European Radiology

, Volume 28, Issue 9, pp 3953–3962 | Cite as

Quantitative MDCT assessment of binder effects after pelvic ring disruptions using segmented pelvic haematoma volumes and multiplanar caliper measurements

  • David Dreizin
  • Uttam Bodanapally
  • Daniel Mascarenhas
  • Robert V. O’Toole
  • Nikki Tirada
  • Ghada Issa
  • Jason Nascone



To assess effects of pelvic binders for different instability grades using quantitative multidetector computed tomography (MDCT) parameters including segmented pelvic haematoma volumes and multiplanar caliper measurements.


CT examinations of 49 patients with binders and 49 controls performed from January 2008–June 2016, and matched 1:1 for Tile instability grade and Pennal/Young-Burgess force vector, were compared for differences in pubic symphysis and sacroiliac displacement using caliper measurements in three orthogonal planes. Pelvic haematoma volumes (ml) were derived using semi-automated seeded region-growing segmentation. Median caliper measurements and volumes were compared using the Mann-Whitney U test, and correlations assessed with Pearson’s correlation coefficient. Relevant caliper measurement cutoffs were established using ROC analysis.


Rotationally unstable (Tile B) patients with binders showed significant decreases in sacroiliac diastasis (2.7 mm vs. 4.5 mm; p=0.003) and haematoma volumes (135 ml vs. 295 ml; p=0.008). Globally unstable (Tile C) binder patients showed decreased sacroiliac diastasis (4.7 mm vs. 6.4 mm, p=0.04), without significant difference in haematoma volumes (284 ml vs. 234 ml, p=0.34). Four Tile C patients with binders demonstrated over-reduction resulting in pubic body over-ride.


Rotationally unstable patients with binders have significantly less sacroiliac diastasis versus controls, corresponding with significantly lower haematoma volumes.

Key Points

• Haematoma segmentation and multiplanar caliper measurements provide new insights into binder effects.

• Binder reduction corresponds with decreased pelvic haematoma volume in rotationally unstable injuries.

• Discrimination between rotational and global instability is important for management.

• Several caliper measurement cut-offs discriminate between rotationally and globally unstable injuries.

• Pubic symphysis over-ride is suggestive of binder over-reduction in globally unstable injuries.


Pelvis Pelvic bones Injuries Tomography, X-ray computed Imaging, Three-dimensional 



Abbreviated injury scale




Antero-posterior compression


Antero-posterior pubic symphysis offset


Antero-posterior sacroiliac offset


Combined mechanism


Computed tomography


Exam under anaesthesia


Intraclass correlation coefficient


Interquartile range


Injury severity score


Lateral compression


Likelihood ratio


Multidetector computed tomography


Pelvic circumferential compression device


Pubic symphysis diastasis


Odds ratio


Receiver operating characteristic




Sacroiliac diastasis


Vertical pubic symphysis offset


Vertical shear


Vertical sacroiliac offset



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is David Dreizin, MD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• case-control study

• cross-sectional study

• observational

• performed at one institution

Supplementary material

330_2018_5303_MOESM1_ESM.docx (17 kb)
ESM 1 (DOCX 17.3 kb)


