Circumferential pelvic binders have been developed to allow rapid closure of the pelvic ring in unstable fracture patterns. Despite evidence to support the use of pelvic binders, there is a paucity of clinical data regarding the effect of binder position on symphyseal diastasis reduction. All patients presenting to the UK's military hospital in Afghanistan who survived and underwent pelvic radiography were reviewed. Cases were identified by retrospective assessment of all digital plain pelvic radiographs performed between January 2008 and July 2010. All radiographs and CT images were assessed to identify the presence of any pelvic fracture. Patients were grouped into three categories according to the vertical level of the buckle: superior to the trochanters (high), inferior to the trochanters (low) and at the level of the trochanters (troch). Diastasis reduction was measured in patients with Anterior-Posterior Compression (APC) grades II and III, or Combined Mechanical Injuries(CMI). Comparison of diastasis reduction between the high and troch groups was assessed by an independent samples Student's t-test. We identified 172 radiographs where the metallic springs in the buckle of a SAM Pelvic Sling. ™. were clearly visible. The binders were positioned at the trochanteric level in 50% of radiographs. A high position was the commonest site of inaccurate placement (37%). In the patients with fractures and an open diastasis, the mean pelvic diastasis gap was 2.75 times greater in the high group compared to the trochanteric level (mean difference 22 mm) (p < 0.01). Application of pelvic binders superior to the greater trochanters is commonplace and associated with inadequate fracture reduction, which is likely to delay cardiovascular recovery in these significantly injured casualties

The radiological evidence of implant failure following plate fixation of traumatic pubic symphysis diastasis can be up to 75%. We report the complications following symphyseal double orthogonal plating in patients with pubic symphysis diastasis over a period of 2.5 years. Patient records and radiographs of 38 consecutive patients were reviewed with mean follow up of 12.5 months. 5 patients (13%) had radiological evidence of implant failure with one patient (2.6%) requiring revision surgery. There was no evidence of wound complications. We conclude that our lower rate of revision surgery and metal work failure is attributed to double orthogonal plating.