Cerclage Wiring in Subtrochanteric Hip Fractures. Analysis of Benefits and Complications
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Published:
Apr 18, 2022
Keywords:
Subtrochanteric fracture, cerclage wire, union, nonunion, infection, malalignment
Main Article Content
Abstract
Background: The aim of this retrospective study was to assess whether open reduction with cerclage wire affected the union and/or complication rate in subtrochanteric hip fractures treated with cephalomedullary nails.
Materials and Methods: We analyzed all patients who had undergone surgery in our center between January 2010 and December 2017. We comparatively analyzed those treated with (Group A) and without (Group B) cerclage wire in terms of fracture type, hospital stay, surgical time, blood transfusions, malalignment, union, and complications (infection rates, non-union, and reoperations).
Results: Fifty-eight patients were included. Group A consisted of 20 patients and Group B of 38. The most frequent type of fracture was 3A (p 0.0004). The mean hospital stay was similar (9 vs 10.6 days p 0.81), the surgical time and transfusions were higher in group A (p<0.0001 and p 0.58 respectively). The union rate was similar (90 vs 92.1%;p 0.09, respectively). Malalignment was only observed in group B (5 - 13.5%; p 0.01). Thecomplication (15 vs 18.4%) and reoperation (15 vs 15.8%) rates were similar (p 0.99).
Conclusions: The use of cerclage wire in subtrochanteric hip fractures treated with cephalomedullary nails generated a significant increase in surgical time and a lower rate of malalignment. It allowed a lower rate of re-operation, although it was not significant.
Materials and Methods: We analyzed all patients who had undergone surgery in our center between January 2010 and December 2017. We comparatively analyzed those treated with (Group A) and without (Group B) cerclage wire in terms of fracture type, hospital stay, surgical time, blood transfusions, malalignment, union, and complications (infection rates, non-union, and reoperations).
Results: Fifty-eight patients were included. Group A consisted of 20 patients and Group B of 38. The most frequent type of fracture was 3A (p 0.0004). The mean hospital stay was similar (9 vs 10.6 days p 0.81), the surgical time and transfusions were higher in group A (p<0.0001 and p 0.58 respectively). The union rate was similar (90 vs 92.1%;p 0.09, respectively). Malalignment was only observed in group B (5 - 13.5%; p 0.01). Thecomplication (15 vs 18.4%) and reoperation (15 vs 15.8%) rates were similar (p 0.99).
Conclusions: The use of cerclage wire in subtrochanteric hip fractures treated with cephalomedullary nails generated a significant increase in surgical time and a lower rate of malalignment. It allowed a lower rate of re-operation, although it was not significant.
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How to Cite
Garabano, G., Gessara, A., Rodríguez, J., Dainotto, T., & del Sel, H. (2022). Cerclage Wiring in Subtrochanteric Hip Fractures. Analysis of Benefits and Complications. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(2), 143-151. https://doi.org/10.15417/issn.1852-7434.2022.87.2.1400
Section
Clinical Research
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References
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https://doi.org/10.1007/s00068-018-01071-4
4. Afsari A, Liporace F, Lindvall E, Infante A, Sagi HC, Haidukewych GJ. Clamp-assisted reduction of high
subtrochanteric fractures of the femur. J Bone Joint Surg Am 2009;91(8):1913-8. https://doi.org/10.2106/JBJS.H.01563
5. Robinet JM, Torres M, Moreno MB, Alonso JA, García SG. Minimally invasive clamp-assisted reduction and
cephalomedullary nailing without cerclage cables for subtrochanteric femur fractures in the elderly: surgical
technique and results. Injury 2015;46(6):1036-41. https://doi.org/10.1016/j.injury.2015.01.0119
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7. Rhie JT, Widmaier JC. Technique of obtaining and maintaining reduction during nailing of femur fractures.
Orthopedics 2009;32(8):581-8. https://doi.org/10.3928/01477447-20090624-17
8. Appivatthakakul T, Phaliphot J, Leuvitoonvechkit S. Percutaneous cerclage wiring, does it disrupt femoral blood
supply? A cadaveric injection study. Injury 2013;44(2):168-74. https://doi.org/10.1016/j.injury.2012.10.016
9. Perren SM. Evolution of internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br 2002;84(8):1093-110. https://doi.org/10.1302/0301-620x.84b8.13752
10. Vaidya SV, Dholakia DB, Chatterjee A. The use of dynamic condylar screw and biological reduction techniques for subtrochanteric femur fracture. Injury 2003;34(2):123-8. https://doi.org/10.1016/s0020-1383(02)00319-4
11. Celebi L, Can M, Muratli HH, Yagmurlu MF, Yuksel HY, Sicimoglu AN. Indirect reduction and biological internal
fixation of comminuted subtrochanteric fractures of the femur. Injury 2006;37(8):740-50. https://doi.org/10.1016/j.injury.2005.12.022
12. Seinsheimer F. Subtrochanteric fractures of the femur. J Bone Joint Surg Am 1978;60:300-6. PMID: 649632
13. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am 1995;77:1058-64.
