Effectiveness and complications of primary C-clamp stabilization or external fixation for unstable pelvic fractures.
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.
['Schmal|Hagen|H|', 'Larsen|Morten Schultz|MS|', 'Stuby|Fabian|F|', 'Strohm|Peter C|PC|', 'Reising|Kilian|K|', 'Goodwin Burri|Kelly|K|']
D000328:Adult D000368:Aged D001863:Bone Screws D003430:Cross-Sectional Studies D005260:Female D005592:Fracture Fixation D017102:Fracture Healing D050723:Fractures, Bone D006801:Humans D007593:Joint Instability D008297:Male D008875:Middle Aged D010384:Pelvic Bones D011183:Postoperative Complications D011859:Radiography D012042:Registries D012086:Reoperation D012446:Sacroiliac Joint D013530:Surgical Wound Infection D016896:Treatment Outcome
Complication Unstable pelvic fracture Registry Mortality Emergency fixation Logistic regression models Treatment