Subtrochanteric hip fractures treated with cerclage cables and long cephalomedullary nails: A review of 17 consecutive cases over 2 years

Kennedy, M.T.; Mitra, Aniruddha; Hierlihy, Timothy G.; Harty, James; Reidy, Declan; Dolan, M.

doi:10.1016/j.injury.2011.03.023

Cited by 62 publications

(27 citation statements)

References 28 publications

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“…In the subsequent reports, however, Partridge and Evans 19) , Fitzgerald and Southgate 20) concluded that there was no association between the cerclage wiring fixation and nonunion. Recently, it was demonstrated that the minimal invasive reduction method along with percutaneous cerclage wiring in the intramedullary nailing operation resulted in satisfactory clinical outcomes for femoral subtrochanteric fractures 14 , 21 , 22 , 23 , 24) . Hwang et al 25) suggested that the minimal invasive open reduction method in parallel with additional fixation might be a helpful means to securing sound internal fixation as well as anatomical reduction when compared to the closed reduction method.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Time to Bony Union of Femoral Subtrochanteric Fractures Treated with Intramedullary Devices

et al. 2014

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PurposeTo evaluate the factors affecting the bone union time and the occurrence of nonunion after intramedullary nailing of subtrochanteric femoral fractures in adults.Materials and MethodsWe retrospectively reviewed data from 31 patients (22 men and 9 women) who had undergone femoral intramedullary nailing at least 1 year post-operatively and analyzed the bone union time, nonunion rates, and factors that affected the bone union time according to the fracture classification (AO and Fielding classifications), comminution of the medial cortex, reduction method, and additional cerclage wiring.ResultsThe average union time was 26.4 weeks. There were no differences in the bone union time according to the fracture classification, reduction method, or additional cerclage wiring. Significant differences were found in the bone union time between the medial cortex comminution and non-comminution groups. A relatively strong positive correlation was detected between the degree of post-operative displacement and the bone union time. Nonunion occurred in three cases and there was no failure of implants.ConclusionThe bone union time was not affected by the reduction method nor additional cerclage wiring in intramedullary nailing of subtrochanteric femur fractures. Comminution of the medial cortex and the degree of the postoperative displacement of fractures contributed to the delayed time of union.

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Section: Discussionmentioning

confidence: 99%

Factors Affecting Time to Bony Union of Femoral Subtrochanteric Fractures Treated with Intramedullary Devices

et al. 2014

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“…Therefore, we believe that the cerclage cables had no harmful effects on fracture healing. Some scholars believe that the normal fracture healing time will not be affected by the use of steel cables [25]. Intramedullary nail is the preferred treatment for subtrochanteric fractures, especially unstable intertrochanteric fractures [26]- [32].…”

Section: Discussionmentioning

confidence: 99%

Surgical Selection of Unstable Intertrochanteric Fractures: Proximal Femoral Nail Antirotation Combined With or Without Cerclage Cable

Huang¹,

Wu²

2020

Preprint

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Background: Due to the instability of unstable intertrochanteric fractures, the selection of a suitable internal fixation remains challenging for orthopedic surgeons. This study aims to compare the clinical efficacy of proximal femoral nail antirotation (PFNA) combined with a cerclage cable and without a cerclage cable so as to recommend a stable internal fixation method.Methods: From January 2014 to January 2018, we retrospectively analyzed all unstable intertrochanteric fracture cases who received treatment in the Orthopedics Department of our hospital. One hundred and twenty cases were screened, of which 51 were treated with a cerclage cable, and 69 without a cerclage cable. The follow-up period was one year. Patients were divided into either the PFNA and cerclage cable group (PFNA+cable) or the PFNA only (PFNA) group. Results: The Harris hip score (HHS), Barthel Index (BI), and Radiographic Union Scale for Hip (RUSH) were evaluated.The fracture healing and weight-bearing time of the PFNA+cable group were shorter than the PFNA group. Regarding the HHS, BI, and RUSH, the PFNA+cable group was higher than the PFNA group at 1, 3, 6, and 12 months after the operation. For the HHS rating, the PFNA+cable group had a higher-excellent rate than the PFNA group, with 96.1% and 84.1%, respectively. All the results mentioned above were statistically significant. The application of a cerclage cable was found to reduce the incidence of complications.It was found that PFNA combined with a cerclage cable improved the stability of fracture reductions, shortened the fracture healing time and postoperative weight-bearing time, significantly improved patients’ ability to self-care, and reduced the incidence of postoperative complications. Conclusions: Therefore, we think PFNA combined with a cerclage cable is a good choice for patients with unstable intertrochanteric fractures.

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“…Likewise, recent studies have not found the use of modern circumferential wires in subtrochanteric fractures to be harmful (Afsari et al 2009, Kennedy et al 2011). These results support ours in that anatomic reduction was achieved in most cases for a more stable construction, which allows early weight bearing.…”

Section: Discussionmentioning

confidence: 99%

Circumferential wires as a supplement to intramedullary nailing in unstable trochanteric hip fractures

Ban¹,

Birkelund²,

Palm³

et al. 2012

Acta Orthopaedica

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Background and purposeFixation of unstable trochanteric fractures is challenging. Application of a circumferential wire may facilitate bone contact and avoid postoperative fracture displacement. However, the use of circumferential wires remains controversial due to possible disturbance of the blood supply to the underlying bone. We evaluated the results of applied circumferential wires, concentrating mainly on complications and reoperations.Patients and methods60 patients with unstable trochanteric fractures and use of circumferential wires (1 or more) and an intramedullary nail were included from 2 centers. We retrospectively assessed complications and reoperation rates within the first postoperative year.ResultsIn 37 of the 60 patients, 2 or more circumferential wires were used. Anatomic reduction was achieved in 24 of the patients and a total cortical displacement of ≤ 10 mm was achieved in 26 other patients. 6 of the 43 patients with radiographic audit after 12 weeks sustained a subsequent fracture displacement of more than 5 mm. 4 patients underwent reoperation: 1 due to deep infection, 1 due to technical failure during osteosynthesis, 1 had a screw cut out, and 1 sustained a new fracture following a new fall.InterpretationApplication of circumferential wires as a supplement to intramedullary nails in unstable trochanteric fractures is an option as it provides good primary reduction which, in most patients, is maintained over time—with no apparent increase in reoperation rate. Based on our results and on other reports, the use of circumferential wires does not appear to be harmful as sometimes claimed.

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Subtrochanteric hip fractures treated with cerclage cables and long cephalomedullary nails: A review of 17 consecutive cases over 2 years

Cited by 62 publications

References 28 publications

Factors Affecting Time to Bony Union of Femoral Subtrochanteric Fractures Treated with Intramedullary Devices

Factors Affecting Time to Bony Union of Femoral Subtrochanteric Fractures Treated with Intramedullary Devices

Surgical Selection of Unstable Intertrochanteric Fractures: Proximal Femoral Nail Antirotation Combined With or Without Cerclage Cable

Circumferential wires as a supplement to intramedullary nailing in unstable trochanteric hip fractures

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