https://doi.org/10.2106/00004623-199507000-00012
14. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969;51(4):737-55. PMID: 5783851
15. Trikha V, Saudhik D, Prabhat A, Arkesh M, Sunil KD. Role of percutaneous cerclage wire in the management of
subtrochanteric fractures treated with intramedullary nails. Chin J Traumat 2018;21(1):42-9. https://doi.org/10.1016/j.cjtee.2018.01.001
16. Tomas J, Teixidor J, Batalla L, Pacha D, Cortina J. Subtrochanteric fractures: treatment with cerclage wire and long intramedullary nail. J Orthop Trauma 2013;27:e157-160. https://doi.org/10.1097/BOT.0b013e31826fc03f
17. Finsen V. The effect of cerclage wires on the strength of diaphyseal bone. Injury 1995;26(3):159-61.
https://doi.org/10.1016/0020-1383(95)93493-2
18. Muller T, Topp T, Kuhne CA, Gebhart G, Ruchholtz S, Zetti ARE. The benefit of wire cerclage stabilization of the
medial hinge in intramedullary nailing for the treatment of subtrochanteric femoral fractures: a biomechanical study. Int Orthop 2011;35(8):1237-43. https://doi.org/10.1007/s00264-010-1204-4
19. Starr AJ, Hay MT, Reinert CM, Borer DS, Christensen KC. 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 2006;20(4):240-6. https://doi.org/10.1097/00005131-20060400-00002
20. Shukla S, Johnston P, Ahmad MA, Wynn-Jones H, Patel AD, Walton NP. Outcome of traumatic subtrochanteric
femoral fractures fixed using cephalomedullary nails. Injury 2007;38(11):1286-93. https://doi.org/10.1016/j.injury.2007.05.013
21. Kennedy MT, Mitra A, Hierlihy TG, Harty JA, Reidy D, Dolan M. Subtrochanteric hip fractures treated with cerclage cables and long cephalomedullary nails: a review of 17 consecutive cases over 2 years. Injury 2011;42(11):1317-21. https://doi.org/10.1016/j.injury.2011.03.023
22. Malik MHA, Harwood P, Diggle P, Khan SA. Factors affecting rate of infection and nonunion in intramedullary
nailing. J Bone Joint Surg Br 2004;86(4):556-60. PMID: 15174553
23. Krappinger D, Wolf B, Dammerer D, Thaler M, Schwendinger P, Lindtner RA. Risk factors for nonunion after
intramedullary nailing of subtrochanteric femoral fractures. Arch Orthop Trauma Surg 2019;139(6):769-77.
https://doi.org/10.1007/s00402-019-03131-9
24. Edwards C, Counsell A, Boulton C, Moran CG. Early infection after hip fracture surgery: risk factors, cost and
outcomes. J Bone Joint Surg Br 2008;90(6):770-7. https://doi.org/10.1302/0301-620X.90B6.20194
25. Pazzaglia UE, Coniu T, Raspanti M, Ranchetti F, Quacci D. Anatomy of the intracortical canal system. Scanning
electron microscopy study inrabbit femur. Clin Orthop Relat Res 2009;467(9):2446-56. https://doi.org/10.1007/s11999-009-0806-x
https://doi.org/10.1302/0301-620X.90B4.20264
2. Barbosa de Toledo PR, Pires RES. Subtrochanteric fractures of the femur: update. Rev Bras Ortop 2016;51(3):246-53. https://doi.org/10.1016/j.rboe.2016.03.001
3. Karayiannis P, James A. The impact of cerclage cabling on unstable intertrochanteric and subtrochanteric femoral fracture: a retrospective review of 465 patients. Eur J Trauma Emerg Surg 2020;46(5):969-75.
https://doi.org/10.1007/s00068-018-01071-4
4. Afsari A, Liporace F, Lindvall E, Infante A, Sagi HC, Haidukewych GJ. Clamp-assisted reduction of high
subtrochanteric fractures of the femur. J Bone Joint Surg Am 2009;91(8):1913-8. https://doi.org/10.2106/JBJS.H.01563
5. Robinet JM, Torres M, Moreno MB, Alonso JA, García SG. Minimally invasive clamp-assisted reduction and
cephalomedullary nailing without cerclage cables for subtrochanteric femur fractures in the elderly: surgical
technique and results. Injury 2015;46(6):1036-41. https://doi.org/10.1016/j.injury.2015.01.0119
6. Pesciallo C, Mana DP, Barrios JM, del Sel H. Fracturas subtrocantereas de fémur. Tratamiento con clavo de fémur proximal por técnica mínimamente invasiva. Rev Asoc Argent Ortop Traumatol 2009;74(1):13-9. Disponible en: https://www.aaot.org.ar/revista/2009/n1/art03.pdf
