly.

Here are some important things to think about:

  • Identify which specific patients are eligible so you don’t squander this resource
  • Who calls the OR to secure the room (surgeon, resident, other)?
  • Who calls the interventional radiologist?
  • What if another case (TEVAR, etc) is already on the table?
  • What if another case is getting ready to use the OR? How are conflicts resolved?
  • Develop an initial in-room report process so all the teams know the game plan
  • Assign an extra circulator to the room. You’ll need them!
  • Make sure all retractor systems (abdomen, head) fit the table! Remember that little asterisk in the previous section? Some retraction systems may need adaptors to work with your table. Don’t find this out at the last minute!
  • What about lithotomy position? How will this work with your hybrid table? They don’t have sections that break away.
  • Ensure radiation protection for all, including thyroid shields.
  • Bag the bottom x-ray detector, otherwise it will get very, very gross!
  • Create an external fixator equipment cart that can be moved into the hybrid room.
  • Create an embolization cart with appropriate wires, catheters, coils, etc. This stuff may not be stocked normally in the hybrid room

And I’m sure there are more details that I haven’t thought of. If you have some helpful suggestions, policies, or protocols, please share them with me!

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Which Patients May Benefit From A Hybrid OR?

The key to answering this question is to look at the resources that a hybrid OR brings to bear, and then determine what types of patients can take full advantage of them. Sadly, we have no guidance from the trauma literature, so we need to let our imaginations run free.

The basic concept for hybrid room use is this:

“My patient needs interventional radiology plus at least one other surgical specialty procedure”

The additional procedures don’t necessarily need to benefit from or utilize the IR capabilities. But they do need to be of an emergent nature. For example, a patient with a pelvic fracture can undergo angio-embolization and pelvic external fixation, while the gynecologic surgeons repair a vaginal laceration. Simultaneous, but not related to the embolization.

Here’s my list of possibilities. It is by no means complete or exhaustive. It’s just a start. All include the interventional radiologist for some part of it:

  • Pelvic fractures with angioembolization plus:
    • Preperitoneal packing
    • Perineal / gynecologic repair
    • Laparotomy
  • Liver angioembolization plus laparotomy
  • Thoracic aortic injury plus laparotomy
  • Angiographic assistance for management of vascular extremity injury
  • Any of the previous procedures plus craniotomy*
  • And don’t forget to toss REBOA in with this!
  • Plus some other stuff I’m sure you will think up

Tomorrow, some details to think about while setting up your own hybrid OR!

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