A patient with an unstable pelvic ring fracture arrives in haemorrhagic shock. After ATLS primary survey, which immediate measure most effectively reduces pelvic haematoma volume?

• A Emergency external fixator application to the iliac crests
• B Pelvic binder or sheet application to close the pelvic volume ✓
• C Immediate angiography and embolisation of bleeding vessels
• D REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta)

Explanation

The pelvic binder (or improvised sheet wrap at the greater trochanters) is the immediate first-line mechanical intervention to close and tamponade an expanding retroperitoneal pelvic haematoma by reducing pelvic ring volume. It must be applied before transfer to interventional radiology or theatre. External fixation provides similar mechanical reduction but takes more time to apply. Angioembolisation addresses arterial bleeding but is a secondary step after mechanical stabilisation. REBOA is a salvage adjunct in level-1 trauma centres.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.