Emergency Treatment of Multiply Injured Patients with Unstable Disruption of the Posterior Pelvic Ring by Using the “C–Clamp”

Tiemann, A.; Böhme, Jörg; Josten, Christoph

doi:10.1007/s00068-005-2053-5

Cited by 13 publications

(7 citation statements)

References 36 publications

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“…Previous studies have shown that the use of hemoglobin and hematocrit values alone may lead to fatal underestimation of the true hemodynamic status because they do not show any significant correlation with cellular perfusion and regional tissue oxygenation. [ 6 7 ] Traditional vital signs such as blood pressure and heart rate (HR) are not very sensitive in terms of detecting hemorrhage. [ 7 ] In our previous work, we therefore suggested that blood lactate levels and kinetics might be more appropriate parameters for diagnosing hemorrhage severity and for evaluating the efficacy of a therapy.…”

Section: Introductionmentioning

confidence: 99%

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

Lustenberger

Meier

Benninger

et al. 2011

J Emerg Trauma Shock

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Section: Introductionmentioning

confidence: 99%

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

Lustenberger

Meier

Benninger

et al. 2011

J Emerg Trauma Shock

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“…Blood pressure (systolic) has long been sided away since MAP (mean arterial pressure) showed true hemodynamic status. [14][15][16] This study showed that initial MAP did not differ in all patients since they all admitted in poor hemodynamic condition. Albeit the resuscitation and C-clamp insertion, the uncontrolled MAP afterward differed the outcome of the patient.…”

Section: Discussionmentioning

confidence: 85%

“…10,14 The clinical parameter (heart rate, mean arterial pressure) and physiological parameter (lactate levels, hemoglobin, hematocrit) could show the ongoing hemodynamic status. [14][15][16] Tiemann et al 16 showed that Hemoglobin and Hematocrit were not sensitive and could lead to fatal perception of the true hemodynamic status since those two parameters did not have significant correlation with cellular perfusion and regional tissue oxygenation. Blood pressure (systolic) has long been sided away since MAP (mean arterial pressure) showed true hemodynamic status.…”

Section: Discussionmentioning

confidence: 99%

Factors that influence the survival of unstable pelvic fracture in the acute phase

2018

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Background:The fatality rate of unstable pelvic fracture is still high (20-50%) due to acute phase hemorrhage or late multiple organ failure. The assurance for 100% survival in acute phase had been reported if the emergency room team have the right technique, right timing, and right protocol. The aim of this study was to evaluate and to date factors that influence the nonsurvival unstable pelvic fracture within 2x24 hours.Methods: This retrospective study was conducted in emergency unit of Dr. Soetomo General Hospital Surabaya during 2012-2016 for unstable pelvic fracture with unstable hemodynamic, without concomitant head or thoracic injury and admitted within 4 hours after the incident. All patients were handled according to the protocol for resuscitation and C-clamp insertion immediately. X-ray was taken after the insertion to check the C-clamp position and to confirm the diagnosis. The 2x24-hour data were taken whether the patient survive or not survive, including mean arterial pressure (MAP) pre-and post, heart rate (HR) pre-and post, and initial hemoglobin and platelet count. Data were analyzed with independent t-test and multiple regression analysis.Results: Twenty two patients were recorded as the inclusive criteria, separated into 17 survivors and 5 non-survivors. They were comprised of 14 males and 8 female patients, with an average of 31.9±15.3 years old. The MAP post, HR pre-and post, and platelet count were significantly different. The factor that influenced the survival within 2x24 hours was the MAP post C-clamp (>70 mmHg) (p<0.05). Conclusion:The acute phase 2x24-hour outcome after C-clamp insertion and resuscitation was significantly influenced by MAP post C-clamp and resuscitation.

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“…They concluded that the combination of a pelvic C-clamp and packing can effectively control pelvic hemorrhage in patients in extremis (12, 13). In an analysis of 28 patients, Tiemann et al (41) reported their experience using the pelvic C-clamp for emergency treatment of patients with unstable disruption of the posterior pelvic ring. Overall, seven (25%) patients died.…”

Section: Resultsmentioning

confidence: 99%

“…The surviving patients showed blood circulation stabilization as well as consolidation of the oxygenation level 6 h after C-clamping. Five hours after the use of the C-clamp, the number of required blood units decreased significantly (41). The use of the pelvic C-clamp, however, is limited to a subset of indications, and requires often a completion by an anterior external fixator or an anterior plate in C-type fractures.…”

Section: Resultsmentioning

confidence: 99%

Management of Bleeding Pelvic Fractures

Marzi

Lustenberger

2014

Scand J Surg

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Introduction: in patients with severe pelvic fractures, exsanguinating hemorrhage represents the major cause of death within the first 24 h. despite advances in management, the mortality rate in these patients remains significantly high. recently, multiple treatment algorithms have been proposed for patients with severe pelvic fractures; however, the optimal modalities in particular in the hemodynamically unstable patient are still a matter of lively debate.this review article focuses on the recent body of knowledge on the different treatment options in patients with severe pelvic fractures and proposes the possible role of each modality in the management of these patients.Methods: the Medline database was searched for medical literature addressing the management of severe pelvic fractures with specific attention given to recent, clinically relevant publications.Results: angiography and embolization have emerged as excellent methods for addressing arterial bleeding. Mechanical pelvic stabilization and surgical hemostasis by pelvic packing, on the other hand, may effectively control venous bleeding and bleeding from the fractured bony surface. However, since there is no precise way to determine the major source of bleeding that is responsible for the hemodynamic instability, controversy remains over the timing and optimal order of angiography, mechanical pelvic stabilization, and packing.Conclusions: the author's own approach to these patients includes angiographic embolization as a first-line treatment only in hemodynamically stable patients with an arterial blush seen in the computed tomography scan, indicating acute arterial bleeding. Hemodynamically unstable patients are immediately transferred to the operating room, where pelvic packing and mechanical stabilization of the pelvic ring are carried out. optionally, a subsequent postoperative angio-embolization is performed if signs of further bleeding remain present.

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Emergency Treatment of Multiply Injured Patients with Unstable Disruption of the Posterior Pelvic Ring by Using the “C–Clamp”

Cited by 13 publications

References 36 publications

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

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

Factors that influence the survival of unstable pelvic fracture in the acute phase

Management of Bleeding Pelvic Fractures

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