Abstract:
Apparatus and methods for stabilizing a fractured pelvis in an emergency using a sling having a buckle designed to automatically lock the circumference of the sling at a tension level that has been predetermined to be effective for stabilizing a fractured pelvis without excessive or potentially damaging compression.

Description:
CROSS-REFERENCE TO RELATED APPLICATION  
       [0001]    This application claims priority under 35 U.S.C. § 119 and applicable foreign and international law of the following U.S. provisional patent application which is hereby incorporated by reference in its entirety for all purposes: Serial No. 60/362,036, filed Mar. 5, 2002. This application also incorporates by reference application Ser. No. 09/639,544, filed Aug. 16, 2000. 
     
    
     
       FIELD OF THE INVENTION  
         [0002]    The invention relates to emergency treatment of a fractured pelvis. In particular, the invention provides a non-invasive sling device for reducing a fractured pelvis in a manner that minimizes internal bleeding.  
         BACKGROUND OF THE INVENTION  
         [0003]    Many people die from internal bleeding due to a fractured pelvis. Achieving rapid hemodynamic stability in patients who have a fractured pelvis decreases the mortality rate substantially. Unfortunately, currently there is no satisfactory method or device for stabilizing a fractured pelvis in emergency situations outside a hospital. Pelvic stabilization at an emergency site within the first hour after the fracture occurs is critical and may often determine whether the patient lives or dies.  
           [0004]    Stabilization of the pelvis is thought to be the most effective means to control bleeding for the following reasons. First, it decreases fracture fragment motion to prevent dislodgment of hemostatic clots and further tissue damage. Second, fracture reduction reopposes bleeding osseous surfaces, thus decreasing blood loss. Third, reduction decreases pelvic volume, thereby tamponading hemorrhage from the fracture and retroperitoneal tissue. Despite these widely recognized benefits, no adequate pelvic stabilization device for early management of pelvic fractures is currently available.  
           [0005]    The current standard of care for treating pelvic trauma consists of fluid resuscitation, including appropriate use of blood products, angiography if necessary, and early invasive or non-invasive pelvic stabilization. Non-invasive pelvic stabilization techniques have been used. For example, a sheet may be wrapped around the pelvis and tied. Alternatively, a vacuum-type splinting device, or a pneumatic anti-shock garment may be used. These non-invasive techniques have a number of significant problems. One problem is that successful use and application of the device is quite dependent on the emergency caregiver. The person applying the device may not know how much compressive force to apply circumferentially around the pelvis. If too much force is applied, then the pelvis may be overly compressed causing significant complications. On the other hand, insufficient compressive force may leave the fractured pelvis unreduced, and therefore fail to adequately control internal bleeding. These problems are complicated by the fact that the emergency caregiver typically does not know what type of fracture has occurred. Different types of pelvic fractures may require different amounts of constructive tension to achieve optimal stabilization.  
           [0006]    Another problem with some non-invasive pelvic stabilization devices is that they typically prohibit or restrict vital access to the abdomen, perineum, and lower extremity. Furthermore, prolonged application of devices such as the pneumatic anti-shock garment has been associated with significant complications, such as compartment syndrome of the lower limbs.  
           [0007]    Invasive pelvic stabilization methods utilize external fixation, pelvic C-clamps, and open reduction and subsequent internal fixation. External fixation devices can effectively reduce and stabilize the pelvis and are relatively simple to apply.  
           [0008]    Open reduction and internal fixation is the ultimate form of treatment for a fractured pelvis, and is considered the gold standard for accuracy of reduction, protection of neurovascular structures, and rigidity of fixation. However, its invasive nature makes it inappropriate for use in an emergency situation, such as the scene of a car accident, on the side of a mountain, or at a remote location of a traumatic fall where unstable pelvic ring disruptions require rapid pelvic reduction and temporary stabilization with limited information about the type or extent of internal injury. Therefore, invasive pelvic stabilization methods are used mainly in hospital operating rooms.  
           [0009]    Accordingly, an object of the invention is to provide a method and apparatus for pelvic and stabilization that is non-invasive.  
