Skip to main content

Advertisement

SpringerLink
Log in

Percutaneous cerclage wiring followed by intramedullary nailing for subtrochanteric femoral fractures: a technical note with clinical results

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Although intramedullary nailing is an ideal treatment for subtrochanteric femoral fractures, it is technically challenging in fractures extending into the nail entry area and/or involving the lesser trochanter. Although the application of circumferential wire may facilitate reduction in these situations, its use remains controversial due to possible blood supply disturbances to underlying bone. In the present study, we evaluated complex subtrochanteric fractures treated by percutaneous cerclage wiring followed by intramedullary (IM) nailing for anatomical fracture reduction and union.

Methods

Twelve patients (mean age 48.3 years) with an unstable subtrochanteric fracture were prospectively treated. Indications of percutaneous cerclage wiring followed by IM nailing were a fracture extending proximally into the nail entry area deemed difficult to treat by anatomical reconstruction by IM nailing or a fracture with long oblique or spiral component. One or two cerclage wires were percutaneously applied for the temporary reduction of main fragments, and then, a cephalo-medullary or a reconstruction nail was fixed. We assessed radiologic results (union time, alignment), functional results, and complications.

Results

All 12 cases healed, without a bone graft, at an average of 19.1 weeks after surgery (range 16–24). In 11 cases, acceptable alignment was achieved (mean, valgus 0.3° extension 0.6°) with minimal leg-length discrepancy; the other exhibited 1 cm of shortening. All patients were able to return to pre-injury activity levels, and median Merle d’Aubigne score was 16.9 (15–18). No infection or implant-related complication was encountered to latest follow-up (minimum 12 months postoperatively).

Conclusion

Temporary reduction by percutaneous wiring offers a means of satisfactory nailing in difficult subtrochanteric femoral fractures, and affords anatomical reconstruction and favorable bony union.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

References

  1. Bedi A, Le Toan T (2004) Subtrochanteric femur fractures. Orthop Clin North Am 35:473–483. doi:10.1016/j.ocl.2004.05.006

    Article  PubMed  Google Scholar 

  2. Afsari A, Liporace F, Lindvall E, Infante A Jr, Sagi HC, Haidukewych GJ (2009) Clamp-assisted reduction of high subtrochanteric fractures of the femur. J Bone Joint Surg Am 91:1913–1918. doi:10.2106/JBJS.H.01563

    Article  PubMed  Google Scholar 

  3. 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 42:1317–1321. doi:10.1016/j.injury.2011.03.023

    Article  PubMed  Google Scholar 

  4. 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 83:240–243. doi:10.3109/17453674.2012.665329

    Article  PubMed Central  PubMed  Google Scholar 

  5. Haidukewych GJ, Berry DJ (2004) Nonunion of fractures of the subtrochanteric region of the femur. Clin Orthop 419:185–188

    Article  PubMed  Google Scholar 

  6. Starr AJ, Hay MT, Reinert CM, Borer DS, Christensen KC (2006) Cephalomedullary nails in the treatment of high-energy proximal femur fractures in young patients: a prospective, randomized comparison of trochanteric versus piriformis fossa entry portal. J Orthop Trauma 20:240–246

    Article  PubMed  Google Scholar 

  7. Shukla S, Johnston P, Ahmad MA, Wynn-Jones H, Patel AD, Walton NP (2007) Outcome of traumatic subtrochanteric femoral fractures fixed using cephalo-medullary nails. Injury 38:1286–1293. doi:10.1016/j.injury.2007.05.013

    Article  PubMed  Google Scholar 

  8. Oh CW, Kim JJ, Byun YS, Oh JK, Kim JW, Kim SY, Park BC, Lee HJ (2009) Minimally invasive plate osteosynthesis of subtrochanteric femur fractures with a locking plate: a prospective series of 20 fractures. Arch Orthop Trauma Surg 129:1659–1665. doi:10.1007/s00402-009-0815-y

