Factors that influence the survival of unstable pelvic fracture in the acute phase

  • Komang A. Irianto Departement of Orthopedic and Traumatology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya
  • Muhammad Z. Chilmi Departement of Orthopedic and Traumatology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya
  • Gana Adyaksa Departement of Orthopedic and Traumatology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya
Keywords: C-clamp, MAP post-resuscitation, unstable pelvic fracture
Abstract viewed: 1149 times
PDF downloaded: 850 times
HTML downloaded: 95 times
EPUB downloaded: 140 times


Background: The fatality rate of unstable pelvic fracture is still high (20–50%) due to acute phase hemorrhage or late multiple organ failure. The assurance for 100% survival in acute phase had been reported if the emergency room team have the right technique, right timing, and right protocol. The aim of this study was to evaluate and to date factors that influence the non-survival unstable pelvic fracture within 2x24 hours.

Methods: This retrospective study was conducted in emergency unit of Dr. Soetomo General Hospital Surabaya during 2012–2016 for unstable pelvic fracture with unstable hemodynamic, without concomitant head or thoracic injury and admitted within 4 hours after the incident. All patients were handled according to the protocol for resuscitation and C-clamp insertion immediately. X-ray was taken after the insertion to check the C-clamp position and to confirm the diagnosis. The 2x24-hour data were taken whether the patient survive or not survive, including mean arterial pressure (MAP) pre-and post, heart rate (HR) pre-and post, and initial hemoglobin and platelet count. Data were analyzed with independent t-test and multiple regression analysis.

Results: Twenty two patients were recorded as the inclusive criteria, separated into 17 survivors and 5 non-survivors. They were comprised of 14 males and 8 female patients, with an average of 31.9±15.3 years old. The MAP post, HR pre-and post, and platelet count were significantly different. The factor that influenced the survival within 2x24 hours was the MAP post C-clamp (>70 mmHg) (p<0.05).

Conclusion: The acute phase 2x24-hour outcome after C-clamp insertion and resuscitation was significantly influenced by MAP post C-clamp and resuscitation.


  1. Wang H, Robinson RD, Moore B, Kirk AJ, Phillips JL, Umejiego J, et al. Predictors of early versus late mortality in pelvic trauma patients. Scand J Trauma Resusc Emerg Med. 2016;24:27. https://doi.org/10.1186/s13049-016-0220-9

  2. Rudloff MI, Triantafillou KM. Management of pelvic ring injuries in unstable patients. Orthop Clin N Am. 2016;47(3):551–63. https://doi.org/10.1016/j.ocl.2016.03.009

  3. Lau J, Chui KH, Ip KC, Li W. Improved Survival with a standardized multidisciplinary 3 in-1 pelvic damage control protocol for hemodynamically unstable pelvic fracture. J Emerg Trauma Care. 2016;1:1.

  4. Abrassart S, Stern R, Peter R. Unstable pelvic ring injury with hemodynamic instability: What seems the best procedure choice and sequence in the initial management? Orthop Traumatol Surg Res. 2013;99:175–82. https://doi.org/10.1016/j.otsr.2012.12.014

  5. Rommens PM, Hofmann A, Hessmann MH. Management of acute hemorrhage in pelvic trauma: an overview. Eur J Trauma Emerg Surg. 2010;36(2):91–9. https://doi.org/10.1007/s00068-010-1061-x

  6. Wiznia DH, Swami N, Kim CY, Leslie MP. A method of using a pelvic C-clamp for intraoperative reduction of a zone 3 sacral fracture. Case reports in Orthopaedics. Hindawi Publishing Corporation. 2016;2016:8586517. http://dx.doi.org/10.1155/2016/8586517

  7. Petrisor BA, Bhandari M. Injuries to the pelvic ring: incidence, classification, associated injuries and mortality rates. Curr Orthopaed. 2005;19(5):327–33. https://doi.org/10.1016/j.cuor.2005.06.006

  8. Hildegard H, Balogh ZJ. Single training session for first time pelvic C-clamp users: correct pin placement and frame assembly. Injury. 2012;43(4):436–9. https://doi.org/10.1016/j.injury.2011.06.026

  9. Latenser BA, Gentilello LM, Tarver AA, Thalqott JS, Batdorf JW. Improved outcome with early fixation of skeletally unstable pelvic fractures. J Trauma. 1991;31(1):25–31. https://doi.org/10.1097/00005373-199101000-00006

  10. Keel M, Otmar T. Acute management of pelvic ring fractures. Curr Orthopaed. 2005; 19(5):334–44. https://doi.org/10.1016/j.cuor.2005.09.009

  11. Giannooudis PV, Pape HC. Damage control orthopaedics in unstable pelvic ring injuries. Injury. 2004;35(7):671–7. https://doi.org/10.1016/j.injury.2004.03.003

  12. Philip FS, Hammerberg EM. History of pelvic fracture management: a review. World J Emerg Surg. 2016;11:18. https://doi.org/10.1186/s13017-016-0075-4

  13. Giannoudis PV, Giannoudi M, Stavlas P. Damage control orthopaedics: lessons learned. Injury. 2009;40(Suppl 4);S47–52. https://doi.org/10.1016/j.injury.2009.10.036

  14. Lustenberger T, Meier C, Benninger, Lenzlinger PM, Keel MJ. C-clamp and pelvic packing for control of hemorrhage in patients with pelvic ring disruption. J Emerg Trauma Shock. 2011;4(4):477–82.

  15. Hsu JM, Yadev S, Faraj S. Controlling hemorrhage in exsanguinating pelvic fractures: utility of extraperitoneal pelvic packing as a damage control procedure. Int J Crit Illn Inj Sci. 2016;6(3):148–52. https://doi.org/10.4103/2229-5151.190655

  16. Tiemann AH, Boehme J, Jonsten C. Emergency treatment of multiple injured patients with unstable disruption of the posterior pelvic ring by using the C-clamp. Eur J Trauma. 2005;31:244–51. https://doi.org/10.1007/s00068-005-2053-5

  17. Ohmori T, Matsumoto T, Kitamura T, Tamura R, Tada K, Inoue T, et al. Scoring system to predict hemorrhage in pelvic ring fracture. Orthop Traumatol Surg Res. 2016;102(8):1023–28. https://doi.org/10.1016/j.otsr.2016.09.007

  18. Filiberto DM, Fox AD. Preperitoneal pelvic packing: techniques and outcome. Int J Surg. 2016;33(Pt B):222–4.

  19. Papakostidis C, Giannoudis PV. Pelvic injuries with hemodynamic instability: efficacy of pelvic packing, a systematic review. Injury. 2009;40(Suppl 4):S53–61. https://doi.org/10.1016/j.injury.2009.10.037

  20. Boral BM, Williams DJ, Boral LI. Disseminated intravascular coagulation. Am.J.Clin.Pathol. 2016;146(6):670–80. https://doi.org/10.1093/ajcp/aqw195

How to Cite
Irianto KA, Chilmi MZ, Adyaksa G. Factors that influence the survival of unstable pelvic fracture in the acute phase. Med J Indones [Internet]. 2018May8 [cited 2023Sep.22];27(1):33-7. Available from: http://mji.ui.ac.id/journal/index.php/mji/article/view/2078
Clinical Research