Hildegard Koller1, Zsolt J Balogh. 1. Medical University of Graz, Graz, Austria; John Hunter Hospital, Newcastle, NSW, Australia.
Abstract
BACKGROUND: Unstable pelvic fractures with associated haemodynamic instability are major contributors of mortality and morbidity after blunt trauma. The pelvic C-clamp is one of the methods for emergency skeletal stabilization for pelvic ring injuries with posterior instability. The application of this device is taught on courses, but it is seldom used. The safety and efficiency of C-clamp application by trained first time users is unknown. We hypothesised that the pelvic C-clamp cannot be safely positioned on a training model after one training session. METHODS AND MATERIALS: A theoretical and a practical session on the application of the pelvic C-clamp was held within an interval of 11.2±4.4. Twenty-seven participants of various levels of training were assessed on accuracy and efficacy of the application of the pelvic C-clamp was applied to a pelvic model (Pelvic Trainer™). RESULTS: 70.4% of all participants were able to place both pins inside the safe zone, whilst 81.5% of all pins were positioned safe. 18.5% were considered to be in unsafe position. The distance to optimal target point was 9.6±7.8mm on the left (injured) hemipelvis and 8.7±7.8mm on the right (uninjured). The time needed for assembly was 99.7±39.7s, for placement it averaged at 133.9±74s. CONCLUSIONS: The majority of pins were placed into the safe zone on a training model within 4 min after one training session. 18.5% dangerous pin placement within 11 days of the training requires careful consideration (risk/benefit) in the context of a critically injured dying patient.
BACKGROUND: Unstable pelvic fractures with associated haemodynamic instability are major contributors of mortality and morbidity after blunt trauma. The pelvic C-clamp is one of the methods for emergency skeletal stabilization for pelvic ring injuries with posterior instability. The application of this device is taught on courses, but it is seldom used. The safety and efficiency of C-clamp application by trained first time users is unknown. We hypothesised that the pelvic C-clamp cannot be safely positioned on a training model after one training session. METHODS AND MATERIALS: A theoretical and a practical session on the application of the pelvic C-clamp was held within an interval of 11.2±4.4. Twenty-seven participants of various levels of training were assessed on accuracy and efficacy of the application of the pelvic C-clamp was applied to a pelvic model (Pelvic Trainer™). RESULTS: 70.4% of all participants were able to place both pins inside the safe zone, whilst 81.5% of all pins were positioned safe. 18.5% were considered to be in unsafe position. The distance to optimal target point was 9.6±7.8mm on the left (injured) hemipelvis and 8.7±7.8mm on the right (uninjured). The time needed for assembly was 99.7±39.7s, for placement it averaged at 133.9±74s. CONCLUSIONS: The majority of pins were placed into the safe zone on a training model within 4 min after one training session. 18.5% dangerous pin placement within 11 days of the training requires careful consideration (risk/benefit) in the context of a critically injured dying patient.
Authors: Federico Coccolini; Philip F Stahel; Giulia Montori; Walter Biffl; Tal M Horer; Fausto Catena; Yoram Kluger; Ernest E Moore; Andrew B Peitzman; Rao Ivatury; Raul Coimbra; Gustavo Pereira Fraga; Bruno Pereira; Sandro Rizoli; Andrew Kirkpatrick; Ari Leppaniemi; Roberto Manfredi; Stefano Magnone; Osvaldo Chiara; Leonardo Solaini; Marco Ceresoli; Niccolò Allievi; Catherine Arvieux; George Velmahos; Zsolt Balogh; Noel Naidoo; Dieter Weber; Fikri Abu-Zidan; Massimo Sartelli; Luca Ansaloni Journal: World J Emerg Surg Date: 2017-01-18 Impact factor: 5.469