Abstract
Severe bleeding is the major cause of death in unstable pelvic ring fractures. Therefore, a quick and efficient emergency stabilization and bleeding control is inevitable. C-clamp and pelvic binder are efficient tools for temporary bleeding control, especially from the posterior pelvic ring. Yet the C-clamp requires more user knowledge, training and equipment. However, whether this makes up for a more efficient bleeding control, is still under debate. Patients with a type-C pelvic ring fracture were identified from the German Pelvic Registry (GPR) and divided into three groups of 40 patients (1. no emergency stabilization, 2. pelvic binder, 3. C-clamp). The matching occurred according to the parameters age, gender, initial RR and initial HB. Complication—and mortality rates were compared especially regarding bleeding control. Regarding ISS and fracture dislocation there was no difference. The use of the C-clamp resulted in more complications, a higher mortality rate due to severe bleeding and more blood transfusions were admitted. Moreover the pelvic binder was established noticeably faster. However, the C-clamp was more often rated as effective. There is no evidence of advantage comparing the C-clamp to the pelvic binder, regarding bleeding control in type-C pelvic ring fractures. In fact, using the pelvic binder even showed better results, as the time until established bleeding control was significantly shorter. Therefore, the pelvic binder should be the first choice. The C-clamp should remain a measure for selected cases only, if an adequate bleeding control cannot be achieved by the pelvic binder.
Highlights
Severe bleeding is the major cause of death in unstable pelvic ring fractures
That unstable pelvic ring fractures with complete discontinuity of the posterior pelvic ring, have the highest probability of all pelvic fractures for potentially fatal bleeding[7,8,9]
In the group without emergency stabilization a significantly lower ISS could be identified compared to both, the pelvic binder group (p = 0.002) and the C-Clamp group (p = 0.027)
Summary
Severe bleeding is the major cause of death in unstable pelvic ring fractures. a quick and efficient emergency stabilization and bleeding control is inevitable. C-clamp and pelvic binder are efficient tools for temporary bleeding control, especially from the posterior pelvic ring. There is no evidence of advantage comparing the C-clamp to the pelvic binder, regarding bleeding control in type-C pelvic ring fractures. Treatment options of severely bleeding pelvic ring fractures range from non invasive procedures, like the pelvic binder, through minimally invasive procedures like the pelvic C-clamp or the external fixator or interventional radiological coiling, up to open surgical pelvic packing. Drastically, regarding the invasiveness of the procedure, and regarding the need for technical and infrastructural resources and the personal experience and training of the treating p hysician[10,11,12]
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