           [0010]    Another object is to provide a method and apparatus for pelvic stabilization that is capable of even and incremental application of hoop stress to both hemi-pelves while avoiding reactive forces that potentially can decrease the quality of reduction.  
           [0011]    Another object of the invention is to provide a method and apparatus for pelvic reduction and stabilization that applies and maintains hoop stress around the pelvis at a preset and safe level, while avoiding the application of excessive hoop stress.  
           [0012]    A further object of the invention is to provide a method and apparatus for stabilization of a fractured pelvis that can be applied in a rapid and simple manner by a single person without extensive training.  
           [0013]    Still another object of the invention is to provide a method and apparatus for stabilizing a fractured pelvis that can be applied at an emergency site without the need for additional complex or heavy equipment.  
           [0014]    Another object of the invention is to provide a method and apparatus for stabilizing a fractured pelvic in a nonintrusive manner, while allowing vital access to conduct other important emergency procedures on the patient.  
           [0015]    Another object of the invention is to provide a method and apparatus that permits stable pelvic reduction prior to and during the application of a pelvic external fixator in the clinical setting.  
         SUMMARY OF THE INVENTION  
         [0016]    The invention provides beneficial methods and apparatus for stabilizing a fractured pelvis in an emergency setting without requiring use of complex or invasive equipment. The invention may be used and carried out by a single person without extensive training or expertise.  
           [0017]    The invention provides a sling device for stabilizing a fractured pelvis. A buckle is connected to a strap member to form a closed loop. The buckle has at least one automatic locking mechanism that allows the strap member to be tightened around a fractured pelvis until a predetermined threshold force is reached. The closed loop then maintains a substantially constant circumference until the strap member is released from the buckle.  
           [0018]    The invention also provides a method of stabilizing a fractured pelvis. First, a belt is secured around a person&#39;s fractured pelvis. The tension of the belt is then automatically set at a level that has been predetermined to substantially reduce a fracture pelvis without excessive compression. In a preferred embodiment of the invention, the tension level of the belt is automatically set in the range of approximately 100 N to 180 N. 
       
    
    
     BRIEF DESCRIPTION OF THE FIGURES  
       [0019]    [0019]FIG. 1 is a front view of the pelvic ring.  
         [0020]    [0020]FIGS. 2A and 2B are front views of unstable pelvic ring disruptions.  
         [0021]    [0021]FIG. 3 is a top view of a pelvic sling.  
         [0022]    [0022]FIG. 4 is a front view of a pelvic sling applied to a fractured hip.  
         [0023]    [0023]FIG. 5 is a side view of the sling and hipbone structure shown in FIG. 4.  
         [0024]    [0024]FIG. 6 is a perspective view of a buckle for use on a pelvic sling.  
         [0025]    [0025]FIG. 7 is a partial front view of a sling showing one end portion of the sling engaging the buckle of FIG. 6.  
         [0026]    FIGS.  8 - 10  are cross-sectional views of the sling shown in FIG. 7, illustrating a mechanism for locking the tension of the belt.  
         [0027]    [0027]FIG. 11 is a partial cross-sectional view of the buckle shown in FIG. 6.  
         [0028]    [0028]FIG. 12 is a top view of an alternative pelvic sling design according to the invention.  
         [0029]    [0029]FIG. 13 is a partial front view of the pelvic sling shown in FIG. 12.  
         [0030]    [0030]FIGS. 14A and 14B are perspective views of the buckle used in the pelvic sling shown in FIG. 12, in the disengaged and engaged positions, respectively.  
         [0031]    [0031]FIG. 15 is a schematic side view of the buckle shown in FIG. 14.  
         [0032]    [0032]FIGS. 16A and 16B are cross sectional views of the buckle shown in FIG. 15.  
         [0033]    [0033]FIG. 17 is a front view of the buckle shown in FIG. 15.  
         [0034]    [0034]FIGS. 18A and 18B are cross-sectional views of the buckle shown in  
         [0035]    [0035]FIG. 17, in the disengaged and engaged positions, respectively.  
         [0036]    [0036]FIG. 19 is a perspective view of the pelvic sling as shown in FIG. 12, rolled up for storage.  
