Article Text

Download PDFPDF
Improving the improvisational pelvic circumferential compression technique for open-book pelvic fractures using a simulation model and a sphygmomanometer
  1. Paul Patrick Rega1,
  2. B Fink1,
  3. M Sexton2,
  4. J Schneiderman3,
  5. E Kakish4,
  6. N McKenzie5,
  7. K Kenney1 and
  8. C Jones4
  1. 1 School of Population Health, College of Health and Human Services, University of Toledo, Toledo, Ohio, USA
  2. 2 College of Nursing, University of Toledo, Toledo, Ohio, USA
  3. 3 Interprofessional Immersive Simulation Center, University of Toledo, Toledo, Ohio, USA
  4. 4 Department of Emergency Medicine, University of Toledo, Toledo, Ohio, USA
  5. 5 School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, Ohio, USA
  1. Correspondence to Dr Paul Patrick Rega,School of Population Health, University of Toledo College of Health and Human Services, Toledo, USA; Paul.Rega{at}


Background Open-book pelvic fractures are associated with significant mortality. Emergency management may require a commercial pelvic circumferential compression device to reduce the fracture and compress haemorrhaging pelvic vasculature. Standard, commercial, twin-sized bedsheets are acceptable should commercial devices be unavailable. However, obese victims or personnel with insufficient body strength may impede successful reduction.

Objective To demonstrate the value of an improvisational windlass (intravenous pole) in improving the ability to reduce an open-book pelvic fracture.

Methods The Institutional Review Board-approved study involved 28 diverse healthcare students and emergency medicine residents. Each participant’s demographic information and physical characteristics were recorded. A METIman was prepared with knee and ankle binding and a sphygmomanometer set at 40 mm Hg placed over the symphysis pubis. Two-person teams were randomly selected to place a bedsheet at greater trochanter level and atop the sphygmomanometer. The bedsheet was secured with maximum effort by the pairs and the pressure recorded. Following this, the pairs inserted an intravenous pole in the knot and torqued the pole to maximum effort and a repeat pressure recorded.

Results The mean increase in pressure using only the bedsheet was 106.43 mm Hg per team. With bedsheet and intravenous pole, the mean pressure increase was 351.79 mm Hg per team. The difference was statistically significant (independent samples t-test: t = 17.177, p < 0.001, 95% CI (216.65 to 274.07 mm Hg). There was no correlation between pressure increases and the individual physical characteristics of the subjects (r = − 0.183, p = 0.352).

Conclusions Regardless of personnel’s physical attributes, the addition of an improvisational windlass to a pelvic circumferential compression bedsheet can improve the ability to reduce an open-book fracture, especially in obese victims.

  • emergency medicine
  • pelvic fracture
  • pelvic binder
  • improvisation
  • trauma management

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors All authors on this manuscript provided invaluable contribution to this work. Paul Rega was the lead in study design and teaching of the techniques applied in the study. Brian Fink performed data entry, analysis, assisted in interpretation. Nicole McKenzie assisted in the study design and teaching. Martha Sexton assisted in the teaching and data collection. Kevin Kenney assisted in data collection and teaching. Edward Kakish assisted in study design and data interpretation. Jeffrey Schneiderman assisted in providing the equipment needed for the study and assisted in teaching and data collection.

  • Competing interests None declared.

  • Ethics approval Biomedical Institutional Review Board - University of Toledo.

  • Provenance and peer review Not commissioned; externally peer reviewed.