Minimally invasive clamp-assisted reduction and cephalomedullary nailing without cerclage cables for subtrochanteric femur fractures in the elderly: Surgical technique and results

Mingo-Robinet, J.; Torres-Torres, M.; Moreno-Barrero, M.; Alonso, Jaime Almenar; García-González, Sara

doi:10.1016/j.injury.2015.01.019

Cited by 39 publications

(31 citation statements)

References 26 publications

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“…In the present study, one or two cerclages were used in the majority of cases (85%), while three cerclages remained the exception (15%). This is in line with recent studies, where also mainly one cerclage was used [32][33][34][35]. In our setting, the use of additional cerclage wiring meanwhile is considered as gold standard with more than 80% of AO/OTA type A3 fractures treated using this technique.…”

Section: Discussionsupporting

confidence: 87%

“…If anatomical reduction cannot be achieved sufficiently, the biomechanical basis for the necessary stability and the subsequent bone healing is missing. The supplemental use of cable cerclage wiring also reduces the risk of secondary varization of the axis and related complications [32][33][34][35]. The current study can contribute to this key point to the extent that the results have confirmed the above-mentioned intrinsic stability clinically.…”

Section: Discussionsupporting

confidence: 55%

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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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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 55%

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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“…One potential pitfall with cerclage use is that, it increases operation time and blood loss; significantly higher average operation time (104.47 ± 14.53 vs 87.59 ± 18.77 min; p = 0.001), and blood loss (200 vs 150 ml; p = 0.004) was recorded with cerclage wire application. Mingo-Robinet et al 23 expressed concern that more soft-tissue stripping and increase surgery time might increase the risk of infection; however, none of the patients in our series had any superficial or deep infection. Surprisingly, we had achieved shorter operation time and less blood loss when using cerclage wire compared to what was previously reported.…”

Section: Discussionmentioning

confidence: 50%

Role of percutaneous cerclage wire in the management of subtrochanteric fractures treated with intramedullary nails

Trikha

Das

Agrawal

et al. 2018

Chinese Journal of Traumatology

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PurposeCerclage wire application has emerged as a potential therapeutic adjunct to intramedullary nailing for subtrochanteric fractures. But its popularity is plagued by the concern of possible negative effect on fracture zone biology. This study was intended to analyze the clinico-radiological outcome and complications associated with cerclage wire application.MethodsRetrospective analysis was performed on all the subtrochanteric fractures operated with intramedullary nailing between January 2012 and January 2016. After exclusion, 48 patients were available with an average follow-up of 20.8 months. Long oblique, spiral, spiral wedge or comminuted fracture configurations with butterfly fragments were particularly considered for cerclage wire application, which was employed by percutaneous cerclage passer in 21 patients. Assessment was done in terms of operation time, blood loss, quality of reduction, neck-shaft angle, follow-up redisplacement, union time, complications, and final functional evaluation by Merle d’Aubigne'-Postel score.ResultsAverage operation time and blood loss were significantly higher in cerclage group (p < 0.05). However, cerclage use substantially improved quality of reduction in terms of maximum cortical displacement (p = 0.003) and fracture angulation (p = 0.045); anatomical reduction was achieved in 95.23% of cases as compared to 74.07% without cerclage. Union time was shorter, although not statistically different (p = 0.208), in cerclage group. Four patients in non-cerclage group developed non-union, 2 of them had nail breakage. No infection or any other implant related complications were reported with cerclage use.ConclusionMinimally-invasive cerclage wire application has proved to be beneficial for anatomical reconstruction in difficult subtrochanteric fractures, whenever applicable, without any harmful effect on fracture biology.

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“…Proper reduction is difficult for severely comminuted fractures, and so additional techniques are required, such as limited open reduction with clamp or cables. 8 , 18 Ali et al 19 claimed that one implant was insufficient for fixation of severely comminuted subtrochanteric femoral fractures of Seinsheimer classification type IV or V, and so additional fixation was required. In the present study, all 7 cases that showed nonunion involved comminution, and five cases were Seinsheimer classification type IV or V. In particular, additional fixation is thought to be required for type IV fractures with a comminuted segmental fragment ( Fig.1 ).…”

Section: Discussionmentioning

confidence: 99%

Nonunion of subtrochanteric fractures: Comminution or Malreduction

Park

Kong

et al. 2016

Pak J Med Sci

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Objective:This study aimed to investigate the impact on nonunion of the extent of comminution and postoperative displacement in patients surgically treated for subtrochanteric fractures.Methods:From 2008 to 2013, 44 patients with subtrochanteric fractures underwent surgery and follow-up. Retrospective data collection showed that it had 32 male and 12 female. Their mean age was 45 years. The case distribution according to Seinsheimer classification was as follows: IIA,8; IIB, 5; IIC, 7; IIIA, 8; IIIB, 3; IV, 9; and V, 4. Cephalomedullary nails were used in 28 cases; ordinary nails, in 9; and plates, in 7. After surgery, the fractures were evaluated for displacement on anteroposterior (AP) and lateral radiography.Results:Of the 44 patients, 37 achieved union from primary surgery at a mean time of 8.4 months. Five cases did not show union within the follow-up period. Two cases of nail breakage were diagnosed as non-union. Among the non-union cases, two were Seinsheimer classification IIIA; 3, IV; and 2, V. Displacement was observed on the lateral and A Pradiographs of 4 cases, on only the lateral radiographs of two cases, and in neither radiograph of one case. The risk of non-union was approximately 15.4 and 24.2 times higher when displacement was observed on the AP (95% confidence interval [CI]: 1.33–176.82) and lateral images (95% CI: 1.76–335.67), respectively.Conclusion:When displacement occurred after surgical treatment for subtrochanteric fractures, the risk of nonunion increased owing to the difficulty achieving stable fixation.

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Minimally invasive clamp-assisted reduction and cephalomedullary nailing without cerclage cables for subtrochanteric femur fractures in the elderly: Surgical technique and results

Cited by 39 publications

References 26 publications

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

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

Role of percutaneous cerclage wire in the management of subtrochanteric fractures treated with intramedullary nails

Nonunion of subtrochanteric fractures: Comminution or Malreduction

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