7. Rhie JT, Widmaier JC. Technique of obtaining and maintaining reduction during nailing of femur fractures.
Orthopedics 2009;32(8):581-8. https://doi.org/10.3928/01477447-20090624-17
8. Appivatthakakul T, Phaliphot J, Leuvitoonvechkit S. Percutaneous cerclage wiring, does it disrupt femoral blood
supply? A cadaveric injection study. Injury 2013;44(2):168-74. https://doi.org/10.1016/j.injury.2012.10.016
9. Perren SM. Evolution of internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br 2002;84(8):1093-110. https://doi.org/10.1302/0301-620x.84b8.13752
10. Vaidya SV, Dholakia DB, Chatterjee A. The use of dynamic condylar screw and biological reduction techniques for subtrochanteric femur fracture. Injury 2003;34(2):123-8. https://doi.org/10.1016/s0020-1383(02)00319-4
11. Celebi L, Can M, Muratli HH, Yagmurlu MF, Yuksel HY, Sicimoglu AN. Indirect reduction and biological internal
fixation of comminuted subtrochanteric fractures of the femur. Injury 2006;37(8):740-50. https://doi.org/10.1016/j.injury.2005.12.022
12. Seinsheimer F. Subtrochanteric fractures of the femur. J Bone Joint Surg Am 1978;60:300-6. PMID: 649632
13. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am 1995;77:1058-64.
https://doi.org/10.2106/00004623-199507000-00012
14. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969;51(4):737-55. PMID: 5783851
15. Trikha V, Saudhik D, Prabhat A, Arkesh M, Sunil KD. Role of percutaneous cerclage wire in the management of
subtrochanteric fractures treated with intramedullary nails. Chin J Traumat 2018;21(1):42-9. https://doi.org/10.1016/j.cjtee.2018.01.001
16. Tomas J, Teixidor J, Batalla L, Pacha D, Cortina J. Subtrochanteric fractures: treatment with cerclage wire and long intramedullary nail. J Orthop Trauma 2013;27:e157-160. https://doi.org/10.1097/BOT.0b013e31826fc03f
17. Finsen V. The effect of cerclage wires on the strength of diaphyseal bone. Injury 1995;26(3):159-61.
https://doi.org/10.1016/0020-1383(95)93493-2
18. Muller T, Topp T, Kuhne CA, Gebhart G, Ruchholtz S, Zetti ARE. The benefit of wire cerclage stabilization of the
medial hinge in intramedullary nailing for the treatment of subtrochanteric femoral fractures: a biomechanical study. Int Orthop 2011;35(8):1237-43. https://doi.org/10.1007/s00264-010-1204-4
19. Starr AJ, Hay MT, Reinert CM, Borer DS, Christensen KC. 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 2006;20(4):240-6. https://doi.org/10.1097/00005131-20060400-00002
20. Shukla S, Johnston P, Ahmad MA, Wynn-Jones H, Patel AD, Walton NP. Outcome of traumatic subtrochanteric
femoral fractures fixed using cephalomedullary nails. Injury 2007;38(11):1286-93. https://doi.org/10.1016/j.injury.2007.05.013
21. Kennedy MT, Mitra A, Hierlihy TG, Harty JA, Reidy D, Dolan M. Subtrochanteric hip fractures treated with cerclage cables and long cephalomedullary nails: a review of 17 consecutive cases over 2 years. Injury 2011;42(11):1317-21. https://doi.org/10.1016/j.injury.2011.03.023
22. Malik MHA, Harwood P, Diggle P, Khan SA. Factors affecting rate of infection and nonunion in intramedullary
nailing. J Bone Joint Surg Br 2004;86(4):556-60. PMID: 15174553
23. Krappinger D, Wolf B, Dammerer D, Thaler M, Schwendinger P, Lindtner RA. Risk factors for nonunion after
intramedullary nailing of subtrochanteric femoral fractures. Arch Orthop Trauma Surg 2019;139(6):769-77.
https://doi.org/10.1007/s00402-019-03131-9
24. Edwards C, Counsell A, Boulton C, Moran CG. Early infection after hip fracture surgery: risk factors, cost and
outcomes. J Bone Joint Surg Br 2008;90(6):770-7. https://doi.org/10.1302/0301-620X.90B6.20194
25. Pazzaglia UE, Coniu T, Raspanti M, Ranchetti F, Quacci D. Anatomy of the intracortical canal system. Scanning
electron microscopy study inrabbit femur. Clin Orthop Relat Res 2009;467(9):2446-56. https://doi.org/10.1007/s11999-009-0806-x