Emergent management of APC-2 pelvic ring injuries with an anteriorly placed C-clamp.

OBJECTIVE: Can anteriorly placed pelvic C-clamps be used successfully in the emergent management of APC-2 pelvic fractures? DESIGN: Prospective cohort. SETTING: Level 1 trauma center. PATIENTS: A single-surgeon series of 24 patients with an anteroposterior compression type 2 pelvic fracture. INTERVENTION: Application of an anteriorly placed pelvic C-clamp within 2 hours of presentation. MAIN OUTCOME MEASUREMENTS: Response to hypotension, complications related to pin placement, application time, and symphyseal reduction measured on anteroposterior radiograph. RESULTS: Twenty-four patients with a mean age of 29 years (14-58 years) had an APC-2 pelvic fracture diagnosed by an anteroposterior radiograph of the pelvis on presentation. All patients were emergently managed with an anteriorly placed C-clamp applied in the emergency room (10), angiography suite (9), or operating room (5). Eleven patients presented with hypotension (systolic blood pressure <90 mm Hg) and had an average elevation of their blood pressure of 23 mm Hg (10-44 mm Hg). The symphyseal separation was reduced from a mean of 4.5 cm (3-9 cm) to <2 cm in all cases and to <1 cm in 21 of 24 cases. Complications included 1 misdiagnosis of an APC-3 injury and 2 cases in which the clamp became dislodged when the patients were rolled in the intensive care unit. Thirteen patients required laparotomy or angiography for further management after the C-clamp was applied. The C-clamp was easily draped out of the field for both procedures. CONCLUSIONS: The pelvic C-clamp can be placed anteriorly as a part of the early management of APC-2 pelvic fractures with a short application time in a variety of patient care areas.

Duke Scholars

Author Marc Joseph Richard Orthopaedic Surgery