         [0037]    [0037]FIG. 20 is a front view of the pelvic sling shown in FIG. 12.  
         [0038]    [0038]FIG. 21 is a front view of the pelvic sling shown in FIG. 12 strapped around a person&#39;s pelvis.  
         [0039]    [0039]FIG. 22 is a graph illustrating the amount of tension required to reduce a fractured pelvis when the sling is applied at different locations.  
         [0040]    [0040]FIG. 23 is a bar graph illustrating the results of an experiment to determine the amount of sling tension required to adequately reduce the symphysis gap in an open-book pelvic fracture.  
         [0041]    [0041]FIG. 24 is a set of four CT images showing a fractured pelvis before and after sling-induced reduction.  
         [0042]    [0042]FIG. 25 is a bar graph showing the results of an experiment to compare the efficacy of various pelvic stabilizing techniques. 
     
    
     DESCRIPTION OF THE INVENTION  
       [0043]    The invention includes many aspects that may be employed advantageously to stabilize a fractured pelvis in an emergency situation. Generally, the invention employs a compressive device that can be easily applied to a patient to provide an appropriate level of hoop stress so that the fractured pelvis is significantly reduced or at least stabilized but not overly compressed. Preferred examples and embodiments of the invention are described below with reference to the figures.  
         [0044]    [0044]FIG. 1 shows the bone structure that is referred to as the pelvic ring  10 . The pelvic ring is formed by the sacrum  12 , ilium  14 , acetabulum  15 , ischium  16 , pubic rami  17 , and symphysis pubis  18 . Anteriorly, pelvic ring  10  contains a fibro cartilage joint. Posteriorly, the pelvic ring  10  contains the sacroiliac joints  20 , which connect the sacrum  12  with the left and right ilium.  
         [0045]    Unstable pelvic ring disruptions are usually manifested by two or more fracture sites. In an “open-book” fracture, as shown in FIG. 2A, pelvic ring disruption is evident at symphysis pubis  18  and at one or both sacroiliac joints  20 . FIG. 2B illustrates a lateral compression fracture in which pelvic ring disruption occurs at pubic rami  17  and at sacroiliac joint  20 .  
         [0046]    [0046]FIG. 3 shows a top view of a sling  30  including a belt member  32  operatively combined with buckle device  34 . Belt member  32  is comprised of two overlapping lateral portions  36   a  and  36   b . Belt portions  36   a  and  36   b  have a variably overlapping region  38  for making gross adjustments to the circumference of the sling so that one sling device can be used on people of different sizes. Any appropriate mechanism may be used to provide variable overlap fixation of lateral belt portions  36   a  and  36   b , for example, hook and loop type fasteners, for example, VELCRO™, may be utilized in overlapping region  38 .  
         [0047]    [0047]FIG. 4 is a front view of a pelvic sling shown in operative association with a human pelvis. FIG. 5 shows a side view of the same sling and pelvis of FIG. 4. Pelvic sling  50  has a belt portion  51  including an approximately 6-inch wide posterior sling component  52 . Posterior sling component  52  is situated behind sacrum  12  with its lower edge located at the level of the superior rim  54  of symphysis pubis  18 . Posterior sling component  52  is preferably made of a radiolucent material that is cushioned toward the skin interface to ensure a high degree of pressure distribution. The material is of sufficient stiffness to transmit tensile forces of at least 200 N without exhibiting strain larger than 10%. The material also has sufficient inherent elasticity to conform in part to body geometry. Posterior sling component  52  extends laterally toward the anterior portion of the abdomen. Symmetrical sling extensions  56   a  and  56   b  gradually decrease in width to approximately 2-inches as they circumvent the sides of the pelvis. The centerline of sling extensions  56   a  and  56   b  is approximately 2-inches above the lower edge of posterior sling component  52 . Sling extensions  56   a  and 56 b  are directed through buckle  58  which is centered over the abdomen. Buckle  58  reverses the direction of both sling extensions  56   a  and  56   b . Simultaneous application of sideward directed tensile force to each sling extension  56   a  and  56   b  yields in tensioning of the entire sling, which in turn induces even hoop stress around the pelvis. The hoop-stress subsequently reduces the geometric integrity of the disrupted pelvic ring and promotes stability of the fracture fragments. After application of sling tension at the appropriate level, the ends of sling extensions  56   a  and  56   b  are attached to lateral sling portions, for example, by hook and loop fasteners, to maintain sling tension.  
