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

Purpose： Cerclage 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. Methods： Retrospective 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 appli- cation, 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. Results： Average 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 statis- tically 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. Conclusion： Minimally-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.

Intramedullary nailing for irreducible spiral subtrochanteric fractures:A comparison of cerclage and non-cerclage wiring

Purpose:Intramedullary nailing is the preferred internal fixation technique for the treatment of subtrochanteric fractures because of its biomechanical advantages.However,no definitive conclusion has been reached regarding whether combined cable cerclage is required during intramedullary nailing treatment.This study is performed to compare the clinical effects of intramedullary nailing with cerclage and non-cerclage wiring in the treatment of irreducible spiral subtrochanteric fractures.Methods:Patients with subtrochanteric fractures admitted to our center from January 2013 to December 2021 were retrospectively analyzed.The patients were enrolled in the case-control study according to the inclusion and exclusion criteria and divided into the non-cerclage group and the cerclage group.The patients'clinical data,including the operative time,intraoperative blood loss,hospital stay,reoperation rate,fracture union time,and Harris hip score,were compared between these 2 groups.Categorical variables were compared using Chi-square or Fisher's exact test.Continuous variables with normal distribution were presented as mean±standard deviation and analyzed with Student's t-test.Nonnormally distributed variables were expressed as median(Q_(1),Q_(3))and assessed using the Mann-Whitney test.A p<0.05 was considered significant.Results:In total,69 patients were included in the study(35 patients in the non-cerclage group and 34 patients in the cerclage group).The baseline data of the 2 groups were comparable.There were no significant difference in the length of hospital stay(z=-0.391,p=0.696),operative time(z=-1.289,p=0.197),or intraoperative blood loss(z=-1.321,p=0.186).However,compared with non-cerclage group,the fracture union time was shorter(z=-5.587,p<0.001),the rate of nonunion was lower(χ^(2)=6.030,p=0.03),the anatomical reduction rate was higher(χ^(2)=5.449,p=0.03),and the Harris hip score was higher(z=-2.99,p=0.003)in the cerclage group,all with statistically significant differences.Conclusions:Intramedullary nailing combined with cable cerclage wiring is a safe and reliable technique for the treatment of irreducible subtrochanteric fractures.This technique can improve the reduction effect,increase the stability of fracture fixation,shorten the fracture union time,reduce the occurrence of nonunion,and contribute to the recovery of hip joint function.

A Double Tension Band Technique for Patellar Fractures—A New Concept

Amongst the many known techniques used for the management of fractures of the patella, the tension band wire fixation is a reliable treatment modality and has given consistently good results. In transverse patellar fractures, a combination of cerclage wiring and tension band fixation gives a good mechanical stability and an environment conducive to healing. The fracture described herein is classified as 45-C1 (based on Orthopaedic Trauma Association classification) of the right knee of a forty three years old male patient. It was fixed with three vertical 1.5 mm K wires and double cerclage wire looped proximally through the quadriceps tendon and distally through the patellar ligament in a double figure-of-eight configuration. The average follow-up period was 7 months. The Activity of Daily Living Scale (ADLS) of the Knee Outcome Survey was used to assess symptoms and functional capability of the knee. The fracture union was achieved at an average of 10 weeks. Full range of knee motion was achieved by end of the third postoperative month. No complications, such as infection and implant failure were noted. The technique aims to stress the advantage of giving a balanced fixation addressing the bony elements (the fractured ends) as well as the soft tissue (the extensor apparatus).