  1. 1.
    Chesser TJS, Cross AM, Ward AJ (2012) The use of pelvic binders in the emergent management of potential pelvic trauma. Injury 43:667–669CrossRefPubMedGoogle Scholar
  2. 2.
    Spanjersberg WR, Knops SP, Schep NWL, van Lieshout EMM, Patka P, Schipper IB (2009) Effectiveness and complications of pelvic circumferential compression devices in patients with unstable pelvic fractures: a systematic review of literature. Injury 40:1031–1035CrossRefPubMedGoogle Scholar
  3. 3.
    Dreizin D, Munera F (2012) Blunt Polytrauma: evaluation with 64-section whole-body CT angiography. RadioGraphics 32:609–631CrossRefPubMedGoogle Scholar
  4. 4.
    Vermeulen B, Peter R, Hoffmeyer P, Unger P (1999) Prehospital stabilization of pelvic dislocations: a new strap belt to provide temporary hemodynamic stabilization. Swiss Surg 5Google Scholar
  5. 5.
    Toth L, King KL, McGrath B, Balogh ZJ (2012) Efficacy and safety of emergency non-invasive pelvic ring stabilisation. Injury 43:1330–1334CrossRefPubMedGoogle Scholar
  6. 6.
    Bonner TJ, Eardley WGP, Newell N et al (2011) Accurate placement of a pelvic binder improves reduction of unstable fractures of the pelvic ring. J Bone Joint Surg Br Vol 93-B:1524–1528CrossRefGoogle Scholar
  7. 7.
    Surgeons ACo (2006) Advanced trauma life support for doctors, Student Course Manual, 7, ChicagoGoogle Scholar
  8. 8.
    Cullinane DC, Schiller HJ, Zielinski MD et al (2011) Eastern Association for the Surgery of Trauma practice management guidelines for hemorrhage in pelvic fracture—update and systematic review. J Trauma Acute Care Surg 71:1850–1868CrossRefGoogle Scholar
  9. 9.
    Kortbeek JB, Al Turki SA, Ali J et al (2008) Advanced trauma life support, 8th edition, the evidence for change. J Trauma Acute Care Surg 64:1638–1650CrossRefGoogle Scholar
  10. 10.
    Krieg J, Mohr M, Ellis T, Simpson T, Madey S, Bottlang M (2005) Emergent stabilization of pelvic ring injuries by controlled circumferential compression: a clinical trial. J Trauma 59:659–664CrossRefPubMedGoogle Scholar
  11. 11.
    Tan E, van Stigt S, van Vugt A (2010) Effect of a new pelvic stabilizer (T-POD®) on reduction of pelvic volume and haemodynamic stability in unstable pelvic fractures. Injury 41:1239–1243CrossRefPubMedGoogle Scholar
  12. 12.
    DeAngelis NA, Wixted JJ, Drew J, Eskander MS, Eskander JP, French BG (2008) Use of the trauma pelvic orthotic device (T-POD) for provisional stabilisation of anterior–posterior compression type pelvic fractures: a cadaveric study. Injury 39:903–906CrossRefPubMedGoogle Scholar
  13. 13.
    Bottlang M, Krieg J, Mohr M, Simpson T, Madey S (2002) Emergent management of pelvic ring fractures with use of circumferential compression. J Bone Joint Surg Am 84-A Suppl 2:43–47CrossRefPubMedGoogle Scholar
  14. 14.
    Pizanis A, Pohlemann T, Burkhardt M, Aghayev E, Holstein JH (2013) Emergency stabilization of the pelvic ring: clinical comparison between three different techniques. Injury 44:1760–1764CrossRefPubMedGoogle Scholar
  15. 15.
    Nunn T, Cosker TDA, Bose D, Pallister I (2007) Immediate application of improvised pelvic binder as first step in extended resuscitation from life-threatening hypovolaemic shock in conscious patients with unstable pelvic injuries. Injury 38:125–128CrossRefPubMedGoogle Scholar
  16. 16.
    Heckbert S, Vedder N, Hoffman W et al (1998) Outcome after hemorrhagic shock in trauma patients. J Trauma 45:545–549CrossRefPubMedGoogle Scholar
  17. 17.
    Manson T, O’Toole RV, Whitney A, Duggan B, Sciadini M, Nascone J (2010) Young-burgess classification of pelvic ring fractures: does it predict mortality, transfusion requirements, and non-orthopaedic injuries? J Orthop Trauma 24:603–609CrossRefPubMedGoogle Scholar
  18. 18.
    Holstein J, Culemann U, Pohlemann T (2012) What are predictors of mortality in patients with pelvic fractures? Clin Orthop Relat Res® 470:2090-2097Google Scholar