         [0048]    [0048]FIG. 6 shows a perspective view of a buckle design for use on a pelvic sling. Buckle  80  is characterized by side-to-side symmetry relative to axis AA. Each of lateral buckle portions  82   a  and  82   b  is designed to engage and secure an end of sling extensions  56   a  and  56   b , respectively, at an appropriate tension level. The details described below in relation to lateral buckle portions  82   b  are the same for lateral buckle portion  82   a , unless expressly distinguished.  
         [0049]    Lateral buckle portion  82   b  includes rotating cylinder  84  that is free to rotate when buckle  80  is unlocked. As shown in FIG. 7, sling extension  56   b  wraps around cylinder  84 . Cylinder  84  rotates in direction  86  when the sling is being tightened. Holes  88  are provided in cylinder  84 , as shown in FIG. 6, for engaging a pin to lock rotation of cylinder  84  as described in more detail. Gap  90  is defined between cylinder  84  and side bar  92 . Gap  90  is maintained by springs that are not shown in FIG. 11. As belt tension increases, cylinder  84  is pulled toward side bar  92 , thereby decreasing gap  90 . Eventually, a pin member extending from side bar  92  engages hole  88  in cylinder  84 , causing rotation of cylinder  84  to lock. The surface of cylinder  84  is devised to frictionally hold and resist slipping of the belt material around cylinder  84  when rotation is locked.  
         [0050]    Buckle  80  is preferably comprised of reliable and robust design components to enable reproducible sling application to a preset and safe tension level. Sling extensions  56   a  and  56   b  are inserted through center portion  94  of buckle  80  and reverted by means of cylinder  84 . Cylinder  84  have a rough outer surface to provide a high friction interface for engaging sling extensions  56   a  and  56   b . Cylinder  84  rotates with low friction on a polyethylene roller core (not shown). The roller cores can slide laterally on parallel guide rods  100 .  
         [0051]    FIGS.  8 - 10  show cross-sectional views through the sling of FIG. 7, illustrating the mechanism for locking rotational movement of cylinder  84 . Lateral translation of cylinder  84  on guide rod  100  in direction  102  causes lock pin  104  to engage holes  88  in cylinder  84 , disabling further rotation of cylinder  84 . This in turn disables further sling tensioning due to the high friction interface between sling extension  56   b  and the outer surface of cylinder  84 . This feature of the sling device automatically and reproducibly sets the tension of the sling at a predetermined level. The preset tensioning level is in the range of 100 N to 180 N, preferably 140 N.  
         [0052]    Once the sling tension level is reached, lock pin  104  engages hole  88  on cylinder  84  and enters a second hole of bigger diameter in cylinder  84 . Lock pin  104  has a widened tip portion that engages the inner lumen of cylinder  84 . Thus, even if the applied sling tensions decrease somewhat, cylinder  84  is not able to slide off lock pin  104 , since cylinder  84  will impinge the widened tip portion of lock pin  104 . Only if the applied sling tension decreases substantially will cylinder  84  be pushed off lock pin  104  by means of compression springs illustrated in FIG. 11. This design feature, referred to as “locking hysteresis,” makes it possible to maintain the preset sling tension, even if the applied tension to the sling extensions decreases. An emergency technician can affix the ends of sling extensions  56   a  and  56   b  to the lateral sling portions without the need to maintain full sling tension for a prolonged amount of time, and without losing the preset sling tension.  
