• G Jansen, T Hefke, G Wittenberg, T Vordemvenne, and F Mertzlufft.
• Klinik für Anästhesiologie, Intensiv‑, Notfall‑, Transfusionsmedizin und Schmerztherapie, Evangelisches Klinikum Bethel, Burgsteig 13, 33617, Bielefeld, Deutschland. gerritjansen@web.de.
• Anaesthesist. 2018 Nov 1; 67 (11): 837-849.

BackgroundSevere hemorrhage is a dreaded complication of pelvic fractures. It has a significant impact on early trauma-associated mortality. Hemorrhage that is secondary to pelvic fractures can be reduced by external stabilization devices. Despite the commercial availability of many different systems, they are infrequently used. The aim of this computed tomography (CT) study was to examine the use of external pelvic stabilization devices.MethodsBetween 1 January 2011 and 31 December 2015 a total of 982 images produced in CT trauma scans at a level 1 trauma centre were retrospectively examined with respect to the presence of external pelvic stabilizers. The type of device applied, its actual position including deviation from optimal position as well as pelvic parameters and complications were determined.ResultsIn 67 out of 982 patients (6.82%) with suspected multiple trauma, an external pelvic stabilizer was employed. In 41.8% the devices were not placed in concordance with prevailing scientific knowledge, 53.73% of devices did not comply with the manufacturer's instructions and 51.85% of systems with pneumatic cuffs caused significant malrotation. In one patient the cuff induced hypoperfusion of the leg but without further sequelae.ConclusionWhile the prehospital use of pelvic slings is increasing, misplacement is very common. Especially inconsistencies between manufacturers' manuals and current scientific knowledge warrant further improvement. In systems with pneumatic cuffs malrotation of the device is common and clinically relevant. Hypoperfusion of the lower extremities is possible and should be taken into account when employing these devices.

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