Intraoperative Use of the Pelvic c-clamp as an Aid in Reduction for Posterior Sacroiliac Fixation

Abstract

Posterior pelvic ring injuries with dissociation of the sacroiliac joint can be a therapeutic challenge. Open procedures for reduction have a significant risk for wound complications although inadequate reductions using percutaneous methods can have poor long-term outcomes. Several indirect reduction methods have been previously described for closed reduction of the sacroiliac joint. We present our technique for the intraoperative use of the pelvic c-clamp as a reduction aid for the posterior pelvis in conjunction with percutaneous iliosacral screw fixation. This technique has been used routinely in our patients who sustain injuries to the sacroiliac joint and are candidates for closed reduction and percutaneous fixation. Our objective is to provide orthopedic surgeons an additional means by which to reduce sacroiliac disruptions by percutaneous means.

Case Report: The Prone Reduction of a Sacroiliac Disruption with a Pelvic C-clamp

“…Although used infrequently even in busy Level I trauma centers, the pelvic C-clamp may be applied with the patient supine, as reported by Wright et al [15], or in the prone position, as we describe in our patient. We believe this was advantageous in our patient as it allowed us to perform definitive fixation of the pelvic wing and the acetabulum in this position.…”

“…Wright et al [15] described using the pelvic C-clamp for the closed reduction and definitive fixation of an SI diastasis. The method seems particularly useful in patients who are obese and in those with marked displacement of the SI joint or a sacral fracture.…”

A Method of Using a Pelvic C-Clamp for Intraoperative Reduction of a Zone 3 Sacral Fracture

“…Wright et al describe successful reduction and fixation of a sacroiliac joint dissociation associated with a contralateral Denis classification zone 2 sacral fracture in a 26-year-old male using the pelvic C-clamp. The authors describe the use of the C-clamp intraoperatively, which allowed for reduction of the dissociated sacroiliac joint and the placement of transsacroiliac screws [15]. Wright et al recommend conducting the surgery with the patient in the supine position, obtaining fixation of the anterior pelvic ring injury first, and applying the C-clamp at the S2 level [15].…”

Emergent Management of APC-2 Pelvic Ring Injuries With an Anteriorly Placed C-Clamp

“…3,[14][15][16][29][30][31] Application of a pelvic C-clamp to unstable pelvic injuries, particularly posterior injuries, is an alternative method of temporary stabilization preceding definitive fixation. 1,2,16,32,33 The purpose of its application is identical to the rationale for early iliac external fixation: to restore the pelvic volume and reoppose fracture edges to reduce bleeding and to potentially allow hemostasis and clot formation by tamponade. There are 2 commercially available pelvic C-clamps.…”

“…We routinely prep the clamp out of the field but leave it in place until the reduction is maintained with a bone tenaculum, then remove it before the final adjustment of the reduction. 33 The disadvantages of the C-clamp are that it requires the institution to have the specialized equipment and the skilled personnel to use it.…”