title: C-clamp and pelvic packing for control of hemorrhage in patients with pelvic ring disruption.
abstract: BACKGROUND
  Exsanguinating hemorrhage is the major cause of death in patients with pelvic ring disruption.
  
  
  OBJECTIVE
  The aim of this study was to document outcomes after the stabilization of pelvic ring injuries by a C-clamp and control of hemorrhage by pelvic packing. Physiological parameters were tested as prognostic factors.
  
  
  METHODS
  This was a retrospective study at a level I trauma center. The study period was from January 1996 to December 2007.
  
  
  METHODS
  Fifty patients with pelvic ring disruption and hemorrhagic shock were analyzed. The pelvic rings were fixed by a C-clamp, and patients with ongoing hemorrhage underwent laparotomy and extra- and/or intra-peritoneal pelvic packing. Clinical parameters (heart rate, mean arterial pressure) and physiological parameters (lactate levels, hemoglobin, hematocrit) were documented at admission and at different time points during the initial treatment (1, 2, 3, 4, 6, 8, and 12h after admission).
  
  
  RESULTS
  Within 12 h of admission, 16 patients died (nonsurvivors) due to hemorrhagic shock (n=13) or head injuries (n=3). In this group, 12 patients underwent laparotomy with pelvic packing. Thirty-four patients survived the first 12 h (early survivors) after fixation by a C-clamp and additional packing in 23 patients. Four of these patients died 12.3±7.1 days later due to multiple organ failure (n=3) or severe head injury (n=1). The blood lactate level at admission was significantly higher in the group of nonsurvivors (7.2±0.8 mmol/L) compared to the early survivors (4.3±0.5 mmol/L, P<0.05). While hemoglobin values improved within the first 2 h in nonsurvivors, lactate levels continued to increase.
  
  
  CONCLUSIONS
  Pelvic packing in addition to the C-clamp fixation effectively controls severe hemorrhage in patients with pelvic ring disruption. Early sequential measurements of blood lactate levels can be used to estimate the severity of shock and the response to the shock treatment.
authors.affiliation: Departments of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University, Frankfurt am Main, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lustenberger
authors.forename: Christoph
authors.initials: C
authors.lastname: Meier
authors.forename: Emanuel
authors.initials: E
authors.lastname: Benninger
authors.forename: Philipp M
authors.initials: PM
authors.lastname: Lenzlinger
authors.forename: Marius J B
authors.initials: MJ
authors.lastname: Keel
references.citation: J Trauma. 2005 Dec;59(6):1510-4
references.pmid: 16394933
references.citation: Curr Opin Crit Care. 2003 Dec;9(6):515-23
references.pmid: 14639072
references.citation: J Bone Joint Surg Br. 2006 Apr;88(4):427-33
references.pmid: 16567774
references.citation: J Orthop Trauma. 2002 Sep;16(8):553-61
references.pmid: 12352563
references.citation: Arch Orthop Trauma Surg. 2005 Sep;125(7):443-7
references.pmid: 15977021
references.citation: J Am Coll Surg. 2007 May;204(5):935-9; discussion 940-2
references.pmid: 17481514
references.citation: J Orthop Trauma. 1996;10 Suppl 1:v-ix, 1-154
references.pmid: 8814583
references.citation: JAMA. 1980 Mar 21;243(11):1156-9
references.pmid: 7359667
references.citation: J Trauma. 2002 Aug;53(2):303-8; discussion 308
references.pmid: 12169938
references.citation: J Orthop Trauma. 2001 Sep-Oct;15(7):468-74
references.pmid: 11602828
references.citation: Ann Surg. 2001 Jun;233(6):843-50
references.pmid: 11407336
references.citation: Injury. 2009 Jan;40(1):54-60
references.pmid: 19041967
references.citation: J Trauma. 1997 Sep;43(3):395-9
references.pmid: 9314298
references.citation: Resuscitation. 2008 Jun;77(3):363-8
references.pmid: 18367305