Role of percutaneous cerclage wire in the management of subtrochanteric fractures treated with intramedullary nails
Purpose: Cerclage wire application has emerged as a potential therapeutic adjunct to intramedullary nailing for subtrochanteric fractures. But its popularity is plagued by the concern of possible negative effect on fracture zone biology. This study was intended to analyze the clinico-radiological ou...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2018-02-01
|
| Series: | Chinese Journal of Traumatology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1008127518300178 |
| _version_ | 1828445374711332864 |
|---|---|
| author | Vivek Trikha Saubhik Das Prabhat Agrawal Arkesh M Sunil Kumar Dhaka |
| author_facet | Vivek Trikha Saubhik Das Prabhat Agrawal Arkesh M Sunil Kumar Dhaka |
| author_sort | Vivek Trikha |
| collection | DOAJ |
| description | Purpose: Cerclage wire application has emerged as a potential therapeutic adjunct to intramedullary nailing for subtrochanteric fractures. But its popularity is plagued by the concern of possible negative effect on fracture zone biology. This study was intended to analyze the clinico-radiological outcome and complications associated with cerclage wire application.
Methods: Retrospective analysis was performed on all the subtrochanteric fractures operated with intramedullary nailing between January 2012 and January 2016. After exclusion, 48 patients were available with an average follow-up of 20.8 months. Long oblique, spiral, spiral wedge or comminuted fracture configurations with butterfly fragments were particularly considered for cerclage wire application, which was employed by percutaneous cerclage passer in 21 patients. Assessment was done in terms of operation time, blood loss, quality of reduction, neck-shaft angle, follow-up redisplacement, union time, complications, and final functional evaluation by Merle d’Aubigne'-Postel score.
Results: Average operation time and blood loss were significantly higher in cerclage group (p < 0.05). However, cerclage use substantially improved quality of reduction in terms of maximum cortical displacement (p = 0.003) and fracture angulation (p = 0.045); anatomical reduction was achieved in 95.23% of cases as compared to 74.07% without cerclage. Union time was shorter, although not statistically different (p = 0.208), in cerclage group. Four patients in non-cerclage group developed non-union, 2 of them had nail breakage. No infection or any other implant related complications were reported with cerclage use.
Conclusion: Minimally-invasive cerclage wire application has proved to be beneficial for anatomical reconstruction in difficult subtrochanteric fractures, whenever applicable, without any harmful effect on fracture biology. |
| first_indexed | 2024-12-10T21:56:50Z |
| format | Article |
| id | doaj.art-a558d96c49104b10b6c4b1384519d8f6 |
| institution | Directory Open Access Journal |
| issn | 1008-1275 |
| language | English |
| last_indexed | 2024-12-10T21:56:50Z |
| publishDate | 2018-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Chinese Journal of Traumatology |
| spelling | doaj.art-a558d96c49104b10b6c4b1384519d8f62022-12-22T01:32:01ZengElsevierChinese Journal of Traumatology1008-12752018-02-01211424910.1016/j.cjtee.2018.01.001Role of percutaneous cerclage wire in the management of subtrochanteric fractures treated with intramedullary nailsVivek TrikhaSaubhik DasPrabhat AgrawalArkesh MSunil Kumar DhakaPurpose: Cerclage wire application has emerged as a potential therapeutic adjunct to intramedullary nailing for subtrochanteric fractures. But its popularity is plagued by the concern of possible negative effect on fracture zone biology. This study was intended to analyze the clinico-radiological outcome and complications associated with cerclage wire application. Methods: Retrospective analysis was performed on all the subtrochanteric fractures operated with intramedullary nailing between January 2012 and January 2016. After exclusion, 48 patients were available with an average follow-up of 20.8 months. Long oblique, spiral, spiral wedge or comminuted fracture configurations with butterfly fragments were particularly considered for cerclage wire application, which was employed by percutaneous cerclage passer in 21 patients. Assessment was done in terms of operation time, blood loss, quality of reduction, neck-shaft angle, follow-up redisplacement, union time, complications, and final functional evaluation by Merle d’Aubigne'-Postel score. Results: Average operation time and blood loss were significantly higher in cerclage group (p < 0.05). However, cerclage use substantially improved quality of reduction in terms of maximum cortical displacement (p = 0.003) and fracture angulation (p = 0.045); anatomical reduction was achieved in 95.23% of cases as compared to 74.07% without cerclage. Union time was shorter, although not statistically different (p = 0.208), in cerclage group. Four patients in non-cerclage group developed non-union, 2 of them had nail breakage. No infection or any other implant related complications were reported with cerclage use. Conclusion: Minimally-invasive cerclage wire application has proved to be beneficial for anatomical reconstruction in difficult subtrochanteric fractures, whenever applicable, without any harmful effect on fracture biology.http://www.sciencedirect.com/science/article/pii/S1008127518300178Cerclage wireFractureIntramedullary nailingPercutaneousSubtrochantericOutcome |
| spellingShingle | Vivek Trikha Saubhik Das Prabhat Agrawal Arkesh M Sunil Kumar Dhaka Role of percutaneous cerclage wire in the management of subtrochanteric fractures treated with intramedullary nails Chinese Journal of Traumatology Cerclage wire Fracture Intramedullary nailing Percutaneous Subtrochanteric Outcome |
| title | Role of percutaneous cerclage wire in the management of subtrochanteric fractures treated with intramedullary nails |
| title_full | Role of percutaneous cerclage wire in the management of subtrochanteric fractures treated with intramedullary nails |
| title_fullStr | Role of percutaneous cerclage wire in the management of subtrochanteric fractures treated with intramedullary nails |
| title_full_unstemmed | Role of percutaneous cerclage wire in the management of subtrochanteric fractures treated with intramedullary nails |
| title_short | Role of percutaneous cerclage wire in the management of subtrochanteric fractures treated with intramedullary nails |
| title_sort | role of percutaneous cerclage wire in the management of subtrochanteric fractures treated with intramedullary nails |
| topic | Cerclage wire Fracture Intramedullary nailing Percutaneous Subtrochanteric Outcome |
| url | http://www.sciencedirect.com/science/article/pii/S1008127518300178 |
| work_keys_str_mv | AT vivektrikha roleofpercutaneouscerclagewireinthemanagementofsubtrochantericfracturestreatedwithintramedullarynails AT saubhikdas roleofpercutaneouscerclagewireinthemanagementofsubtrochantericfracturestreatedwithintramedullarynails AT prabhatagrawal roleofpercutaneouscerclagewireinthemanagementofsubtrochantericfracturestreatedwithintramedullarynails AT arkeshm roleofpercutaneouscerclagewireinthemanagementofsubtrochantericfracturestreatedwithintramedullarynails AT sunilkumardhaka roleofpercutaneouscerclagewireinthemanagementofsubtrochantericfracturestreatedwithintramedullarynails |