Sanjay Agarwala1, Aditya Menon1, Sameer Chaudhari1. 1. Department of Orthopedics and Traumatology, P D Hinduja Hospital and Medical Research Centre, Mahim, Mumbai, Maharashtra, India.
Abstract
INTRODUCTION: Cerclage wiring has been used in the past for osteosynthesis of femoral fractures. However, the technique went into disrepute as extensive soft tissue dissection, and periosteal stripping increased the risk of bone necrosis and delayed union. Advent of new instrumentation and minimally invasive technique has significantly reduced these complications. In spite of the limited indications for its application, reduction and stabilization with cerclage wiring can supplement osteosynthesis especially in spiral or oblique fracture morphology or those with a butterfly fragment instead of interfragmentary screw fixation. This series attempts to describe the feasibility and evaluate outcomes of cerclage wiring as an adjunct to osteosynthesis and reestablish its place in reduction and fixation of femur fractures. CASE REPORT: This is a retrospective case series of patients (January 2011 to October 2015) in whom cerclage wiring was used as an adjunct to osteosynthesis of primary and periprosthetic fractures of femur. Patient demographics, number of wires used, implant used for osteosynthesis, number of days to union, union rate and complications were recorded and analyzed. The patients were followed up for a minimum of 6 months. 11 patients (7 female and 4 male) with a mean age of 67.10 ± 21.64 years were studied. The number of patients with intertrochanteric, subtrochanteric, diaphyseal, and periprosthetic fractures of the femur was two, five, one, and three, respectively. Internal fixation was done with plates in six and cephalomedullary nails in five patients. Mean total number of wires used was 2.10 ± 0.70. Mean duration of follow-up was 15.91 ± 10.03 months. Union was achieved in all cases with a mean duration of 86.63 ± 22.44 days. There were no complications in our study. CONCLUSION: Cerclage wiring technique helps to achieve stable reduction of femoral fractures which can then be supplemented with a nail or a plate. The minimally invasive technique and instrumentation offer the advantage of minimal soft tissue dissection, and the procedure is associated with excellent outcomes without any major complications.
INTRODUCTION: Cerclage wiring has been used in the past for osteosynthesis of femoral fractures. However, the technique went into disrepute as extensive soft tissue dissection, and periosteal stripping increased the risk of bone necrosis and delayed union. Advent of new instrumentation and minimally invasive technique has significantly reduced these complications. In spite of the limited indications for its application, reduction and stabilization with cerclage wiring can supplement osteosynthesis especially in spiral or oblique fracture morphology or those with a butterfly fragment instead of interfragmentary screw fixation. This series attempts to describe the feasibility and evaluate outcomes of cerclage wiring as an adjunct to osteosynthesis and reestablish its place in reduction and fixation of femur fractures. CASE REPORT: This is a retrospective case series of patients (January 2011 to October 2015) in whom cerclage wiring was used as an adjunct to osteosynthesis of primary and periprosthetic fractures of femur. Patient demographics, number of wires used, implant used for osteosynthesis, number of days to union, union rate and complications were recorded and analyzed. The patients were followed up for a minimum of 6 months. 11 patients (7 female and 4 male) with a mean age of 67.10 ± 21.64 years were studied. The number of patients with intertrochanteric, subtrochanteric, diaphyseal, and periprosthetic fractures of the femur was two, five, one, and three, respectively. Internal fixation was done with plates in six and cephalomedullary nails in five patients. Mean total number of wires used was 2.10 ± 0.70. Mean duration of follow-up was 15.91 ± 10.03 months. Union was achieved in all cases with a mean duration of 86.63 ± 22.44 days. There were no complications in our study. CONCLUSION: Cerclage wiring technique helps to achieve stable reduction of femoral fractures which can then be supplemented with a nail or a plate. The minimally invasive technique and instrumentation offer the advantage of minimal soft tissue dissection, and the procedure is associated with excellent outcomes without any major complications.
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