A review of metallic and non-metallic cerclage in orthopaedic surgery: Is there still a place for metallic cerclage?

Cerclage techniques are simple, yet effective techniques to treat certain fractures and are known as one of the first operative techniques in orthopaedic surgery. The days when a twisted metal wire was the only available cerclage technique nonetheless have passed and today there are many different materials and techniques available. This review evaluates the differences between metallic and non-metallic cerclage techniques, thereby looking at biomechanical, technical and biological aspects. It also provides an overview of clinical applications for non-metallic cerclages. The use of metallic versus non-metallic cerclage might differ depending on indication, location and involved tissues. Currently metallic cerclage is mostly used to repair fractures because of its believed higher absolute strength. More recently though, non-metallic cerclage has been proven to withstand the same loads, while having a lower complication rate. This review suggests that mainly in the upper limb a non-metallic cerclage technique might become the golden standard, while in the lower limb both metallic and non-metallic cerclage techniques are complementary and dependent on indication.