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Single training session for first time pelvic C-clamp users: correct pin placement and frame assembly
Hildegard Koller1, Zsolt J Balogh
1Medical University of Graz, Graz, Austria; John Hunter Hospital, Newcastle, NSW, Australia.
Insights
Trained first-time users can apply the pelvic C-clamp to a pelvic model with most pins in the safe zone. However, a significant percentage of unsafe placements warrant caution in critical trauma patients.
Area of Science:
- Trauma Surgery
- Orthopedic Emergencies
- Skeletal Stabilization
Background:
- Unstable pelvic fractures with hemodynamic instability are life-threatening complications of blunt trauma.
- The pelvic C-clamp is an emergency device for stabilizing posterior pelvic ring injuries.
- Its application is taught but rarely used, with unknown safety and efficacy in novice users.
Purpose of the Study:
- To evaluate the safety and efficacy of pelvic C-clamp application by first-time users after a single training session.
- To test the hypothesis that the C-clamp cannot be safely positioned by novice users on a training model.
Main Methods:
- Twenty-seven participants with varying training levels received theoretical and practical C-clamp training.
- Participants applied the C-clamp to a pelvic model (Pelvic Trainer™).
- Accuracy, efficacy, and time for application were assessed.
Main Results:
- 70.4% of participants placed both pins in the safe zone; 81.5% of all pins were safely positioned.
- 18.5% of pin placements were considered unsafe.
- Average placement time was approximately 4 minutes.
Conclusions:
- The majority of pelvic C-clamp pins were placed safely on a training model after one session.
- The 18.5% rate of dangerous pin placement necessitates careful risk-benefit assessment in critically injured patients.
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.
