gms | German Medical Science

Objectives: 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. The C-clamp and the 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.

Methods: 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. treatment without emergency stabilization, 2. treatment with pelvic binder and 3. treatment with C-clamp. The matching occurred according to the parameters age, gender, initial RR and initial HB. Complication - and mortality rates were compared between the groups especially regarding bleeding control. Therefore we compared the amount of admitted blood transfusions and the time until bleeding control was established.

Results: Regarding total ISS and fracture dislocation there was no difference between the three groups. The use of the C-clamp resulted in more complications and a higher mortality rate due to severe bleeding. In the C-clamp group more blood transfusions were admitted (Fig. 1). A significant difference persists in the comparison between the group without emergency stabilization (median 0-24h = 2.5; 0-6h = 2; 7-12h = 0; 13-24h = 0) and the group with c-clamp treatment (median 0-24h = 14; 0-6h = 6.5; 7-12h = 0; 13-24h = 0) only for the time periods 0-24h and 0-6h (0-24h p = 0.015; 0-6h p = 0.028; 7-12h p = 0.109; 13-24h p =0.260). Not significant is the difference between the pelvic binder group (median 0-24h = 6; 0-6h = 4; 7-12h = 2; 13-24h = 0) and both, the C-clamp group (0-24h p = 0.507; 0-6h p = 0.143; 7-12h p = 1; 13-24h p =0.276) and the group without emergency stabilization (0-24h p = 0.138; 0-6h p = 0.204; 7-12h p = 0.256; 13-24h p = 0.053). Moreover the pelvic binder was established noticeably faster. However, the C-clamp was more often rated as effective.

Conclusion: 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 to achieve bleeding control in unstable pelvic ring fractures. The use of the C-clamp should remain a measure for selected cases only, if an adequate bleeding control cannot be achieved by the pelvic binder.