Effectiveness and complications of primary C-clamp stabilization or external fixation for unstable pelvic fractures.

Schmal, Hagen; Larsen, Morten Schultz; Stuby, Fabian; Strohm, Peter C; Reising, Kilian; Goodwin Burri, Kelly (2019). Effectiveness and complications of primary C-clamp stabilization or external fixation for unstable pelvic fractures. Injury - international journal of the care of the injured, 50(11), pp. 1959-1965. Elsevier 10.1016/j.injury.2019.08.039

	Text Schmal Injury 2019_epub.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (409kB) | Request a copy
Preview	Text Schmal Injury 2019_postprint_AAM.pdf - Accepted Version Available under License Creative Commons: Attribution-Noncommercial-No Derivative Works (CC-BY-NC-ND). Download (388kB) | Preview

BACKGROUND AND PURPOSE

Unstable pelvic fractures frequently require emergency stabilization using a C-clamp or external (CC/EF) fixation. However, the effectiveness of this intervention and associated complications are still a matter of debate.

PATIENTS AND METHODS

The analysis used data available from the German Pelvic Trauma Registry to study general complications, infections and mortality after primary stabilization using CC/EF in 5,499 patients (n = 957 with vs n = 4,542 without). Furthermore, the subgroups with secondary surgery (n = 713 vs n = 1,695), and ilio-sacral screw implantation following C-clamp stabilization were evaluated (n = 24 vs n = 219). Calculated odds ratios were adjusted for potential confounders.

RESULTS

Patients treated by CC/EF were younger (45 ± 20 vs 62 ± 24 years), had more C-type fractures (65% vs 28%), higher ISS (≥25 63% vs 20%) and displacement (≥3 mm 81% vs 41%), and more complex fractures (32% vs 5%). These features were independent risk factors for complications (p < 0.001). While mortality was reduced after CC/EF stabilization by 32% (OR 0.68 95%CI 0.49-0.95), the risk for general complications was slightly increased (OR 1.25 95% CI 1.02-1.53). In patients undergoing secondary surgery, CC/EF fixation had no influence on mortality, general complications or infections. Related to preceding C-clamp stabilization (OR 4.67 95% CI 1.06-20.64), the risk for infection increased from 3.2% to 20.8% in ilio-sacral screw fixation.

INTERPRETATION

Primary stabilization of unstable pelvic fractures with C-clamp or external fixation is associated with a decreased mortality and was not an independent risk factor for complications after secondary surgery. However, the risk for infection after ilio-sacral screw fixation increased almost 5-fold after C-clamp use.

Interest & Impact

Downloads

249 since deposited on 09 Sep 2019
53 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item