Pelvic C-Clamp. Emergency stabili- zation instrument for unstable injuries and fractures of the pelvic ring. Technique Guide

Introduction Pelvic C-Clamp 2 Product Information Implants and Instruments 14 O Image intensifier control This guide is not sufficient for an immediate application of the Pelvic C-Clamp. Instruction by an experienced surgeon in hand-ling the Pelvic C-Clamp is highly recommended.

0x6.000.899_AC.qxp:0x6.000.899_AC 10.12.2008 8:51 Uhr Seite 2 Pelvic C-Clamp. Permits rapid reduction and stabilization of the posterior pelvic ring. Description The Pelvic C-Clamp is an emergency stablization instrument for unstable injuries and fractures of the pelvic ring. Unstable pelvic ring fractures can be associated with massive blood loss that can cause terminal shock. The Pelvic C-Clamp allows rapid reduction and stabilization of these unstable pelvic ring fractures. It is therefore an invaluable tool for gaining control of the shock reaction, while neither delaying nor hindering subsequent...

0x6.000.899_AC.qxp:0x6.000.899_AC 10.12.2008 8:51 Uhr Seite 3 In cases of sacral fractures or disruptions of the sacroiliac joint, there is often concomitant blood loss from the fracture surface and from the veins of the presacral plexus. The use of the Pelvic C-Clamp in those settings can save lives. Direct transverse compression of the sacroiliac joint controls bleeding from the fracture surfaces and from the presacral plexus. With the Pelvic C-Clamp applied, there is still adequate access for a laporotomy or tamponade. Inner rail Outer rail Upper arm Lower arm Threaded tube Cannulated nail...

0x6.000.899_AC.qxp:0x6.000.899_AC 10.12.2008 8:51 Uhr Indications The Pelvic C-Clamp is intended for emergency stabilization of sacrum fractures or disruptions of the sacroiliac joint with associated circulatory instability. Caution: Avoid use where: – Fractures of the ilium are present as there is risk of pin perforation through the fracture line – There are comminuted sacral fractures with the risk of compression of the sacral nerve plexus Note: In life threatening situations hemorrhage control takes priority over the potential risk of nerve root compression. 4 Synthes Pelvic C-Clamp Technique...

0x6.000.899_AC.qxp:0x6.000.899_AC 10.12.2008 8:51 Uhr Seite 5 Surgical Technique 1 Pre-operative preparation Instrument 01.306.000 Pelvic C-Clamp complete set The Pelvic C-Clamp set consists of the instruments and implants for the emergency treatment of the indicated fracture types. The bottom layer of the Vario Case houses the Pelvic C-Clamp and the optional pliers. The upper layer houses the cannulated nails in two lengths and the remaining instruments. The complete sterile Pelvic C-Clamp set should be kept ready for use in the resuscitation room. Depending on the type of injury, the orientation...

0x6.000.899_AC.qxp:0x6.000.899_AC 10.12.2008 8:51 Uhr Seite 6 Surgical Technique Preparation of the Pelvic C-Clamp Open the lower side arms by depressing the buttons on the arms to prepare the Pelvic C-Clamp for use. (a) Note: Hold upper and lower arms with both hands and ensure that the lower arm is locked when fully extended. (a) Extend the upper bars by depressing the buttons on the upper rails while simultaneously pulling on the side arms. (b) Note: Maximal extension of the Pelvic C-Clamp is advantageous for easy and safe positioning. (b) With a light twist, place the cannulated nails of...

0x6.000.899_AC.qxp:0x6.000.899_AC 10.12.2008 8:51 Uhr Seite 7 2 Identifying nail insertion point Instrument 03.306.009 Guide Handle, for Kirschner Wire л 2.5 mm Make an incision at the intersection between the extension of the line of the femoral axis over the tip of the greater trochanter, and a vertical line from the anterior superior iliac spine in the dorsal direction (see illustration). If orientation is difficult, use an image intensifier. The surface reference point of the outer side of the ilium changes at the level of the sacroiliac joints. In emergency situations, the resulting “fossa”...

0x6.000.899_AC.qxp:0x6.000.899_AC 10.12.2008 8:51 Uhr Surgical Technique 3 Kirschner Wire placement Instruments 03.306.009 Guide Handle, for Kirschner Wire л 2.5 mm 292.260 Kirschner Wire л 2.5 mm with trocar tip, length 280 mm 398.320 Socket Wrench л 11 mm with Hammer After having identified the insertion point, a Kirschner Wire can be placed through the Guide Handle (only on the uninjured side). Gently hammer the Kirschner Wire into the bone with the Socket Wrench with Hammer. This Kirschner Wire will ensure an exact placement of the cannulated nail and prevents the nail from slipping. Note:...

0x6.000.899_AC.qxp:0x6.000.899_AC 10.12.2008 8:51 Uhr Seite 9 4 Placement of the Pelvic C-Clamp Instruments 03.306.010 Pelvic C-Clamp, complete 02.306.006 or 02.306.007 Nail for Pelvic C-Clamp, cannulated, short, length 190 mm (2‫)؂‬ Nail for Pelvic C-Clamp, cannulated, long, length 210 mm (2‫)؂‬ 321.200 Ratchet Wrench for Nut, hexagonal, 11 mm 391.930 Wire Cutter, large, with multiplication, length 220 mm Optional instruments 359.204 Pliers, flat nosed 395.781 Cap Be sure the fracture is correctly reduced before placement of the Pelvic C-Clamp. After inserting the Kirschner Wire on the uninjured...

0x6.000.899_AC.qxp:0x6.000.899_AC 10.12.2008 8:51 Uhr Seite 10 Surgical Technique Alternative: Both nails can be placed at the same time. To do this take off one side arm. After both nails have been seated properly the arm can be placed over the rail again and compression can be achieved as described below. When both nails are correctly seated, manually compress the upper side arms (a) and ensure final fixation by tightening the threaded tubes with the Ratchet Wrench (b). The Kirschner wire must be cut off with the wire cutter or removed. If desired, place a protective cap on each end of the...

0x6.000.899_AC.qxp:0x6.000.899_AC 10.12.2008 8:51 Uhr Seite 11 5 Postoperative management – AP plain radiograph, CT if required, rarely oblique view films after application of Pelvic C-Clamp and during follow-up. – Do not use the Pelvic C-Clamp to lift the patient. – Wound closure; extended incisions may require a coapting skin suture. – Continuing injury management according to polytrauma protocols. – The nail insertion sites must be meticulously disinfected and dressed. – Should the patient need to be moved, he/she should on no account be placed on his/her side as this could cause one of the...