Past and present of the use of cerclage wires in orthopedics

  • Andrea AngeliniEmail author
  • Concetto Battiato
General Review


Cerclage wiring is a simple technique that has been practiced widely since the advent of surgical treatment of fractures. Many studies have reported the use of various cerclage technologies with a wide range of results and clinical applications. The increasing numbers of periprosthetic fractures have led to a revival of interest for this simple technique. When cerclages function as implants, they may be used alone or together with a protecting device such as external or internal splints (such as plates, nails, stems of prosthesis or a combination of thereof). This article presents a review of the available literature relating cerclage-wiring techniques and updates the recommendations for clinical use.


Cerclage Cerclage-wiring techniques Wire Femoral fracture Periprosthetic fracture Internal fixation Intraoperative fracture Unstable intertrochanteric fracture Intramedullary nailing Reduction Cable Acetabular fracture Minimally invasive techniques Wire passer technology Twist Loop Periosteal blood vessels Vascular injury 


Conflict of interest

None of the authors have any financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work.


  1. 1.
    Evans PE (1983) Cerclage fixation of a fractured humerus in 1775. Fact or fiction? Clin Orthop 174:138–142PubMedGoogle Scholar
  2. 2.
    Götze O (1933) Subcutane Drahnaht bei Tibiaschrägbrüchen. Arch Klin Chir 177:145Google Scholar
  3. 3.
    Perren SM, Fernandez Dell’Oca A, Lenz M, Windolf M (2011) Cerclage, evolution and potential of a Cinderella technology. An overview with reference to periprosthetic fractures. Acta Chir Orthop Traumatol Cech 78(3):190–199PubMedGoogle Scholar
  4. 4.
    Lenz M, Perren SM, Gueorguiev B, Richards RG, Krause F, Fernandez Dell’Oca A, Höntzsch D, Windolf M (2012) Underneath the cerclage: an ex vivo study on the cerclage–bone interface mechanics. Arch Orthop Trauma Surg 132(10):1467–1472CrossRefPubMedGoogle Scholar
  5. 5.
    Cheng SL, Smith TJ, Davey JR (1993) A comparison of the strength and stability of six techniques of cerclage wire fixation for fractures. J Orthop Trauma 7(3):222CrossRefGoogle Scholar
  6. 6.
    Habernek H, Walch G, Dengg C (1989) Cerclage for torsional fractures of the tibia. J Bone Joint Surg 71B:311–313Google Scholar
  7. 7.
    Soeur R (1981) Fractures of the limbs: the relationship between mechanism and treatment. Brussels: La. Clinique Orthopedique:542–3. 7Google Scholar
  8. 8.
    Schopfer A, Willett K, Powell J et al (1993) Cerclage wiring in internal fixation of acetabular fractures. J Orthop Trauma 7(3):236–241CrossRefPubMedGoogle Scholar
  9. 9.
    Stiffler KS (2004) Internal fracture fixation. Clin Tech Small Anim Pract 19:105–113CrossRefPubMedGoogle Scholar
  10. 10.
    Christensen CM, Seger BM, Schultz RB (1989) Management of intraoperative femur fractures associated with revision hip arthroplasty. Clin Orthop Rel Res 248:177–180Google Scholar
  11. 11.
    Fitzgerald RH Jr, Brindley GW, Kavanagh BF (1988) The uncemented total hip arthroplasty: intraoperative femoral fractures. Clin Orthop Relat Res 235:61–66PubMedGoogle Scholar
  12. 12.
    Berend K, Lombardi A, Mallory T et al (2004) Cerclage wires or cables for the management of intraoperative fracture associated with a cementless, tapered femoral prosthesis results at 2 to 16 years. J Arthroplast 19:17–21CrossRefGoogle Scholar
  13. 13.
    Mayle RE Jr, Paprosky WG (2012) Massive bone loss: allograft-prosthetic composites and beyond. J Bone Joint Surg Br 94(11 Suppl A):61–64CrossRefPubMedGoogle Scholar
  14. 14.
    Duncan C, Masri B (1995) Fractures of the femur after hip replacement. Instr Course Lect 44:293–304PubMedGoogle Scholar
  15. 15.
    McCulloch RS, Roe SC, Marcellin-Little DJ, Mente PL (2012) Resistance to subsidence of an uncemented femoral stem after cerclage wiring of a fissure. Vet Surg 41(1):163–167CrossRefPubMedGoogle Scholar
