Effectiveness of antishock garment in acute management of open-book injuries of pelvic fractures in hemodynamically unstable patients


  • Khaled Morsy Salama Department of Emergency,Suez Canal University,Ismailia, Egyp
  • Hany Abbas El-Louly Department of Emergency,Suez Canal University,Ismailia, Egyp
  • Yasin Saqr El-Ghoul Department of Orthopedics,Suez Canal University,Ismailia, Egyp
  • Mohamed Saleh Mousta Department of Orthopedics,Suez Canal University,Ismailia, Egyp
  • Gouda Mohamed Ellabban Department of Surgery, Faculty of Medicine,Suez Canal University,Ismailia, Egypt




Anterior external fixator, Haemodynamic state, Open book fracture pelvis, Pelvic binder


Background: Stabilizing unstable pelvic fractures with rapidly applied pelvic binder or the garment has long been a standard practice in patients suspected to be bleeding from their pelvic injuries. External fixation is believed to provide better tamponade, by decreasing the pelvic volume and, thereby, the space for blood loss.

Methods: Prospective case control randomized study.  A total of 30 patients were enrolled in this study. They were recruited from Suez Canal University hospital (Ismailia). They were categorized into two groups. They were selected by simple randomization method using the table of random number. Group I: patients were subjected to antishock garment (15 patients). Group II: patients were subjected to external pelvic fixation (15 patients).

Results: Data analysis of the 30 patients showed that symphysis pubis diastasis was decreased from (3.2 to 2.8 cm) in binder group in comparison to (3.8 to 2.2cm)  in EX-FIX group with statistically significant different (p value = P = 0.04). But there were no marked difference in the degree of shock index improvement between the two groups (p-value >0.05).

Conclusions: Although EX-FIX is showing significant improvement in pelvic stability and more decreasing diastasis in comparison with binder, there was no difference in improving the haemodynamic state between both maneuvers.


Browner BD, Jupiter JP, Levine AM, Trafton PG. Assessment of Pelvic Disruption. Browner: Skeletal Trauma: Basic Science, Management, and Reconstruction, 3rd ed. Saunders, Elsevier; 2003:1217-8.

Ertel W, Keel M, Eid K. Control of severe hemorrhage using C-clamp and pelvic packing in multiply injured patients with pelvic ring disruption. J Orthop Trauma. 2001;15:468-74.

White CE, Hsu JR, Holcomb JB. Haemodynamically unstable pelvic fractures, Injury, Int J Care Injured. 2009;40:1023-30.

Van Vugt AB, van Kampen A. An unstable pelvic ring: the killing fracture. J Bone Joint Surg Br. 2006;88:427-33.

Kataoka Y, Maekawa K, Nishimaki H. Iliac vein injuries in hemodynamically unstable patients with pelvic fracture caused by blunt trauma. J Trauma. 2005;58:704-8.

Cothren CC, Osborn PM, Moore EE. Preperitoneal pelvic packing for hemodynamicallyunstable pelvic fractures: a paradigm shift. J Trauma. 2007;62:834-42.

Arazi M, Kutlu A, Mutlu M. The pelvic external fixation: the mid-term results of 41 patients treated with a newly designed fixator. Arch Orthop Trauma Surg. 2000;120:584-6.

Totterman A, Madsen JE, Skaga NO, Roise O. Extraperitoneal pelvic packing: a salvage procedure to control massive traumatic pelvic hemorrhage. J Trauma. 2007;62:843-52.

Jaspal Singh, Gulzar Gupta, RamneeshGarg and ashish Gupta. Evaluation of trauma and prediction of outcome using TRISS method. J Emerg Trauma Shock. 2011;4(4):446-9.

Clarke JR, Trooskin SZ, Doshi PJ, Greenwald L, Mode CJ. Time to laparotomy for intra-abdominal bleeding from trauma does affect survival for delays up to 90 minutes. J Trauma. 2002;52(3):420-5.

Ben-Menachem Y, Coldwell DM, Young JW, Burgess AR. Haemorrhage associated with pelvic fractures: causes, diagnosis, and emergent management. AJR Am J Roentgenol. 1991;157:1005-14.

Doro CJ, Forward DP, Kim H, Nascone JW. Does 2.5 cm of symphyseal widening differentiate anteroposterior compression I from anteroposterior compression II pelvic ring injuries? J Orthop Trauma. 2010;24(10):610-5.

Galois L, Pfeffer F, Mainard D, Delagoutte JP. The value of external fixation. Acta Orthopædica Belgica. 2003;69:4.






Original Research Articles