Pelvic clamp
A pelvic clamp (engl. "Pelvic C-clamp") is a surgical emergency instrument.
indication
The pelvic clamp is used in severe, unstable pelvic fractures to achieve an initial stabilization of the pelvis and thus to control the bleeding if it can be assumed that the patient has or is threatened with hemorrhagic shock as a result of the fracture . The pelvic clamp is therefore used very early in the hospital, often as part of the emergency room treatment . A severe pelvic fracture is associated with a high mortality rate from bleeding to death, as there are a large number of veins and arteries in the area that can be ruptured by the fracture.
technology
Basically, the pelvic clamp is a pre-assembled external fixator ("external tensioner"). It is attached to two steel pins ("Schanz screws") inserted into the two pelvic blades through small incisions in the skin and then adjusted , similar to the screw clamp used by craftsmen. This allows the fragments of the fracture to be roughly anatomically aligned and, ideally, pressure can also be exerted on the fracture gap. In this way, on the one hand, the bleeding from the bone itself is reduced and, on the other hand, the occurrence of new bleeding, which would occur when manipulating the patient such as repositioning, etc. by tearing further blood vessels, is prevented. The always present retroperitoneal hematoma has the chance of so-called "self-tamponade" due to the immobilization (the pressure that the hematoma exerts on torn blood vessels reduces the bleeding).
It is not a long-term supply, but is immediately life-saving. After the first stabilization, the pelvic clamp is replaced by an operative osteosynthesis .
Complications
The pelvic clamp requires the pelvic blades as a point of attack and the sacrum against which the pelvic blades are pressed. In the case of comminuted fractures of the sacrum, this is missing as an abutment, in which case the use of the pelvic clamp can cause further soft tissue injuries. If the pool blades are destroyed, it is impossible to use the pool clamp due to the lack of starting points.
Alternatives
A pelvic clamp is usually only available in specialized hospitals ; it is not used in the emergency services . As an alternative, the basin can also be compressed from the outside with a tightly twisted cloth. Industrially manufactured compression systems for pelvic fractures are also becoming increasingly popular in the rescue service.