         [0053]    [0053]FIG. 11 shows another cross-section through buckle  80  of FIG. 7. Compression spring  110  counteracts lateral translation of cylinder  84  along guidepost  100 . Compression spring  110  is mounted over guide rod  100 , between side bar  92  and cylinder  84 , and is covered by spring cage  112 . This design component allows guided lateral translation of cylinder  84  against a pair of compression springs  110 , only one of which is shown in FIG. 11. Collar  114  is located on the center region of guidepost  100 . Collar  114  can plant rigidly to any site on guidepost  100  via screws. Collar  114  is used to hold each cylinder  84  in a laterally translated position, at which spring  110  is compressed to a preset value, for example 70N for each compression spring. Therefore, cylinder  84  will maintain its position during sling tensioning up to the preset force value, while sling extensions  56   a  and  56   b  are pulled over the respective rotating cylinders. Only if the sling tension exceeds the preset value, will lateral translation of cylinder  84  be induced.  
         [0054]    The sling buckle components are preferably designed to be fabricated from non-metallic, radiolucent materials, excluding the cylinders, lock pins, and compression springs. This enables radiographic examination while maintaining pelvic reduction and stabilization.  
         [0055]    The sling design constitutes two distinct components, the sling or belt and the sling buckle, which are combined in a functional unit with minimal effort. Different size-specific slings may be used with the same buckle. Furthermore, it may be desirable to provide a sling device in which the belt component is disposable and the buckle is reusable, or in which the entire sling including the buckle is disposable.  
         [0056]    FIGS.  12 - 21  show an alternative embodiment of the invention. In FIG. 12 pelvic sling  200  includes main belt portion  206  for encircling at least about ¾ of a person&#39;s pelvis. Belt portion  206  has two ends  208  and  210 . Mounting member  212  can be removably attached, for example, by Velcro, to different positions on belt portion  206 . In FIG. 12 mounting member  212  is attached near end  210  of belt portion  206 . Mounting member  212  is connected to strap member  214  which may be threaded through buckle  216 . The end of strap member  214  has a loop or handle  218 . Buckle  216  is mounted near end  208  of belt portion  206 . A second handle  220  is connected to belt portion  206  near buckle  216  so that pelvic sling  200  may be tightened by pulling handles  218  and  220  in opposite directions.  
         [0057]    A partial front view of pelvic sling  200  is shown in FIG. 13. Strap member  214  has two rows of holes  230  for receiving spring biased pins in buckle  216 .  
         [0058]    Perspective views of buckle  216  are shown in FIGS. 14A and 14B. Buckle  216  is made primarily from two parts, namely, rigid buckle frame  240  and sliding block  242 . Sliding block  242  is movable in direction A-A relative to buckle frame  240 . A pair of holes  244  are provided in sliding block  242 . When strap member  214  is pulled against sliding block  242  internal springs are compressed, eventually resulting in extension of pins  246  through apertures  244 , as shown in FIG. 14B. Pin structures  246  may then engage holes  230  in strap member  214 .  
         [0059]    [0059]FIGS. 19A and 19B show spring  250  positioned around one of pins  246 . An identical spring  250  (not shown) is used on the other pin structure. FIGS. 18A and 18B show different sectional views of spring  250  in the disengaged and engaged positions, respectfully. Note that spring  250  in the disengaged position is already compressed significantly so that substantial force must be applied to sliding block  242  before it begins moving relative to buckle frame  240 . Flange  270  on buckle frame  240  engages lip  272  of sliding block  242 , thus retaining assembly of buckle frame  240  in sliding block  242  against the force of spring  250 . When buckle  216  is engaged, as shown in FIG. 18B, lip  272  on sliding block  242  brackets bottom corners of buckle frame  240 . This creates an audible “click” so that the user knows the buckle is engaged. Further, the flange bracketing creates a hysteresis affect which is explained in more detailed below.  
         [0060]    In use, main belt portion  206  is placed around the back of a person&#39;s pelvis. Mounting member  212  is positioned at an appropriate location on the external side of belt portion  206 , depending on the size of the patient. Strap member  214  is already pre-threaded through buckle  216 . The caregiver then simply pulls handles  218  and  220  in opposite directions until the pins in buckle  216  emerge from holes  244  and engage holes  230  in strap member  214 . Spring  250  is selected to have an appropriate spring constant, and length so that an optimal amount of force is required to engage buckle  216  with holes  230  in strap member  214 . Studies have shown that the appropriate amount of tension is between 100 N to 180 N; or preferably between about 130 N to 150 N.  
