Skip to main content

A modified cable wiring technique with C-shaped passer through a mini-open approach to assist reduction in femoral fractures


Femur fractures reduction can be technically challenging due to the deforming forces exerted by the muscles causing displacement of the fracture fragments. Cerclage wiring is one of the reduction techniques frequently performed, allowing anatomical reduction of the fragments and a more stable fixation when an accurate closed reduction is not possible. We describe a modified cerclage wiring through a minimally invasive technique, using a conventional cannulated C-shaped passer.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6


  1. 1.

    Hak DJ, Wu H, Dou C, Mauffrey C, Stahel PF (2015) Challenges in subtrochanteric femur fracture management. Orthopedics 38:498–502.

    Article  PubMed  Google Scholar 

  2. 2.

    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.

    Article  PubMed  Google Scholar 

  3. 3.

    Li J, Zhang L, Zhang H et al (2019) Effect of reduction quality on post-operative outcomes in 31–A2 intertrochanteric fractures following intramedullary fixation: a retrospective study based on computerised tomography findings. Int Orthop 43(8):1951–1959.

    Article  PubMed  Google Scholar 

  4. 4.

    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(11):1317–1321.

    Article  PubMed  Google Scholar 

  5. 5.

    Apivatthakakul T, Phornphutkul C, Bunmaprasert T, Sananpanich K, Fernandez Dell’Oca A (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 132:813–822.

    Article  PubMed  Google Scholar 

  6. 6.

    Codesido P, Mejía A, Riego J, Ojeda-Thies C (2017) Cerclage wiring through a mini-open aproach to assist reduction of subtrochanteric fractures treated with cephalomedullary fixation: surgical technique. J Orthop Trauma 31(8):e263-268.

    Article  PubMed  Google Scholar 

  7. 7.

    Link BC, Apivatthakakul T, Hill BW, Cole PA, Babst R (2014) Minimally Invasive Plate Osteosynthesis (MIPO) of periprosthetic femoral fractures with percutaneous cerclage wiring for fracture reduction: tips and technique. JBJS Essent Surg Tech 9;4(3):e13–23.

  8. 8.

    Apivatthakakul T, Siripipattanamongkol P, Oh CW, Sananpanich K, Phornphutkul C (2018) Safe zones and a technical guide for cerclage wiring of the femur: a computed topographic angiogram (CTA) study. Arch Orthop Trauma Surg 138(1):433–450.

    Article  Google Scholar 

  9. 9.

    Ehlinger M, Niglis L, Favreau H, Kuntz S, Bierry G, Adam P, Bonnomet F (2018) Vascular complication after percutaneous femoral cerclage wire. Orthop Traumatol Surg Res 104:377–381.

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Devendra A, Avinash M, Chidambaram D, Dheenadhayalan J, Rajasekaran S (2018) Vascular injuries due to cerclage passer: relevant anatomy and note of caution. J Orthop Surg (Hong Kong) 26(1):1–6.

    Article  Google Scholar 

  11. 11.

    Pape HC, Tarkin IS (2009) Intraoperative reduction techniques for difficult femoral fractures. J Orthop Trauma 23(Suppl 5):S6-11.

    Article  PubMed  Google Scholar 

  12. 12.

    Angelini A, Battiato C (2015) Past and present of the use of cerclage wires in orthopedics. Eur J Orthop Surg Traumatol 25(4):623–635.

    Article  PubMed  Google Scholar 

  13. 13.

    Agarwala S, Menon A, Chaudhari S (2017) Cerclage wiring as an adjunct for the treatment of femur fractures: series of 11 cases. J Orthop Case Rep 7(4):39–43.

  14. 14.

    Tomás J, Teixidor J, Batalla L, Pacha D, Cortina J (2013) Subtrochanteric fractures: treatment with cerclage wire and long intramedullary nail. J Orthop Trauma 27:e157–e160.

    Article  PubMed  Google Scholar 

  15. 15.

    Hoskins W, Bingham R, Joseph S et al (2015) Subtrochanteric fracture: the effect of cerclage wire on fracture reduction and outcome. Injury 46:1992–1995.

    Article  PubMed  Google Scholar 

  16. 16.

    Abdelkhalek M, Ali AM, Abdelwahab M (2013) Cemented bipolar hemiarthroplasty with a cerclage cable technique for unstable intertrochanteric hip fractures in elderly patients. Eur J Orthop Surg Traumatol 23:443–448.

    Article  PubMed  Google Scholar 

  17. 17.

    Mingo-Robinet J, Torres-Torres M, Moreno-Barrero M, Alonso JA, García-González S (2015) Minimally invasive clamp-assisted reduction and cephalomedullary nailing without cerclage cables for subtrochanteric femur fractures in the elderly: surgical technique and results. Injury 46:1036–1041.

    Article  PubMed  Google Scholar 

  18. 18.

    Apivatthakakul T, Phaliphot J, Leuvitoonvechkit S (2013) Percutaneous cerclage wiring, does it disrupt femoral blood supply? A cadaveric injection study. Injury 44(2):168–174.

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    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 Othop 37:125–130.

    Article  Google Scholar 

  20. 20.

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

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Angelini A, Battiato C (2016) Combination of low-contact cerclage wiring and osteosynthesis in the treatment of femoral fractures. Eur J Orthop Surg Traumatol 26:397–406.

    Article  PubMed  Google Scholar 

  22. 22.

    Shin WC, Moon NH, Jang JH, Jeong JY, Suh KT (2019) Technical note and surgical outcomes of percutaneous cable fixation in subtrochanteric fracture: a review of 51 consecutive cases over 4 years in two institutions. Injury 50:409–414.

    Article  PubMed  Google Scholar 

Download references


No funding was received to assist with the preparation of this manuscript. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Author information



Corresponding author

Correspondence to Marian Vives-Barquiel.

Ethics declarations

Conflict of interest

Financial Interests: authors declare they have no financial interests. Non-financial interests: none.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Camacho-Carrasco, P., Renau-Cerrillo, M., Campuzano-Bitterling, B. et al. A modified cable wiring technique with C-shaped passer through a mini-open approach to assist reduction in femoral fractures. Eur J Orthop Surg Traumatol (2021).

Download citation


  • Cerclage wire
  • Femoral fracture
  • Fracture reduction
  • Mini-invasive approach