C-clamp and pelvic packing for control of hemorrhage in patients with pelvic ring disruption

Lustenberger, Thomas; Meier, Christoph; Benninger, Emanuel; Lenzlinger, Philipp M.; Keel, Marius

doi:10.4103/0974-2700.86632

Cited by 37 publications

(11 citation statements)

References 14 publications

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“…However, application may not be effective in patients with vertical shear type fractures, concomitant proximal femur, or acetabular fractures (60% in the present study and 1.5% of pelvic fractures requiring emergency external stabilization [7]) and carries a risk of overreduction, misplacement, and pressure sores after 24-36 h [45,[48][49][50]. In the context of the interregional variation of preferences and algorithms [14,26,40,51], the clarification of the resuscitative potential of C-clamps within the cascade of emergency management is essential.…”

Section: Discussionmentioning

confidence: 71%

“…The decrease in C-clamp use over the past decades may be a result of concerns about the correct indication, technique, effectiveness, and safety of this procedure [7]. Despite great variation (8% to 58%) in reported mortality rates after C-clamp application [2,3,6,14,15,20,25,[34][35][36][37]), it is believed to contribute to a reduction in mortality [OR 0.68 (0.49-0.95)] [6]. Therefore, many authors favor the use of pelvic C-clamp application before extra-and/or intraperitoneal pelvic packing and angiography [11,[38][39][40][41].…”

Section: Discussionmentioning

confidence: 99%

“…In Tile types B and C, Young and Burgess types APCII/III, and VS fractures [2,3,6,7,14,15,20,28,35,37,[52][53][54][55], pelvic C-clamp application has long been a component of clinical practice, aimed at achieving direct sacroiliac compression for hemorrhage control ('first line of defense' [11]) [2,3,21,34,38]. Additionally, C-clamp application can be used instead of pelvic binders if a patient's condition does not permit timely, definitive stabilization or to facilitate nursing and transfer.…”

Section: Discussionmentioning

confidence: 99%

“…Considering the balancing act of sABP correction in hemorrhage (maintenance of end organ perfusion versus allowance for clot maturation), the attainment of cut-off values within a given range seems more important compared to the absolute sABP increase [27,58]. While sABP is known to be rather insensitive with regard to the detection of hemorrhage because it changes with levels of pain, emotional distress, and hypoxia [14,20,31], underlying mechanistic considerations can only partially be assumed for the stabilization of hemorrhage. The contribution of pelvic C-clamp application to sABP stabilization in 62% of patients that did not respond to initial fluid resuscitation is the most important finding of this retrospective study.…”

Section: Discussionmentioning

confidence: 99%

“…Lesions of the posterior pelvic ring have an 80% risk of concomitant and potentially fatal hemorrhage, with reported mortality rates of up to 57% [3,[9][10][11][12]. In these cases, relevant and potentially occult pelvic bleeding originates from the venous plexus or cancellous bone in 80-90% of patients [11,13,14]. The discontinuity of Medicina 2022, 58, 1291 2 of 13 the pelvic compartment borders caused by damage to ligaments of the pelvic ring, pelvic floor and iliopectineal fascia results in an increased pelvic volume and limits self-tamponade in a 'chimney effect' [2,15,16].…”

Section: Introductionmentioning

confidence: 99%

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Effect of C-Clamp Application on Hemodynamic Instability in Polytrauma Victims with Pelvic Fracture

et al. 2022

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Background and Objectives: C-clamp application may reduce mortality in patients with unstable pelvic fractures and hemodynamic instability. Decreasing C-clamp use over the past decades may have resulted from concerns about its effectiveness and safety. The purpose of this study was to document effective hemodynamic stabilization after C-clamp application by means of vital parameters (primary outcome parameter), and the subsequent effect on metabolic indices and volume management (secondary outcome parameters). Materials and Methods: C-clamp application was performed between 2014 and 2021 for n = 13 patients (50 ± 18 years) with unstable pelvic fractures and hemodynamic instability. Vital parameters, metabolic indices, volume management, and the correlation of factors and potential changes were analyzed. Results: After C-clamp application, increases were measured in systolic blood pressure (+15 mmHg; p = 0.0284) and mean arterial pressure (+12 mmHg; p = 0.0157), and a reduction of volume requirements (p = 0.0266) and bolus vasoactive medication needs (p = 0.0081) were observed. The earlier C-clamp application was performed, the greater the effect (p < 0.05; r > 0.6). Heart rate, shock index, and end-tidal CO2 were not significantly altered. The extent of base deficit, hemoglobin, and lactate did not correlate with changes in vital parameters. Conclusions: In the majority of hemodynamically unstable trauma patients not responding to initial fluid resuscitation and severe pelvic fracture, early C-clamp application had an additive effect on hemodynamic stabilization and reduction in volume substitution. Based on these findings, there is still a rationale for considering early C-clamp stabilization in this group of severely injured patients.

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