Pelvic Binder: location, location, location.

Another abstract on location for SI belts. In reviewing multiple images of diastasis, it is interesting to note that the separation at the symphysis can be severe such as greater than 1" (2.54 cm), yet the increased width at the sacroiliac joints is much less, only a few millimeters. It seems reasonable that for subtle forms of SIJ hypermobility that do not show on MRI, that the same low application of the support is appropriate. The high application is certainly contraindicated for most post-partum because it actually replicates the lower pubic joint distractive forces. Specific research needed on a large scale for the subtler SIJD cases of which many are not actually hypermobile, in spite of symptoms. 
J Bone Joint Surg Br. 2011 Nov;93(11):1524-8.
Accurate placement of a pelvic binder improves reduction of unstable fractures of the pelvic ring.
Bonner TJ, Eardley WG, Newell N, Masouros S, Matthews JJ, Gibb I, Clasper JC.
Source
Royal Centre for Defence Medicine, Academic Department of Military Surgery and Trauma, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ, UK. [email protected]
Abstract
The aim of this study was to assess the accuracy of placement of pelvic binders and to determine whether circumferential compression at the level of the greater trochanters is the best method of reducing a symphyseal diastasis. Patients were identified by a retrospective review of all pelvic radiographs performed at a military hospital over a period of 30 months. We analysed any pelvic radiograph on which the buckle of the pelvic binder was clearly visible. The patients were divided into groups according to the position of the buckle in relation to the greater trochanters: high, trochanteric or low. Reduction of the symphyseal diastasis was measured in a subgroup of patients with an open-book fracture, which consisted of an injury to the symphysis and disruption of the posterior pelvic arch (AO/OTA 61-B/C). We identified 172 radiographs with a visible pelvic binder. Five cases were excluded due to inadequate radiographs. In 83 (50%) the binder was positioned at the level of the greater trochanters. A high position was the most common site of inaccurate placement, occurring in 65 (39%). Seventeen patients were identified as a subgroup to assess the effect of the position of the binder on reduction of the diastasis. The mean gap was 2.8 times greater (mean difference 22 mm) in the high group compared with the trochanteric group (p < 0.01). Application of a pelvic binder above the level of the greater trochanters is common and is an inadequate method of reducing pelvic fractures and is likely to delay cardiovascular recovery in these seriously injured patients.