Subtrochanteric Fractures

Abstract

Fracture malalignment and nonunion are not infrequent after treating subtrochanteric fractures with intramedullary nails. The use of a cerclage wire with a minimally invasive approach to aid and maintain reduction in certain subtrochanteric fracture patterns can be an effective surgical strategy to improve outcome. It allows the surgeon to obtain and maintain an anatomic reduction with more bone contact, which will aid in fracture consolidation. This has the added advantage of optimizing the greater trochanteric starting point. It minimizes malreductions of the proximal femoral fragment, and, we believe, that its rational use with a minimally invasive technique is a key factor in achieving good results.

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

“… 9 , 17 Fracture reduction before starting nailing procedure helps substantially to accurately localize the starting point of nail, which is of paramount importance. 10 , 11 Furthermore, it is postulated to have added benefit of substantial reduction of radiation exposure to surgeons. 7 Biomechanical study by Müller et al 18 noted that additional wire cerclage significantly reduced osteosysthesis failure (100 vs 10%) after IM nailing of subtrochanteric fractures ( p = 0.037).…”

“… 21 , 22 Recent clinical studies also could not find any significant harmful effect on vascularity or healing of fracture. 5 , 7 , 8 , 9 , 10 , 11 , 12 However, Kennedy et al 8 had cautioned against overzealous use of cerclage cable, as they observed 1 nonunion in their series of 17 patients, where 4 cables were used. Our results are also in close agreement to those previously reported ( Table 3 ).…”

“…However, favourable reports in literature of cerclage use in subtrochanteric fractures are a portent of its usefulness. 8 , 9 , 10 , 11 , 12 …”

Subtrochanteric fractures of the femur: update

“…Some authors add cerclage to maintain the reduction of the fracture. 24 , 25 Nonetheless, there are questions regarding the potential bone devascularization caused by cerclage.…”

“…Tomás et al 24 performed cerclage in 12 patients who underwent osteosynthesis with cephalomedullary nails for the fixation of subtrochanteric fractures. All the fractures were consolidated and there were no superficial or deep infections.…”