Authors of section

Authors

Rahul Banerjee, Peter Brink, Matej Cimerman, Tim Pohlemann, Matevz Tomazevic

Executive Editor

Peter Trafton

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External fixation: Emergency stabilization with a C-clamp

1. Preparation of entry point

Orientation and skin incision

Draw a line from the anterior superior iliac spine to posterior superior iliac spine.

Palpate the greater femoral trochanter and draw a line along the axis of the femoral shaft perpendicular to the first line.

A small skin incision for the entry point is made at the junction of the two lines.

external fixation emergency stabilization with a c clamp

Bone entry point

Spread the subcutaneous layers and muscle with scissors till bony contact is reached.

Let the scissors glide into the depression between the oblique orientation of the iliac wing and the vertical part of the posterior iliac wing until the center of the cavity is reached.

This is the ideal entry point directly opposite of the S1 body of the sacrum.

If available, image intensifier should be used in the lateral projection to confirm that the entry point overlies the center of the S1 body.

external fixation emergency stabilization with a c clamp

Teaching video

AO teaching video: Pelvis – Unstable Fractures of the Pelvic Ring – Emergency Stabilization with Pelvic C-clamp

2. Reduction

The pelvis should be realigned as well as possible before the C-clamp is applied.

Traction and/or rotation of the leg is used to restore alignment.

Control under image intensification!

external fixation emergency stabilization with a c clamp

3. Clamp positioning

The side struts with attached nails are advanced through the incisions to the bone until the tips have a firm hold in the lateral cortex at the correct entry point.

external fixation emergency stabilization with a c clamp

Compression

With the pelvis realigned and the spikes appropriately positioned, the spike tips are hammered into the outer cortex of the ilium.

The posterior pelvic ring is closed by the C-clamp by manual compression of the side struts in a medial direction.

external fixation emergency stabilization with a c clamp

Tightening of screws

The screws are tightened to secure the frame.

acute pelvic treatment

Control reduction and positioning of clamp under image intensification with multiple views.

external fixation emergency stabilization with a c clamp

The C-clamp can be turned to make space for laparotomy or diagnostic tools.

external fixation emergency stabilization with a c clamp

Note

If the C-clamp is positioned too far ventral in the ilium, there may be perforation of this thin part of the ilium or internal rotation of the pelvic ring (A).

If the C-clamp is positioned too far posterior in the ilium, the result will be an external rotation widening of the pelvic ring (B).

Caudal position increases risk of the pins passing through the greater sciatic foramen into the pelvis, injuring nerves and vessels (C).

external fixation emergency stabilization with a c clamp

4. Aftercare following C-clamp fixation

A C-clamp is normally applied as an emergency in patients with pelvic and hemodynamic instability. As soon as the causes of the hemodynamic instability have been addressed, definitive fixation of the pelvis can be performed and the C-clamp removed.