    Article  PubMed  Google Scholar 

  9. Ma CH, Tu YK, Yu SW, Yen CY, Yeh JH, Wu CH (2010) Reverse LISS plates for unstable proximal femoral fractures. Injury 41:827–833. doi:10.1016/j.injury.2010.03.028

    Article  PubMed  Google Scholar 

  10. Wieser K, Babst R (2010) Fixation failure of the LCP proximal femoral plate 4.5/5.0 in patients with missing posteromedial support in unstable per-, inter-, and subtrochanteric fractures of the proximal femur. Arch Orthop Trauma Surg 130:1281–1287. doi:10.1007/s00402-010-1074-7

    Article  PubMed  Google Scholar 

  11. Glassner PJ, Tejwani NC (2011) Failure of proximal femoral locking compression plate: a case series. J Orthop Trauma 25:76–83. doi:10.1097/BOT.0b013e3181e31ccc

    Article  PubMed  Google Scholar 

  12. Apivatthakakul T, Phornphutkul C (2012) Percutaneous cerclage wiring for reduction of periprosthetic and difficult femoral fractures. A technical note. Injury 43:966–971. doi:10.1016/j.injury.2011.11.007

    Article  CAS  PubMed  Google Scholar 

  13. Loizou CL, McNamara I, Ahmed K, Pryor GA, Parker MJ (2010) Classification of subtrochanteric femoral fractures. Injury 41:739–745. doi:10.1016/j.injury.2010.02.018

    Article  CAS  PubMed  Google Scholar 

  14. Pazzaglia UE, Congiu T, Raspanti M, Ranchetti F, Quacci D (2009) Anatomy of the intracortical canal system: scanning electron microscopy study in rabbit femur. Clin Orthop 467:2446–2456. doi:10.1007/s11999-009-0806-x

    Article  PubMed Central  PubMed  Google Scholar 

  15. 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 78:190–199

    CAS  PubMed  Google Scholar 

  16. 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 132:1467–1472. doi:10.1007/s00402-012-1572-x

    Article  PubMed  Google Scholar 

  17. 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 37:125–130. doi:10.1007/s00264-012-1702-7

    Article  PubMed Central  PubMed  Google Scholar 

  18. Apivatthakakul T, Phaliphot J, Leuvitoonvechkit S (2013) Percutaneous cerclage wiring, does it disrupt femoral blood supply? A cadaveric injection study. Injury 44:168–174. doi:10.1016/j.injury.2012.10.016

    Article  CAS  PubMed  Google Scholar 

  19. Müller T, Topp T, Kühne CA, Gebhart G, Ruchholtz S, Zettl R (2011) The benefit of wire cerclage stabilisation of the medial hinge in intramedullary nailing for the treatment of subtrochanteric femoral fractures: a biomechanical study. Int Orthop 35:1237–1243. doi:10.1007/s00264-010-1204-4

    Article  PubMed Central  PubMed  Google Scholar 

  20. Aleto T, Ritter MA, Berend ME (2008) Case report: superficial femoral artery injury resulting from cerclage wiring during revision THA. Clin Orthop 466:749–753. doi:10.1007/s11999-007-0109-z

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Conflict of interest

All authors have certified that they have no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with this article.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Guri, Republic of Korea

    Ki-Chul Park

  2. Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Republic of Korea

    Jong-Keon Oh & Yong-Cheol Yoon

  3. Department of Orthopaedic Surgery, Kyungpook National University Hospital, 50, 2-Ga, Samdok, Chung-gu, Daegu, 700-721, Republic of Korea

    Joon-Woo Kim, Chang-Wug Oh & Hyo-Won Chang

Authors
  1. Joon-Woo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ki-Chul Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jong-Keon Oh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chang-Wug Oh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yong-Cheol Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hyo-Won Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chang-Wug Oh.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, JW., Park, KC., Oh, JK. et al. Percutaneous cerclage wiring followed by intramedullary nailing for subtrochanteric femoral fractures: a technical note with clinical results. Arch Orthop Trauma Surg 134, 1227–1235 (2014). https://doi.org/10.1007/s00402-014-2023-7

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-014-2023-7

Keywords

Search

Navigation