Underneath the cerclage: an ex vivo study on the cerclage-bone interface mechanics

Lenz, Mark; Perren, Stephan M.; Gueorguiev, Boyko; Richards, R. Geoff; Krause, Fabian; Dell’Oca, Alberto Fernandez; Höntzsch, Dankward; Windolf, Markus

doi:10.1007/s00402-012-1572-x

Cited by 43 publications

(30 citation statements)

References 16 publications

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“…Blood supply of periosteal and consecutively cortical bone may be impaired by additional osteosynthetic devices, especially circumferentially attached cerclages. Favorable fixation characteristics of multifilament cerclages have been shown in different biomechanical studies additionally to the current investigation [14,23]. As animal and cadaveric studies refute a negative influence of cerclages [23][24][25][26], gaining adequate primary stability by use of multifilament cerclages seems to be of higher importance with respect to durability and implant failure than potential low risk of necrosis of cortical bone.…”

Section: Discussionmentioning

confidence: 87%

Influence of cerclages on primary stability of tumor megaprostheses subjected to distal femur defects

Jahnke

Jakubowitz

Ishaque

et al. 2016

Injury

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Section: Discussionmentioning

confidence: 87%

Influence of cerclages on primary stability of tumor megaprostheses subjected to distal femur defects

Jahnke

Jakubowitz

Ishaque

et al. 2016

Injury

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“…6 In support of this, recent experimental and cadaveric studies did not find any deleterious effect of cerclage on bone blood supply. 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.…”

Section: Discussionmentioning

confidence: 99%

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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“…Secondly, twisting of stainless steel wires to the desired tension may also be highly variable based on surgeon's experience, with insufficient twisting leading to loosening and overtwisting leading to breakage. 16,17 The precise tightening control afforded by the cable tensioner and crimp in the titanium cable system helps to spread the pressure of cable and avoid excessive pressure concentration such as with wire twisting. 6 This ultimately reduces the risk of cable loosening or breakage during postoperative rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

“…6 This ultimately reduces the risk of cable loosening or breakage during postoperative rehabilitation. 16 Thirdly, the ends of the steel wires are often sharp, especially when the cut occurs at the wire protrusions; however, if the cut is performed at the wire twist, a significant amount of cerclage tension is lost. 6 The subcutaneous location of the wire ends often causes soft tissue irritation.…”

Section: Discussionmentioning

confidence: 99%

The modified anterior ellipsoidal cap titanium cable tension band for comminuted patellar fractures

Wang

Luo

Chen

et al. 2019

J Orthop Surg (Hong Kong)

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Purpose: The purpose of this study was to assess the outcomes in a series of patients, who underwent cerclage and figure-of-eight tension band wiring using a single titanium cable for comminuted patellar fractures. Methods: We describe a modified tension band technique using a single titanium cable to create an ellipsoidal cap structure that combines the circumferential and figure-of-eight wrapping in the fixation of closed Association for the Study of Internal Fixation/Orthopaedic Trauma Association 34C2 and 34C3 patellar fractures. We retrospectively reviewed 25 patients (16 males and 9 females, mean age 54 years) who underwent the described fixation technique between 2015 and 2017. Postoperative function was evaluated using the Böstman score. Results: At the mean follow-up of 25 months (range 17–39 months), the mean Böstman score was 27.3 ± 2.6 points (range 23–30). Eighteen patients (72%) had excellent results (score ≥28); seven patients (28%) had good results (score 20–27); and no patients had an unsatisfactory result (score < 20). All surgical incisions healed without major wound complications. Two patients reported minor complications (soft tissue irritation, cellulitis). No patients demonstrated loss of reduction or implant failure during the follow-up period. Conclusion: The modified anterior ellipsoidal cap tension band using a single titanium cable created an effective tension band structure in the treatment of comminuted patella fractures. It is a simple operative technique that produced a stable fixation construct, which allowed early functional rehabilitation and weight-bearing with a high rate of excellent outcomes at 2 years after surgery.

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Underneath the cerclage: an ex vivo study on the cerclage-bone interface mechanics

Cited by 43 publications

References 16 publications

Influence of cerclages on primary stability of tumor megaprostheses subjected to distal femur defects

Influence of cerclages on primary stability of tumor megaprostheses subjected to distal femur defects

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

The modified anterior ellipsoidal cap titanium cable tension band for comminuted patellar fractures

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