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PRACTICE OF USING THE PELVIC C-CLAMP IN PATIENTS WITH SEVERE CONCOMITANT PELVIC INJURY

https://doi.org/10.24884/0042-4625-2018-177-4-38-43

Abstract

The  OBJECTIVE  the  study  is to rate  the  clinical efficacy  of pelvic C-clamp  in patients with unstable pelvic ring injuries  and signs  of intrapelvical  ongoing  bleeding. MATERIAL AND METHODS.  We  studied the  results of treatment of 87  patients with unstable pelvic  ring injuries signs  of unstable hemodynamics. Pelvic  C-clamp  was  used for mechanical stabilization of the  posterior pelvic  half-ring  in order  to stop  the  ongoing  pelvic  bleeding. Surgical methods of hemostasis in addition to  the  stabilization of the  pelvis  were  used in 30  patients. Control  of systolic  blood  pressure in the  dynamics,  volume and   duration   of  blood   transfusion  therapy  were   carried   out  to  assess the   effectiveness  of  hemostasis.  Additionally, spiral computed tomography with intravenous contrast enhancement and pelvic diagnostic angiography were performed. RESULTS.   Surgical   methods of  hemostasis  combined with  mechanical  stabilization of  the  damaged pelvic  ring  made allow  to  achieve the  final  stopping of  the  ongoing   pelvic  bleeding in  ¾   patients. CONCLUSION. In severe concomitant pelvic  injury,  surgical   methods of  hemostasis in  combination with  mechanical  stabilization of  the  damaged pelvic  ring should   be  actively  used in  patients in  critical  condition.

About the Authors

I. V. Kazhanov
Federal State Budgetary Institution «Saint-Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine»; Federal State Budgetary Military Educational Institution of Higher Education «Military Medical Academy named after S.M. Kirov» of the Ministry of Defence of the Russian Federation
Russian Federation
St. Petersburg.


V. A. Manukovskii
Federal State Budgetary Institution «Saint-Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine»; Federal State Budgetary Military Educational Institution of Higher Education «Military Medical Academy named after S.M. Kirov» of the Ministry of Defence of the Russian Federation
Russian Federation
St. Petersburg.


I. M. Samokhvalov
Federal State Budgetary Institution «Saint-Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine»; Federal State Budgetary Military Educational Institution of Higher Education «Military Medical Academy named after S.M. Kirov» of the Ministry of Defence of the Russian Federation
Russian Federation
St. Petersburg.


G. M. Besaev
Federal State Budgetary Institution «Saint-Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine»
Russian Federation
St. Petersburg.


S. I. Mikityuk
Federal State Budgetary Institution «Saint-Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine»; Federal State Budgetary Military Educational Institution of Higher Education «Military Medical Academy named after S.M. Kirov» of the Ministry of Defence of the Russian Federation
Russian Federation
St. Petersburg.


V. G. Bagdasariants
Federal State Budgetary Institution «Saint-Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine»
Russian Federation
St. Petersburg.


References

1. Abrassart S., Stern R., Peter R. Unstable pelvic ring injury with hemodynamic instability : what seems the best procedure choice and sequence in the initial management? // Orthop. Traumatol. Surg. Res. 2013. Vol. 99. P. 175–182.

2. Esmer E., Derst P., Schulz M. et al. Influence of external pelvic stabilization on hemodynamically unstable pelvic fractures // Unfallchirurg. 2017. Vol. 120, Supp. 4. P. 312–319.

3. Gansslen A., Krettek C., Pohlemann T. Emergency stabilization with the pelvic C-clamp // Eur. J. Trauma. 2004. Vol. 30. P. 412–419.

4. Ankin L. N., Pipiya G. G., Ankin N. L. Lechenie povrezhdenii taza u postradavshich s isolirovannoy i sochetannoi travmoi // Vestnik traumatologii i ortopedii.2007. № 3. P. 32–35.

5. Halawi M. J. Pelvic ring injuries : emergency assessment and management // J. Clin. Orthop. Trauma. 2015. Vol. 6. P. 252–258.

6. Lustenberger T., Fau M.C., Benninger E. et al. C-clamp and pelvic packing for control of hemorrhage in patients with pelvic ring disruption // J. Emerg. Trauma Shock. 2011. Vol. 4. P. 477–482.

7. Stahel P. F., Mauffrey C., Smith W. R. et al. External fixation for acute pelvic ring injuries : decision making and technical options // J. Trauma Acute Care Surg. 2013. Vol. 75. P. 882–887.

8. The antishock pelvic clamp / R. Ganz, R. J. Krushell, R. P. Jakob, J. Kuffer // Clin. Orthop. Relat. Res. 1991. Vol. 267. P. 71–78.

9. Dyatlov M. M. Neotlozhnaya i srochnaya pomoshch’ pri tyazhelykh travmakh taza: rukovodstvo dlya vrachei. Gomel’: IMMS NAN Belarusi,2003. 296 p.

10. Tiemann A. H., Schmidt C., Gonschorek O. et al. Use of the «C-clamp» in the emergency treatment of unstable pelvic fractures // Zentralbl. Chir. 2004. Vol. 129. P. 245–251.

11. Marzi I., Lustenberger T. Management of bleeding pelvic fractures // Scand. J. Surg. 2014. Vol. 103. P. 104–111.

12. Pohlemann T., Braune C. et al. Pelvic emergency clamps : anatomic landmarks for a safe primary application // Orthop. Trauma. 2004. Vol. 18, № 2. P. 102–105.

13. Rommens P. M., Hofmann A., Hessmann M. H. Management of acute hemorrhage in pelvic trauma : an overview // Eur. J. Trauma Emerg. Surg. 2010. Vol. 36. P. 91–99.

14. Ertel W., Keel M., Eid K. et al. Control of severe hemorrhage using C-clamp and pelvic packing in multiply injured patients with pelvic ring disruption // J. Orthop. Trauma. 2001. Vol. 15, № 7. P. 468–474.

15. Poenaru D. V., Popescu M., Anglitoiu B et al. Emergency pelvic stabilization in patients with pelvic posttraumatic instability // Int. Orthop. 2015. Vol. 39. P. 961–965.

16. Koller H., Balogh Z. J. Single training session for first time pelvic C-clamp users : correct pin placement and frame assembly // Injury. 2012. Vol. 43. P. 436–439.


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For citations:


Kazhanov I.V., Manukovskii V.A., Samokhvalov I.M., Besaev G.M., Mikityuk S.I., Bagdasariants V.G. PRACTICE OF USING THE PELVIC C-CLAMP IN PATIENTS WITH SEVERE CONCOMITANT PELVIC INJURY. Grekov's Bulletin of Surgery. 2018;177(4):38-43. (In Russ.) https://doi.org/10.24884/0042-4625-2018-177-4-38-43

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