  16. 16.
    Mallory TH, Kraus TJ, Vaughn BK (1989) Intraoperative femoral fractures associated with cementless total hip arthroplasty. Orthopedics 12(2):231–239PubMedGoogle Scholar
  17. 17.
    Otani T, Whiteside LA, White SE, McCarthy DS (1995) Reaming technique of the femoral diaphysis in cementless total hip arthroplasty. Clin Orthop Relat Res 311:210–221PubMedGoogle Scholar
  18. 18.
    Zeh A, Radetzki F, Diers V, Bach D, Röllinghoff M, Delank KS (2011) Is there an increased stem migration or compromised osteointegration of the Mayo short-stemmed prosthesis following cerclage wiring of an intrasurgical periprosthetic fracture? Arch Orthop Trauma Surg 131(12):1717–1722CrossRefPubMedGoogle Scholar
  19. 19.
    Fishkin Z, Han S, Ziv I (1999) Cerclage wiring technique after proximal femoral fracture in total hip arthroplasty. J Arthroplast 14:98–101CrossRefGoogle Scholar
  20. 20.
    Zuckerman JD (1996) Hip fracture. N Engl J Med 334:1519–1525CrossRefPubMedGoogle Scholar
  21. 21.
    Cho SH, Lee SH, Cho HL, Ku JH, Choi JH, Lee AJ (2011) Additional fixations for sliding hip screws in treating unstable pertrochanteric femoral fractures (AO Type 31-A2): short-term clinical results. Clin Orthop Surg 3(2):107–113CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Ban I, Birkelund L, Palm H, Brix M, Troelsen A (2012) Circumferential wires as a supplement to intramedullary nailing in unstable trochanteric hip fractures: 4 reoperations in 60 patients followed for 1 year. Acta Orthop 83(3):240–243CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Kennedy MT, Mitra A, Hierlihy TG, Harty JA, Reidy D, Dolan M (2011) Subtrochanteric hip fractures treated with cerclage cables and long cephalomedullary nails: a review of 17 consecutive cases over 2 years. Injury 42:1317–1321CrossRefPubMedGoogle Scholar
  24. 24.
    Winquist RA, Hansen ST Jr, Clawson DK (1984) Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg Am 66(4):529–539PubMedGoogle Scholar
  25. 25.
    Roberts CS, Nawab A, Wang M, Voor MJ, Seligson D (2002) Second generation intramedullary nailing of subtrochanteric femur fractures: a biomechanical study of fracture site motion. J Orthop Trauma 16(4):231–238CrossRefPubMedGoogle Scholar
  26. 26.
    Lin HH, Hung SH, Su YP, Chiu FY, Liu CL (2012) Cerclage wiring in displaced associated anterior column and posterior hemi-transverse acetabular fractures. Injury 43(6):917–920CrossRefPubMedGoogle Scholar
  27. 27.
    Chen CM, Chiu FY, Lo WH, Chung TY (2001) Cerclage wiring in displaced both-column fractures of the acetabulum. Injury 32(5):391–394CrossRefPubMedGoogle Scholar
  28. 28.
    Pike J, Davidson D, Garbuz D, Duncan CP, O’Brien PJ, Masri BA (2009) Principles of treatment for periprosthetic femoral shaft fractures around well-fixed total hip arthroplasty. J Am Acad Orthop Surg 17(11):677–688PubMedGoogle Scholar
  29. 29.
    Johannsson JE, McBroom R, Barrington TW, Hunter GA (1981) Fracture of the ipsilateral femur in patients with total hip replacement. J Bone Joint Surg Am 63(9):1435–1442Google Scholar
  30. 30.
    Dennis MG, Simon JA, Kummer FJ, Koval KJ, DiCesare PE (2000) Fixation of periprosthetic femoral shaft fractures occurring at the tip of the stem: a biomechanical study of five techniques. J Arthroplast 15(4):523–528CrossRefGoogle Scholar
  31. 31.
    Apivatthakakul T, Phaliphot J, Leuvitoonvechkit S (2013) Percutaneous cerclage wiring, does it disrupt femoral blood supply? A cadaveric injection study. Injury 44(2):168–174Google Scholar
  32. 32.
    Xue H, Tu Y, Cai M, Yang A (2011) Locking compression plate and cerclage band for type B1 periprosthetic femoral fractures preliminary results at average 30-month follow-up. J Arthroplast 26(3):467–471CrossRefGoogle Scholar
  33. 33.