         [0061]    Pelvic sling  200  is made from a minimal number of components, and at minimal expense. The materials, except for the springs, are radiolucent. The sling design provides a completely assembled solution, ready for application.  
         [0062]    Pelvic sling  200  uses a positive form-based locking design at a predetermined belt tension. The belt is guided over the semi-cylindrical surface of the sliding block. At a predetermined belt tension, the sliding block retracts so the two prongs advance through corresponding openings in the semi-cylindrical surface of the sliding block. The prongs engage equally-sized holes in a portion of the belt to prevent any further sliding of the belt over the sliding block. The holes in the belt have a slightly larger diameter than the prongs so that engagement occurs smoothly at the desired tension level.  
         [0063]    Pelvic sling  200  requires a user to apply a predetermined sling tension of approximately 100 N to 180 N, at which point the prongs engage the perforated belt section. To facilitate definitive attachment of the belt end to the lateral belt portion by means of Velcro, the prongs stay engaged and hold the sling tension even if the user reduces the applied sling tension during the belt attachment procedure. Only if the sling tension is reduced by over about 50% will the prongs disengage which will yield an immediate release of pelvic circumferential compression. This hysteresis effect is achieved in part by friction between the engaged prongs and the belt and in part by a lip on the sliding block which partially engages rear corners of the buckle frame.  
         [0064]    As soon as the predetermined belt tension is achieved, the lip of the sliding block will “snap” over edges of the buckle frame, which is accompanied by a clearly audible “click” sound. This sound intuitively provides the user with an audible feedback on the positive locking between the belt and the buckle, exactly at the time of the actual locking of the belt in the buckle.  
         [0065]    Compressive springs are installed between the sliding block and the buckle frame to allow retraction of the sliding block and penetration of the prongs through the sliding block at a predetermined belt tension. The springs are installed with significant pre-tension. Therefore, even if the user applies a significant belt tension, the sliding block will not retract over the buckle frame. Only if the user applies a tension which approaches the desired locking tension, for example, approximately 140 N, will the sliding block retract. This pre-tension supports the user&#39;s intuitive feedback on positive locking, since only after a certain sling tension will the sliding block rapidly retract and prongs then quickly engage to stop the belt from further tensioning.  
         [0066]    The belt buckle consists of one or more compression springs in two polyethylene parts (i.e., buckle frame and sliding block). The buckle is assembled by placing the springs on the buckle frame, and by snapping the sliding block over the springs on the buckle frame. Two lips on the sliding block engage edges on the buckle frame to provide permanent engagement. Disassembly can be achieved with a simple tool by prying the buckle frame and sliding block apart.  
         [0067]    With exception of the compression springs, the belt buckle and the belt are radiolucent. The compression springs can be used as a radiographic index and documentation for the application and maintenance of sling tension. Alternatively, the compression springs might be replaced by a properly-dimensioned, oblique sliding surface on the buckle frame. This oblique surface will require the sliding block to expand upon retraction, where the amount of expansion can be dimensioned to yield the desired sling tension limit.  
         [0068]    The assembled buckle constitutes a coherent, essentially rectangular unit with rounded edges and smooth surfaces. The design does not have exposed interfaces between moving parts, which could cause entrapment of fabric or pinching of skin during sling application. The buckle is permanently attached to one side of the belt. A tensioning handle on the opposite belt side is already engaged through the belt buckle. The tensioning handles are color coded in a bright fashion. Application of the sling requires three steps: (1) overlap and secure the belt end (mounting member  212 ) via Velcro; (2) pull the tensioning handles until the tensioning limit is reached; and (3) secure the tensioning handles via Velcro to the medio-lateral belt portion.  
