Effectiveness and complications of primary C-clamp stabilization or external fixation for unstable pelvic fractures

Abstract

Background and purpose Unstable pelvic fractures frequently require emergency stabilization using a C-clamp or external (CC/EF) fixation. However, the effectiveness of this intervention and associated complications are still a matter of debate. Patients and methods The analysis used data available from the German Pelvic Trauma Registry to study general complications, infections and mortality after primary stabilization using CC/EF in 5,499 patients (n=957 with vs n=4,542 without). Furthermore, the subgroups with secondary surgery (n=713 vs n=1,695), and ilio-sacral screw implantation following C-clamp stabilization were evaluated (n=24 vs n=219). Calculated odds ratios were adjusted for potential confounders. Results Patients treated by CC/EF were younger (45±20 vs 62±24 years), had more C-type fractures (65% vs 28%), higher ISS (≥25 63% vs 20%) and displacement (≥3mm 81% vs 41%), and more complex fractures (32% vs 5%). These features were independent risk factors for complications (p<0.001). While mortality was reduced after CC/EF stabilization by 32% (OR 0.68 95%CI 0.49-0.95), the risk for general complications was slightly increased (OR 1.25 95% CI 1.02-1.53). In patients undergoing secondary surgery, CC/EF fixation had no influence on mortality, general complications or infections. Related to preceding C-clamp stabilization (OR 4.67 95% CI 1.06-20.64), the risk for infection increased from 3.2% to 20.8% in ilio-sacral screw fixation. Interpretation Primary stabilization of unstable pelvic fractures with C-clamp or external fixation is associated with a decreased mortality and was not an independent risk factor for complications after secondary surgery. However, the risk for infection after ilio-sacral screw fixation increased almost 5-fold after C-clamp use.

Comparison of pelvic C-clamp and pelvic binder for emergency stabilization and bleeding control in type-C pelvic ring fractures

“…We evaluated the effectiveness and the complications of the C-clamp compared to the pelvic binder only in type-C pelvic ring injuries. Regarding the fracture dislocation, which is discussed to be an indicator of injury severity and bleeding risk 15,19 , we could not find a significant difference between the pelvic binder and the C-clamp. While the group matching ensured that age and gender, and especially the initial hemodynamic conditions, such as initial blood pressure and initial HB level, were not different between the two groups, injury severity as a possible confounder was ruled out, since only patients p = 0.015; 0-6 h p = 0.028; 7-12 h p = 0.109; 13-24 h p = 0.260).…”

“…Recently, Schmal et al 15 showed that mortality and complication rates after invasive emergency treatment (c-clamp and external fixator) are higher than in the non-invasive treatment group (pelvic binder). They attributed this observation to other risk factors, in particular age and ISS.…”

“…These advantages of the pelvic binder might be the reason why its use has increased over the past years, whereas the pelvic C-clamp has been used less frequently 15 . In contrast, Schmal et al showed that the invasive primary emergency stabilization of pelvic fractures with either a pelvic C-clamp or an external fixator is associated with a reduced mortality 15 compared to the non-invasive primary care with the pelvic binder.…”

“…These advantages of the pelvic binder might be the reason why its use has increased over the past years, whereas the pelvic C-clamp has been used less frequently 15 . In contrast, Schmal et al showed that the invasive primary emergency stabilization of pelvic fractures with either a pelvic C-clamp or an external fixator is associated with a reduced mortality 15 compared to the non-invasive primary care with the pelvic binder. In consequence, there has been a noticeable shift towards the pelvic C-clamp in injuries with increased severity as part of the damage control concept, as the pelvic C-clamp is considered the more effective therapy regarding bleeding control, especially in type-C pelvic ring fractures 10 , 15 .…”

Pre-peritoneal Pelvic Pack with External Fixator versus Pelvic Pack Alone for Hemodynamically Unstable Patients with Pelvic Fracture; a Historical Cohort Study

“…xator was established as the mainstay in treatment, while some others used PPP with C-Clamp in according with external xator (11,12). There is no evidence about comparing different types of surgeries.…”