The effect of the cerclage wire in the treatment of subtrochanteric femur fracture with the long proximal femoral nail: A review of 52 cases

Kılınç, Bekir Eray; Öç, Yunus; Kara, Adnan; Ertürer, Erden

doi:10.1016/j.ijsu.2018.06.035

Cited by 22 publications

(22 citation statements)

References 36 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: 54%

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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: 54%

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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“…Afsari, A et al believe that the proper use of cerclage cables for clamp-assisted reduction and intramedullary nail xations can achieve a good reduction effect and high fracture healing rate [13]. Kulkarni proposed that open reductions combined with cerclage cables do not adversely impact fracture healing [16]. It has been reported that the e cacy of using minimally invasive cerclage cables to subtrochanteric fractures is similar to that of reverse intertrochanteric fractures [13].…”

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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“…In 1987, Fitzgerald documented excellent results of using cerclage wires in comminuted fractures of the femur [3]. Subsequently, successful procedures for comminuted fractures of the femur have been reported [4][5][6][7][8][9], and percutaneous wiring techniques are being continually improved [10][11].…”

Section: Introductionmentioning

confidence: 99%

Role of open cerclage wires used in patients with comminuted fractures of femoral shaft treated with intramedullary nails

Wang

Chuang

Kuan

et al. 2021

Preprint

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IntroductionThe role of open cerclage wiring in comminuted femoral shaft fracture treatment with intramedullary nails remains unclear. Here, we analyzed the effect of open cerclage wiring and the risk factors for nonunion after interlocking nailing in comminuted femoral shaft fracture treatment. We hypothesize that open cerclage wiring is applicable to patients with severe comminuted femoral shaft fractures without affecting bone healing.Patients and MethodsThis retrospective cohort study used data of consecutive patients who underwent interlocking nail fixation of a comminuted femoral shaft fracture between January 1, 2009, and December 31, 2016. First, eligible patients were divided into wire and no wire groups according to the surgical technique used and their union rate was recorded. The patients were then divided into union and nonunion groups and their perioperative data were analyzed.ResultsIn total, 71 comminuted femoral shaft fractures treated with interlocking nail fixation were included: 38 fractures (53.5%) augmented with the open wiring technique and 33 reduced with closed or mini–open wound without wiring. The wire group demonstrated significant improvements in fracture reduction compared with the no wire group, whereas no significant difference was observed in the union rate between the wire and no wire groups (p = 0.180). Moreover, 46 (65%) of 71 fractures united smoothly, and no significant difference was observed in any perioperative data between union and nonunion groups.DiscussionAugmented open cerclage wiring is indicated for comminuted femoral shaft fractures treated with intramedullary nails, even when the fragments are large or far displaced. Thus, open cerclage wiring can be used for fracture treatment, without decreasing the union rate.

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The effect of the cerclage wire in the treatment of subtrochanteric femur fracture with the long proximal femoral nail: A review of 52 cases

Abstract: Open reduction and the use of cerclage did not produce a negative effect in terms of fracture union. The generation of medial support by anatomical reduction of the fracture prevents the implant failure and provide a basis for union.

Cited by 22 publications

References 36 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?

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

Role of open cerclage wires used in patients with comminuted fractures of femoral shaft treated with intramedullary nails

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