    Younger TI, Bradford MS, Magnus RE et al (1995) Extended proximal femoral osteotomy. A new technique for femoral revision arthroplasty. J Arthroplast 10(3):329–338CrossRefGoogle Scholar
  34. 34.
    Jakubowitz E, Kinkel S, Nadorf J, Heisel C, Kretzer JP, Thomsen MN (2011) The effect of multifilaments and monofilaments on cementless femoral revision hip components: an experimental study. Clin Biomech (Bristol, Avon) 26(3):257–261CrossRefGoogle Scholar
  35. 35.
    Schwab JH, Camacho J, Kaufman K, Chen Q, Berry DJ, Trousdale RT (2008) Optimal fixation for the extended trochanteric osteotomy: a pilot study comparing 3 cables vs 2 cables. J Arthroplast 23(4):534–538CrossRefGoogle Scholar
  36. 36.
    Campbell JT, Moore RS, Iannotti JP, Norris TR, Williams GR (1998) Periprosthetic humeral fractures: mechanisms of fracture and treatment options. J Shoulder Elbow Surg 7:406–413CrossRefPubMedGoogle Scholar
  37. 37.
    Mavrogenis AF, Angelini A, Guerra E, Papagelopoulos PJ, Ruggieri P, Rotini R (2009) Periprosthetic fractures of the humerus. J Long Term Eff Med Implants 19(4):305–311CrossRefPubMedGoogle Scholar
  38. 38.
    Wutzler S, Laurer HL, Huhnstock S, Geiger EV, Buehren V, Marzi I (2009) Periprosthetic humeral fractures after shoulder arthroplasty: operative management and functional outcome. Arch Orthop Trauma Surg 129:237–243CrossRefPubMedGoogle Scholar
  39. 39.
    Cameron B, Iannotti JP (1999) Periprosthetic fractures of the humerus and scapula: management and prevention. Orthop Clin North Am 30:305–318CrossRefPubMedGoogle Scholar
  40. 40.
    Mavrogenis AF, Angelini A, Guerra E, Rotini R (2011) Humeral fracture between a total elbow and total shoulder arthroplasty. Orthopedics. 34(4)Google Scholar
  41. 41.
    Choo A, Ramsey ML (2013) Total elbow arthroplasty: current options. J Am Acad Orthop Surg 21(7):427–437CrossRefPubMedGoogle Scholar
  42. 42.
    Bostrom MP, Asnis SE, Ernberg JJ, Wright TM, Giddings VL, Berberian WS et al (1994) Fatigue testing of cerclage stainless steel wire fixation. J Orthop Trauma 8:422–428CrossRefPubMedGoogle Scholar
  43. 43.
    Shaw JA, Daubert HB (1988) Compression capability of cerclage fixation systems: a biomechanical study. Orthopedics 11:1169–1177PubMedGoogle Scholar
  44. 44.
    Lenz M, Perren SM, Richards RG, Mückley T, Hofmann GO, Gueorguiev B, Windolf M (2013) Biomechanical performance of different cable and wire cerclage configurations. Int Orthop 37(1):125–130CrossRefPubMedCentralPubMedGoogle Scholar
  45. 45.
    Ritter MA, Lutgring JD, Davis KE, Berend ME, Meding JB (2006) A clinical, radiographic, and cost comparison of cerclage techniques: wires vs cables. J Arthroplast 21(7):1064–1067CrossRefGoogle Scholar
  46. 46.
    Wähnert D, Lenz M, Schlegel U, Perren S, Windolf M (2011) Cerclage handling for improved fracture treatment. A biomechanical study on the twisting procedure. Acta Chir Orthop Traumatol Cech 78(3):208–214PubMedGoogle Scholar
  47. 47.
    Wilson JW (1987) Effect of cerclage wires on periosteal bone in growing dogs. Vet Surg 16(4):299–302CrossRefPubMedGoogle Scholar
  48. 48.
    Aleto T, Ritter M, Berend ME (2008) Case report: superficial femoral artery injury resulting from cerclage wiring during revision THA. Clin Orthop Relat Res 466(3):749–753CrossRefPubMedCentralPubMedGoogle Scholar
  49. 49.
    Biddau F, Fioriti M, Benelli G (2006) Migration of a broken cerclage wire from the patella into the heart. A case report. JBone Jt Surg Am 88(9):2057–2059CrossRefGoogle Scholar
  50. 50.
    Wirth MA, Lakoski SG, Rockwood CA Jr (2000) Migration of broken cerclage wire from the shoulder girdle into the heart: a case report. J Shoulder Elbow Surg 9:543–544CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France 2014

Authors and Affiliations

  1. 1.Department of Orthopedics, Rizzoli Orthopedic InstituteUniversity of BolognaBolognaItaly
  2. 2.Orthopedics and Traumatology DepartmentAsur Marche Area Vasta 5Ascoli PicenoItaly

Personalised recommendations