KEY POINTS
- Binding the pelvis is potentially life-saving and a key skill for extreme sports practitioners.
- Suspect a pelvic fracture in all serious impacts.
- Pelvic fractures can be associated with heavy internal bleeding.
- Treat by tying a jacket around the base of the hips and tying the ankles together.
EXPLANATION
A broken pelvis is always possibility in a hard impact, particularly where there are also broken legs or spinal fractures. Pelvic fractures are serious as they can bleed heavily, but also internally, so the bleeding isn’t immediately obvious to see. Binding the pelvis can be a life-saving intervention.
The pelvis is made up of a number of rings. When it fractures, these rings can split apart, like an open book. The aim of binding the pelvis is to ‘close the book’, by bringing the rings back to together. The best solution is to use a binder designed for the purpose, however you can also improvise one in the field: tie a bandage, jacket or strap in a loop very firmly around the base of the hips/top of the thighs and also tie the legs together at the ankles. Be sure that once applied it won’t come undone until hospital. As ever, when you improvise something, try it on yourself or an uninjured person first, so you can then apply it smoothly and confidently on the casualty.
The correct position for the binder is usually a little lower than people think, about the level of the middle of the zipper on a pair of trousers. Described anatomically, it is at the level of the greater trochanter of the femur (the bumpy bit on the outside of the thigh).
When to bind and initial assessment
Suspect a pelvic fracture after any high-energy mechanism: a fall from height, a motorcycle or downhill mountain bike crash, being struck by a falling object, or a heavy direct blow to the hips or lower back. In these situations, even a conscious casualty who can move their legs may still have an unstable pelvis. Do not be reassured by a normal-looking limb position.
Look for pain in the groin, hip or lower back, reluctance to move the legs, bruising or swelling around the base of the trunk, and any difference in leg length or rotation. You may also see blood at the urethral opening or feel a grating sensation if you very gently rest a hand over the hip area, but never deliberately press or rock the pelvis to test it. That can reopen a partially clotted bleed.
If the mechanism is serious and you have any doubt, bind the pelvis. Early binding is far safer than waiting for a diagnosis. In a remote or wilderness setting, assume the worst and act while the casualty is still warm and before shock develops.
Improvised materials and correct placement
A purpose-made pelvic binder is ideal, but you can improvise effectively with a broad, non-stretchy item. A folded jacket, a wide webbing strap, a karate belt, a scarf, a triangular bandage folded lengthways, or several loops of a sheet all work. The key is width: aim for something at least 10 to 15 centimetres wide so it spreads pressure and does not cut into skin.
Avoid narrow cords, rope, wire, shoelaces or thin belts unless no alternative exists. If you must use something narrow, pad the skin first with clothing or a folded cloth. Do not place the binder around the waist or over the navel; it must sit around the base of the hips, across the greater trochanters and the pubic symphysis. This is usually lower than people expect.
Tie the improvised binder firmly, but not so tightly that it blocks circulation to the legs or restricts breathing. You should be able to slide two fingers under the knot with difficulty. Check that the knot will not slip or loosen during movement, and secure the ankles together as well to stop the legs rotating outward.
Step-by-step application technique
Work calmly and explain each step to the casualty if they are conscious. Prepare the binder before you touch the injured area so you do not have to fumble or adjust it repeatedly. If possible, have a second person support the legs in a neutral, straight position while you apply the binder, but avoid pulling or straightening the legs forcefully if it causes pain.
- Slide the binder under the casualty at the level of the greater trochanters, not the waist.
- Close the binder over the front of the hips and tighten it until the pelvis feels stable and the casualty reports firm, even pressure.
- Secure the knot or buckle so it cannot work loose, then tie or strap the ankles together with padding between bony points.
- Check both feet for warmth, colour and pulses before and after tightening. Write down the time of application.
Once applied, do not remove the binder to inspect the skin, even if the casualty asks you to loosen it. Loosening can allow bleeding to restart. Only adjust it if it is clearly causing loss of circulation or making breathing difficult, and if you do adjust it, note the new tension and time.
After application, monitoring and handover
Keep the casualty still and warm. Pelvic fractures bleed internally, so even a casualty who looks stable can deteriorate quickly. Check their level of consciousness, breathing and pulse regularly, and look for signs of shock such as pale, cool, clammy skin, rapid breathing, confusion or restlessness.
Do not give food or drink, as surgery may be needed. If the casualty vomits, protect the airway by turning them as a unit with support to the head, neck and pelvis. If the binder becomes loose because of clothing settling or the casualty being moved, tighten it again, but never remove it completely.
When handing over to rescuers or ambulance staff, tell them clearly that a pelvic binder has been applied, when it was applied, how tight it is, and any changes in the casualty's condition since. If you also improvised the binder, describe what was used and where the knot or buckle sits. This information helps the receiving team decide whether to replace or keep your binder in place.