The role of cerclage wiring in the management of subtrochanteric and reverse oblique intertrochanteric fractures: a meta-analysis of comparative studies

Abstract

Purpose Subtrochanteric and reverse oblique intertrochanteric fractures are challenging and often difficult to reduce. While intramedullary nailing (IMN) is considered the standard treatment, achieving anatomic reduction prior to fixation is essential. This study aimed to assess the impact of cerclage wiring with IMN on the outcomes and complication rate in treating subtrochanteric and reverse oblique intertrochanteric fractures. Methods This meta-analysis was conducted in line with PRISMA guidelines. The primary outcome was the time to union. The secondary outcomes were operative time, blood loss, quality of reduction, reduction alignment (if in varus), complications and reoperations. PubMed, Cochrane, Web of Science and Google Scholar were searched till July 2021. Articles that compared intramedullary nailing (IMN) versus intramedullary nailing and cerclage wiring (IMN-C) in the treatment of subtrochanteric and reverse oblique intertrochanteric fractures were included. The risk of bias was assessed using the Newcastle–Ottawa scale. Results This meta-analysis included 415 patients with subtrochanteric and reverse oblique intertrochanteric fracture from six comparative studies. Our findings showed that IMN-C was significantly associated with higher mean duration of surgery and blood loss. However, IMN-C had significantly lower mean time to union compared to IMN alone. In addition, IMN-C had lower pooled prevalence of varus reduction and overall complications. Conclusion This study showed that the use of cerclage wiring is associated with lower time to union, lower prevalence of varus reduction and overall complications. Therefore, cerclage wiring augmentation is a safe technique with low complication rate and may be advised whenever open reduction is needed in the management of subtrochanteric and reverse oblique intertrochanteric fractures.

Preventing Atrophic Long-Bone Nonunion: Retrospective Analysis at a Level I Trauma Center

“…The data on this are very controversial. While some studies assume a delay in healing [22,23], others have even found an acceleration in healing times [24] or no significant difference [25]. A major advantage of using cerclage is improvement in the anatomical position of the fracture fragments in relation to each other and the resulting greater stability [23,25], which can have an effect not only on blood flow but also on the success of fracture healing.…”

Intertrochanteric femur fractures: a current concepts review

“…13 Application of a circumferential cerclage cable after intramedullary fixation of reverse oblique intertrochanteric fractures reduces the risk of implant failure. 14,15 The quantity and range of the posteromedial fragment significantly correlates with postoperative telescoping and varus collapse of the femoral head and neck component. 2 Anteromedial cortical support reduction for unstable intertrochanteric fractures introduced by Chang and colleagues in 2015 is an extension of the nonanatomic positive cortex buttress concept by Gotfried et al 12,16 This reduction aims at using the medial wall of the femur shaft fragment as a functional buttress for the medial cortex of the neck fragment.…”