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Background: Pelvic ring injuries with associated hemorrhage from the presacral venous plexus are major contributors to morbidity and mortality in trauma patients. The Pelvic C-Clamp is an often discussed, yet seldom used device for both skeletal and hemodynamic stabilization. In a recent study we have addressed this issue and have stressed the importance of regular training sessions with the device. This study is aimed as an extended follow up with a special focus on how trained skills are retained over time. Materials and methods: 32 participants with various levels of training were taught to use the clamp. Thirty-six hours later, a hands-on session was performed where the time needed for placement and accuracy of placement were evaluated on a model in individual and team settings. 12 months later a re-evaluation was performed. Results: Evaluation showed that during the first session, 57/64 pins (89.15 %) were placed inside the safe area. The team training results showed reduced times for assembly and more exact pin placement. In the re-evaluation 1 year later, 75 % of all pins were safely placed and the time needed for assembly was significantly longer. Conclusions: The majority of 57 pins were placed in the safe area within 6 min after one single training session. This reproduces the Australian data and supports the theory that adequately educated and skilled physicians should be able to handle the device properly. The data from the re-evaluation suggest that repeating the training session with the device improves performance. [ABSTRACT FROM AUTHOR]

Introduction: Hemorrhage is the leading cause of death in patients with a pelvic fracture. The majority of blood loss derives from injured retroperitoneal veins and broad cancellous bone surfaces. The emergency management of multiply injured patients with pelvic ring disruption and severe hemorrhage remains controversial. Although it is well accepted that the displaced pelvic ring injury must be rapidly reduced and stabilized, the methods by which control of hemorrhagic shock is achieved remain under discussion. It has been proposed to exclusively use external pelvic ring stabilization for control of hemorrhage by producing a 'tamponade effect' of the pelvis. However, the frequency of clinically important arterial bleeding after external fixation of the pelvic ring remains unclear. We therefore undertook this retrospective review to attempt to answer this one important question: How frequently is arterial embolization necessary to control hemorrhage and restore hemodynamic stability after external pelvic ring fixation? Materials and methods: We performed a retrospective review of 55 consecutive patients who presented with unstable types B and C pelvic ring fractures. Those patients designated as being in hemorrhagic shock (defined as a systolic blood pressure less than 90 mmHg after receiving 2 L of intravenous crystalloid) were treated by application of the pelvic C-clamp. Patients who remained in hemorrhagic shock, or were determined to be in severe shock (defined as mandatory catecholamines or more than 12 blood transfusions over 2 h), underwent therapeutic angiography within 24 h in order to control bleeding. Results: Fourteen patients were identified as being hemodynamically unstable (ISS 30.1±11.3 points) and were treated with a C-clamp. In those patients with persistent hemodynamic instability, arterial embolization was performed. After C-clamp application, 5 of 14 patients required therapeutic angiography to control bleeding. Two patients died, one from multiple sources of bleeding and the other from an open pelvic fracture (total mortality 2/14, 14%). Conclusions: Although the C-clamp is effective in controlling hemorrhage, one must be aware of the need for arterial embolization to restore hemodynamic stability in a select subgroup of patients. [ABSTRACT FROM AUTHOR]