Biomechanical performance of different cable and wire cerclage configurations

Abstract

Purpose Cerclage technology is regaining interest due to the increasing number of periprosthetic fractures. Different wiring techniques have been formerly proposed and have hibernated over years. Hereby, they are compared to current cerclage technology. Methods Seven groups (n06) of different cable cerclage (Ø1.7 mm, crimp closure) configurations (one single cerclage looped once around the shells, one single cerclage looped twice, two cerclages each looped once) and solid wire cerclages (Ø1.5 mm, twist closure) (same configurations as cable cerclages, and two braided wires, twisted around each other looped once) fixed two cortical half shells of human femoral shaft mounted on a testing jig. Sinusoidal cyclic loading with constantly increasing force (0.1 N/cycle) was applied starting at 50 N peak load. Cerclage pretension (P), load leading to onset of plastic deformation (D) and load at total failure (T) were identified. Statistical differences between the groups were detected by univariate ANOVA. Results Double looped cables (P442N ± 129; D1334N ± 319; T2734N ± 330) performed significantly better (p< 0.05) than single looped cables (P292N ± 56; D646N ± 108; T1622N ± 171) and were comparable to two single cables (P392N ± 154; D1191N ± 334; T2675N ± 361). Double looped wires (P335N ± 49; D752N ± 119; T1359N ± 80) were significantly better (p<0.05) than single looped wires (P181N ± 16; D343N ± 33; T606N ± 109) and performed similarly to single looped cables. Braided wires (P119N ± 26; D225N ± 55; T919N ± 197) exhibited early loss of pretension and plastic deformation. Conclusion Double looped cerclages provided a better fixation stability compared to a single looped cerclage. Double looped wires were comparable to a single looped cable. The use of braided wires could not be recommended mechanically.

Intraoperative Periprosthetic Femur Fracture: A Biomechanical Analysis of Cerclage Fixation

“…A number of options have been proposed ranging from combinations of long stem femoral components, extramedullary fixation with cerclage cables, plates, and strut grafts [6][7][8]15,17]. Several studies have previously demonstrated differences in fixation technique and biomechanical advantages of various cerclage constructs in fixation of periprosthetic femur fractures [8,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Although metallic cerclage cables have been previously shown to provide more strength than twisted monofilament wire, cable use is associated with other complications and limitations in minimally invasive applications [18][19][20][21][22]32].…”

“…Several studies have previously demonstrated differences in fixation technique and biomechanical advantages of various cerclage constructs in fixation of periprosthetic femur fractures [8,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Although metallic cerclage cables have been previously shown to provide more strength than twisted monofilament wire, cable use is associated with other complications and limitations in minimally invasive applications [18][19][20][21][22]32]. As a result, there has been a renewed interest in wire cerclage systems and newer materials such as synthetic cables have emerged as potential alternatives to traditional metallic cables [23][24][25][33][34][35].…”

Minimally invasive surgery with locking plate for periprosthetic femoral fractures: technical note

“…Cable wiring is a simple technique that can be done with a minimally invasive approach [25] with proven clinical efficiency [25,26]. Doubling the cable wire around the diaphysis seems to give the best mechanical stability [13]. Another option, which is technically more challenging in a minimally invasive approach, is the use of the LAP.…”

“…If proximal fixation is not possible due a bulky stem, stabilisation must be assured by one or more cable wires to avoid breakout forces on the plate. Mechanically, stability is better when two cable wires are used or one cable is wrapped twice around the diaphysis [13]. Some authors suggest additional plates, like LAP with excellent mechanical stability [8,14] and satisfying clinical results [15].…”

Bicortical screw fixation provides superior biomechanical stability but devastating failure modes in periprosthetic femur fracture care using locking plates

“…Different techniques using monocortical screws, cerclage wires, additional plates (e.g. locking attachment plate; Synthes, Umkirch, Germany) or combinations have been described in order to achieve a stable fixation next to the prosthetic stem [7,14,15]. Biomechanical studies investigated the stability of the different fixation options and concluded that stand-alone cerclage wires are insufficient [7,16,17].…”