         [0069]    An optimal sling location has been found to be within a transverse plane at the level of the greater trochanteric region, just proximal of the pubis symphysis. Application of a sling further distally is not feasible from a clinical perspective, disabling vital access to rectal and genital regions and the femoral artery. Application of a sling further proximally results in a significant decrease in the amount and quality of pelvic reduction corresponding to constant amounts of sling tension. FIG. 22 is a bar graph showing the results of an experiment to determine which sling location required the least sling tension to achieve pelvic reduction in different fracture scenarios. The graph shows that distal sling application, i.e., at the level of the acetabulum, required the least sling tension to achieve pelvic reduction in each of four different fracture scenarios: partially stable, unstable, partially stable and hemorrhaging, unstable and hemorrhaging.  
         [0070]    [0070]FIG. 23 shows a bar graph illustrating the results of an experiment to determine the relationship between sling tension and symphysis gap reduction for open-book fractures. A sling tension level of 200 N was required to reduce the symphysis gap to less than 10 mm.  
         [0071]    [0071]FIG. 24 shows four CT images of a fractured pelvis. FIGS. A and B show the fractured pelvis prior to sling-induced reduction. The pelvic ring disruption is apparent by a widened SI joint in image (A) and a symphysis gap of 50 mm (B). As shown in images C and D, sling tension at the acetabular level at a tension of 200 N resulted in efficient translation of the applied sling tension into pelvic reduction.  
         [0072]    [0072]FIG. 25 shows the result of a biomechanical study to determine how much stabilization can be achieved with a non-invasive pelvic sling compared to invasive stabilization alternatives such as a C-clamp or an anterior external fixator. Unstable, unilateral open-book fractures (APC III, 100 mm symphysis diastasis) were created in eight non-embalmed human cadaveric specimens. Stabilization was provided first with the pelvic sling, applied around the greater trochanters, at a tension of 180 N. Subsequently, stabilization was provided with a posterior Pelvic C-clamp (Synthes, Monument, Colo.), and an anterior external fixator (Synthes, Paoli, Pa.). Stability was assessed in terms of the rotation of the unstable hemipelvis (α IR/ER , α FL/EX ) in response to defined stress (9 Nm internal/external rotation or flexion/extension moments).  
         [0073]    The bar graph in FIG. 25 shows that the pelvic sling significantly stabilized the open-book fractures and reduced fracture motion by up to 60%. The pelvic sling provided as much stabilization as the posterior Pelvic C-clamp. Compared to an external fixator, the pelvic sling provided 1/3 of the flexion-extension stability, but 10 times less internal/external rotation stability.  
         [0074]    The experiments referred to in FIGS. 23 and 25 were conducted with cadavers with open-book pelvic fractures. Other types of pelvic fractures such as lateral compression fractures, as shown in FIG. 2B, are also common and may be treated with a pelvic sling in accordance with the invention. Fractures such as a lateral compression fracture should generally be treated with a lower tension level than may be used on an open-book fracture. For example, a 200 N tension may be used effectively on an open-book fracture, but could cause damaging overcompression on a lateral compression fracture. In an emergency situation, it is typically difficult if not impossible to diagnose the type of pelvic fracture. Therefore, it has been determined that the best strategy is to design the buckle to engage at a tension level that is slightly lower than may otherwise be optimally used on an open-book fracture. Accordingly, when treating a pelvic fracture in an emergency situation where it is unknown what type of fracture has occurred, the tension level should be between 100 N to 180 N, preferably 140 N. A 140 N tension level is sufficient to substantially stabilize a lateral compression fracture or an open-book fracture, without causing complications from excess compression, even though the symphysis gap may not be completely reduced.  
         [0075]    Although the invention has been disclosed in its preferred forms, the specific embodiments thereof as disclosed and illustrated herein are not to be considered in a limiting sense, because numerous variations are possible. As used herein, singular terms do not preclude the use of more than one of the associated element, and embodiments using more than one of a particular element are within the spirit and scope of the invention. Applicants regard the subject matter of their invention to include all novel and nonobvious combinations and subcombinations of the various elements, features, functions, and/or properties disclosed herein. The following claims define certain combinations and subcombinations of features, functions, elements, and/or properties that are regarded as novel and nonobvious. Other combinations and subcombinations may be claimed through amendment of the present claims or presentation of new claims in this or a related application. Such claims, whether they are broader, narrower, equal, or different in scope to the original claims, also are regarded as included within the subject matter of applicants&#39; invention.