Combination of low-contact cerclage wiring and osteosynthesis in the treatment of femoral fractures
- 535 Downloads
Background and purpose
Objectives were (1) to evaluate results after cerclage wiring technique for femoral primary and periprosthetic fracture (PPF); (2) to report the incidence of complications and their treatment; (3) to analyze possible prognostic factors.
Patients and methods
We analyzed 54 patients treated with different techniques associated with low-contact cerclage wires for femoral fracture. Fractures were stratified according to AO, Vancouver or Rorabeck classification. Cerclage was used as an exclusive implant in four PPFs or combined with internal devices in 50 cases. Comorbidities were assessed using Charlson Comorbidity Index. The Glasgow Outcome Scale was used to compare activities of daily living pre/postoperatively.
Cerclage wires with three or four spacers were used in 22 and 32 cases, respectively. Nine patients died within 6 months. Mean follow-up of the remaining 42 patients was 10.5 months. Fracture healing was achieved in 38/42 patients (71 %), with a mean time to callus formation of 57 days and to radiographic union of 3 months (1.5–9 months). Four patients had nonunion. Survival to major complications was 92 and 70 % at 1 and 2 years, respectively, significantly better in cerclage wires with three spacers than those with four spacers (p = 0.0188). No other statistical correlations were found.
Cerclage wiring in difficult femoral fractures offers minimally invasive reduction and fixation technique, low cost and early holding. We reinforce the concept of “reduce with cerclage cables first, then nail” for displaced long subtrochanteric fractures and support the use of cerclage wiring for challenge PPF using low-contact wires.
Level of evidence
Therapeutic study, Level IV.
KeywordsPeriprosthetic fractures Femur Intramedullary nailing Osteosynthesis Percutaneous treatment MIPO
Compliance with ethical standards
Conflict of interest
Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted article.
Our study involves human, but the retrospective study does not require approval in our country.
- 13.Franz KL (1998) Stand der Beurteilungsmöglichkeit der Prognose nach SHT-Vorbedingungen für eine Aussage über die Prognose. Neuro Trauma News 9:4–5Google Scholar
- 16.Apivatthakakul T, Phornphutkul C, Bunmaprasert T, Sananpanich K, Dell’Oca AF (2012) Percutaneous cerclage wiring and minimally invasive plate osteosynthesis (MIPO): a percutaneous reduction technique in the treatment of Vancouver type B1 periprosthetic femoral shaft fractures. Arch Orthop Trauma Surg 132(6):813–822CrossRefPubMedGoogle Scholar
- 19.Ganz R, Mast J, Weber B, Perren SM (1991) Clinical aspects of biological plating. Injury 22:4–5Google Scholar
- 20.Zickel RE (1976) An intramedullary fixation device for the proximal part of the femur. None years experience. J Bone Joint Surg [Am] 58-A:866–872Google Scholar