Effectiveness and complications of primary C-clamp stabilization or external fixation for unstable pelvic fractures

Hagen Schmal*, Morten Schultz Larsen, Fabian Stuby, Peter C. Strohm, Kilian Reising, Kelly Goodwin Burri

*Kontaktforfatter for dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

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.

OriginalsprogEngelsk
TidsskriftInjury
Vol/bind50
Udgave nummer11
Sider (fra-til)1959-1965
ISSN0020-1383
DOI
StatusUdgivet - nov. 2019

Fingeraftryk

Registries
Emergencies
Odds Ratio
Wounds and Injuries

Citer dette

Schmal, Hagen ; Larsen, Morten Schultz ; Stuby, Fabian ; Strohm, Peter C. ; Reising, Kilian ; Goodwin Burri, Kelly. / Effectiveness and complications of primary C-clamp stabilization or external fixation for unstable pelvic fractures. I: Injury. 2019 ; Bind 50, Nr. 11. s. 1959-1965.
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abstract = "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.",
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author = "Hagen Schmal and Larsen, {Morten Schultz} and Fabian Stuby and Strohm, {Peter C.} and Kilian Reising and {Goodwin Burri}, Kelly",
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Effectiveness and complications of primary C-clamp stabilization or external fixation for unstable pelvic fractures. / Schmal, Hagen; Larsen, Morten Schultz; Stuby, Fabian; Strohm, Peter C.; Reising, Kilian; Goodwin Burri, Kelly.

I: Injury, Bind 50, Nr. 11, 11.2019, s. 1959-1965.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Effectiveness and complications of primary C-clamp stabilization or external fixation for unstable pelvic fractures

AU - Schmal, Hagen

AU - Larsen, Morten Schultz

AU - Stuby, Fabian

AU - Strohm, Peter C.

AU - Reising, Kilian

AU - Goodwin Burri, Kelly

PY - 2019/11

Y1 - 2019/11

N2 - 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.

AB - 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.

KW - Complication

KW - Emergency fixation

KW - Logistic regression models

KW - Mortality

KW - Registry

KW - Treatment

KW - Unstable pelvic fracture

U2 - 10.1016/j.injury.2019.08.039

DO - 10.1016/j.injury.2019.08.039

M3 - Journal article

C2 - 31477239

AN - SCOPUS:85071499074

VL - 50

SP - 1959

EP - 1965

JO - Injury

JF - Injury

SN - 0020-1383

IS - 11

ER -