  19. 19.
    Sathy AK, Starr AJ, Smith WR et al (2009) The effect of pelvic fracture on mortality after trauma: an analysis of 63,000 trauma patients. J Bone Joint Surg 91:2803–2810CrossRefPubMedGoogle Scholar
  20. 20.
    Burgess A, Eastridge B, Young J et al (1990) Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma Acute Care Surg 30:848–856CrossRefGoogle Scholar
  21. 21.
    Magnussen RA, Tressler MA, Obremskey WT, Kregor PJ (2007) Predicting blood loss in isolated pelvic and acetabular high-energy trauma. J Orthop Trauma 21:603–607CrossRefPubMedGoogle Scholar
  22. 22.
    Blackmore C, Jurkovich GJ, Linnau KF, Cummings P, Hoffer EK, Rivara FP (2003) Assessment of volume of hemorrhage and outcome from pelvic fracture. Arch Surg 138:504–509CrossRefPubMedGoogle Scholar
  23. 23.
    Dreizin D, Bodanapally UK, Neerchal N, Tirada N, Patlas M, Herskovits E (2016) Volumetric analysis of pelvic haematomas after blunt trauma using semi-automated seeded region growing segmentation: a method validation study. Abdom Radiol.
  24. 24.
    Tile M (1988) Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br Vol 70-B:1–12CrossRefGoogle Scholar
  25. 25.
    Tile M (1996) Acute pelvic fractures: I. causation and classification. J Am Acad Orthop Surg 4:143–151CrossRefPubMedGoogle Scholar
  26. 26.
    Dreizin D, Nascone J, Davis DL et al (2016) Can MDCT unmask instability in binder-stabilized pelvic ring disruptions? Am J Roentgenol 207:1244–1251CrossRefGoogle Scholar
  27. 27.
    Pennal GF, Tile M, Waddell JP, Garside H (1980) Pelvic disruption: assessment and classification. Clin Orthop Relat Res 151:12–21Google Scholar
  28. 28.
    Böhning D, Holling H, Patilea V (2011) A limitation of the diagnostic-odds ratio in determining an optimal cut-off value for a continuous diagnostic test. Stat Methods Med Res 20:541–550CrossRefPubMedGoogle Scholar
  29. 29.
    Jaeschke R, Guyatt GH, Sackett DL et al (1994) Users’ guides to the medical literature: III. how to use an article about a diagnostic test b. what are the results and will they help me in caring for my patients? JAMA 271:703–707CrossRefPubMedGoogle Scholar
  30. 30.
    Ghaemmaghami V, Sperry J, Gunst M et al (2007) Effects of early use of external pelvic compression on transfusion requirements and mortality in pelvic fractures. Am J Surg 194:720–723CrossRefPubMedGoogle Scholar
  31. 31.
    Grimm MR, Vrahas MS, Thomas KA (1998) Pressure-volume characteristics of the intact and disrupted pelvic retroperitoneum. J Trauma Acute Care Surg 44:454–459CrossRefGoogle Scholar
  32. 32.
    Moss MC, Bircher MD (1996) Volume changes within the true pelvis during disruption of the pelvic ring - where does the haemorrhage go? Injury 27:21–23CrossRefGoogle Scholar
  33. 33.
    Stover MD, Summers HD, Ghanayem AJ, Wilber JH (2006) Three-dimensional analysis of pelvic volume in an unstable pelvic fracture. J Trauma Acute Care Surg 61:905–908CrossRefGoogle Scholar
  34. 34.
    Bottlang M, Simpson T, Sigg J, Krieg J, Madey S, Long W (2002) Noninvasive reduction of open-book pelvic fractures by circumferential compression. J Orthop Trauma 16:367–373CrossRefPubMedGoogle Scholar
  35. 35.
    Croce MA, Magnotti LJ, Savage SA, Wood GW II, Fabian TC (2007) Emergent pelvic fixation in patients with exsanguinating pelvic fractures. J Am Coll Surg 204:935–939CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Trauma and Emergency Radiology, Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma CenterUniversity of Maryland School of MedicineBaltimoreUSA
  2. 2.University of Maryland School of MedicineBaltimoreUSA
  3. 3.Orthopaedic Traumatology, Department of Orthopaedics, R Adams Cowley Shock Trauma CenterUniversity of Maryland School of MedicineBaltimoreUSA
  4. 4.Department of Diagnostic Radiology and Nuclear MedicineUniversity of Maryland School of MedicineBaltimoreUSA

Personalised recommendations