Cerclage Wiring Through a Mini-Open Approach to Assist Reduction of Subtrochanteric Fractures Treated With Cephalomedullary Fixation: Surgical Technique

Codesido, Pablo; Mejía, Ana; Riego, J.A. Sobrino del; Ojeda-Thies, Cristina

doi:10.1097/bot.0000000000000871

Cited by 17 publications

(25 citation statements)

References 37 publications

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“…Comparing open and closed techniques, open wiring technique is thought to be safer for neurovascular injury with the expense of devitalised tissue, whereas there is concern of vessel injury with the percutaneous minimally invasive technique. 7 Mehta V et al reported a superficial femoral artery and vein ligation by a femoral midshaft cerclage during revision total hip arthroplasty. 3 Aleto T et al described the same complication in the proximal femur during revision total hip arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

Femoral artery entrapment after cerclage wiring of distal femoral shaft fracture: A case report

Gunadham¹,

Kongkreangkrai²

2019

Journal of Orthopaedics, Trauma and Rehabilitation

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Femoral artery injury after femoral fracture fixation is a rare complication. Previous literature studies focused mostly on proximal femur fracture. We described a case of superficial femoral artery entrapment after internal fixation augmented with cerclage wire. An 80-year-old female underwent fixation with distal femur locking compression plate augmented with cerclage wire. Six hours after the operation, she developed pulseless limb and computed tomography angiogram showed femoral artery entrapped by cerclage wire. After vascular exploration and cerclage wire removal, the femoral artery returned to normal flow without further complication. We review available literature studies on vascular injury after cerclage wiring especially in the distal part of the femur, the so-called safe zone, for the great care needed before cerclage wiring and the importance of immediate diagnosis and treatment.

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Section: Discussionmentioning

confidence: 99%

Femoral artery entrapment after cerclage wiring of distal femoral shaft fracture: A case report

Gunadham¹,

Kongkreangkrai²

2019

Journal of Orthopaedics, Trauma and Rehabilitation

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“…Eso no lo hacemos de manera regular, ya que esa técnica puede presentar complicaciones. 23,24 Hoskins y col., 24 en un estudio retrospectivo de 135 pacientes con fractura subtrocantérica cadera describen el uso de cerclaje en un 14,8%. Concluyen que el uso de ese dispositivo es crucial para obtener la reducción anatómica en aquellos casos en que la reducción indirecta no lo logra.…”

Section: Discussionunclassified

Fracturas de Fémur Proximal de Alta Energía Tratadas con Reducción a Través de Mini-open y Clavo Cefalo-medular

Villalón¹,

Cancino

Vigueras

et al. 2019

Rev Chil Ortop Traumatol

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Resumen Objetivo Evaluar los resultados radiológicos de pacientes con fractura de fémur proximal tratados con clavo cefalo-medular y reducción abierta a través de abordaje mini-open. Material y Métodos Estudio retrospectivo-descriptivo de una serie consecutiva de 45 pacientes (38 hombres, 7 mujeres, edad promedio 52 años) con fractura de cadera de alta energía tratados con clavo cefalo-medular y reducción a través de abordaje mini-open. Se registró el mecanismo del accidente y presencia de lesiones asociadas. En todos los casos se contó con radiografías preoperatorias y tomografía axial computada (TAC). Se clasificaron de acuerdo a la AO. Se registró en número de fragmentos que presentaba la fractura. Se tomaron radiografías de control en forma mensual hasta la consolidación. Se midió el ángulo cervico-diafisiario operado y contralateral. Resultados Todos los casos fueron secundarios a un accidente de alta energía. Veintidós pacientes presentaron lesiones asociadas. El número de fragmentos promedio fue de 3. La diferencia entre el ángulo cervico-diafisiario post operatorio de la cadera fracturada versus la cadera contralateral fue de 4,9 grados. Un paciente presentó no-unión. El tiempo promedio hasta la consolidación radiográfica fue de 3,7 meses. Conclusión El uso de clavos cefalo-medulares asociado a reducción a través de mini-open en pacientes jóvenes con fractura de fémur proximal de alta energía, presenta buenos resultados radiológicos con bajo número de complicaciones.

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“…Basically, adequate primary stability is always a precondition for timely secondary stability and osseous integration [11]. However, there is still disagreement whether auxiliary cerclages may only be used temporarily as a reduction aid or whether they can be left in situ [12][13][14]. The use of cerclages is also suspected of disrupting the blood flow to the periosteum depending on the position and thus endangering fracture healing [15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Does auxiliary cerclage wiring provide intrinsic stability in cephalomedullary nailing of trochanteric and subtrochanteric fractures?

Rehme

Woltmann

Brand

et al. 2020

International Orthopaedics (SICOT)

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Purpose The aim of this study was to assess functional and radiological results following cephalomedullary nailing with and without use of auxiliary cable cerclages in a large series of trochanteric and subtrochanteric femoral fractures. Methods In a retrospective study of prospectively collected data between January 2014 and March 2019, a total of 260 consecutive patients (155 women and 105 men) with the diagnosis of AO/OTA A1 to A3 fractures were included. The mean age of patients was 76.4 ± 15.6 years. According to the AO/OTA classification, 72 A1 fractures, 124 A2 fractures, and 64 A3 fractures were found. In 72 patients with auxiliary cerclage wiring three A1 fractures, 27 A2 fractures and 42 A3 fractures were assessed. In the patient group with auxiliary cerclages, fracture healing according to the Radiographic Union Score for Hip (RUSH) within one year after surgery was assessed in 68 out of 72 patients (healing rate 94%). The mean RUSH in the group with cerclages was 28.7 ± 2.2 points and was 28.5 ± 2.2 points in the group without cerclages (p = 0.72). In 91 patients available for a complete follow-up, mean functional outcome according to the Lower Extremity Functional Scale (LEFS) was 65.3 ± 17.2 points in the group with cerclages versus 58.4 ± 21 points in the group without cerclages (p = 0.04). Conclusion The additional use of cerclages provides intrinsic stability and enables axial alignment and medial cortical support during anatomical fracture reduction and cephalomedullary nail insertion. In the current study, this technique resulted in significantly better functional long-term outcomes than without cerclages. Therefore, it can be recommended as a useful supportive tool especially in comminuted trochanteric and subtrochanteric fractures. Trial registration number DRKS00020550, 01/30/2020, retrospectively registered.

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Cerclage Wiring Through a Mini-Open Approach to Assist Reduction of Subtrochanteric Fractures Treated With Cephalomedullary Fixation: Surgical Technique

Cited by 17 publications

References 37 publications

Femoral artery entrapment after cerclage wiring of distal femoral shaft fracture: A case report

Femoral artery entrapment after cerclage wiring of distal femoral shaft fracture: A case report

Fracturas de Fémur Proximal de Alta Energía Tratadas con Reducción a Través de Mini-open y Clavo Cefalo-medular

Does auxiliary cerclage wiring provide intrinsic stability in cephalomedullary nailing of trochanteric and subtrochanteric fractures?

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