Cerclage Wiring Improves Biomechanical Stability in Distal Tibia Spiral Fractures Treated by Intramedullary Nailing
Background: Partial weight-bearing after operatively treated fractures has been the standard of care over the past decades. Recent studies report on better rehabilitation and faster return to daily life in case of immediate weight-bearing as tolerated. To allow early weight-bearing, osteosynthesis n...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-02-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/5/1770 |
| _version_ | 1797615108423155712 |
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| author | Stefan Förch Sabrina Sandriesser Christian von Rüden Edgar Mayr Peter Augat |
| author_facet | Stefan Förch Sabrina Sandriesser Christian von Rüden Edgar Mayr Peter Augat |
| author_sort | Stefan Förch |
| collection | DOAJ |
| description | Background: Partial weight-bearing after operatively treated fractures has been the standard of care over the past decades. Recent studies report on better rehabilitation and faster return to daily life in case of immediate weight-bearing as tolerated. To allow early weight-bearing, osteosynthesis needs to provide sufficient mechanical stability. The purpose of this study was to investigate the stabilizing benefits of additive cerclage wiring in combination with intramedullary nailing of distal tibia fractures. Methods: In 14 synthetic tibiae, a reproducible distal spiral fracture was treated by intramedullary nailing. In half of the samples, the fracture was further stabilized by additional cerclage wiring. Under clinically relevant partial and full weight-bearing loads the samples were biomechanically tested and axial construct stiffness as well as interfragmentary movements were assessed. Subsequently, a 5 mm fracture gap was created to simulate insufficient reduction, and tests were repeated. Results: Intramedullary nails offer already high axial stability. Thus, axial construct stiffness cannot be significantly enhanced by an additive cerclage (2858 ± 958 N/mm NailOnly vs. 3727 ± 793 N/mm Nail + Cable; <i>p</i> = 0.089). Under full weight-bearing loads, additive cerclage wiring in well-reduced fractures significantly reduced shear (<i>p</i> = 0.002) and torsional movements (<i>p</i> = 0.013) and showed similar low movements as under partial weight-bearing (shear 0.3 mm, <i>p</i> = 0.073; torsion 1.1°, <i>p</i> = 0.085). In contrast, additional cerclage had no stabilizing effect in large fracture gaps. Conclusions: In well-reduced spiral fractures of the distal tibia, the construct stability of intramedullary nailing can be further increased by additional cerclage wiring. From a biomechanical point of view, augmentation of the primary implant reduced shear movement sufficiently to allow immediate weight-bearing as tolerated. Especially, elderly patients would benefit from early post-operative mobilization, which allows for accelerated rehabilitation and a faster return to daily activities. |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T07:20:49Z |
| publishDate | 2023-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-aff512c1c04c4f4aa312fd9b30cafc812023-11-17T07:58:06ZengMDPI AGJournal of Clinical Medicine2077-03832023-02-01125177010.3390/jcm12051770Cerclage Wiring Improves Biomechanical Stability in Distal Tibia Spiral Fractures Treated by Intramedullary NailingStefan Förch0Sabrina Sandriesser1Christian von Rüden2Edgar Mayr3Peter Augat4Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156 Augsburg, GermanyInstitute for Biomechanics, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418 Murnau, GermanyInstitute for Biomechanics, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418 Murnau, GermanyDepartment of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156 Augsburg, GermanyInstitute for Biomechanics, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418 Murnau, GermanyBackground: Partial weight-bearing after operatively treated fractures has been the standard of care over the past decades. Recent studies report on better rehabilitation and faster return to daily life in case of immediate weight-bearing as tolerated. To allow early weight-bearing, osteosynthesis needs to provide sufficient mechanical stability. The purpose of this study was to investigate the stabilizing benefits of additive cerclage wiring in combination with intramedullary nailing of distal tibia fractures. Methods: In 14 synthetic tibiae, a reproducible distal spiral fracture was treated by intramedullary nailing. In half of the samples, the fracture was further stabilized by additional cerclage wiring. Under clinically relevant partial and full weight-bearing loads the samples were biomechanically tested and axial construct stiffness as well as interfragmentary movements were assessed. Subsequently, a 5 mm fracture gap was created to simulate insufficient reduction, and tests were repeated. Results: Intramedullary nails offer already high axial stability. Thus, axial construct stiffness cannot be significantly enhanced by an additive cerclage (2858 ± 958 N/mm NailOnly vs. 3727 ± 793 N/mm Nail + Cable; <i>p</i> = 0.089). Under full weight-bearing loads, additive cerclage wiring in well-reduced fractures significantly reduced shear (<i>p</i> = 0.002) and torsional movements (<i>p</i> = 0.013) and showed similar low movements as under partial weight-bearing (shear 0.3 mm, <i>p</i> = 0.073; torsion 1.1°, <i>p</i> = 0.085). In contrast, additional cerclage had no stabilizing effect in large fracture gaps. Conclusions: In well-reduced spiral fractures of the distal tibia, the construct stability of intramedullary nailing can be further increased by additional cerclage wiring. From a biomechanical point of view, augmentation of the primary implant reduced shear movement sufficiently to allow immediate weight-bearing as tolerated. Especially, elderly patients would benefit from early post-operative mobilization, which allows for accelerated rehabilitation and a faster return to daily activities.https://www.mdpi.com/2077-0383/12/5/1770cablecerclagetibia shaftcomminuted fractureintramedullary nailingbiomechanics |
| spellingShingle | Stefan Förch Sabrina Sandriesser Christian von Rüden Edgar Mayr Peter Augat Cerclage Wiring Improves Biomechanical Stability in Distal Tibia Spiral Fractures Treated by Intramedullary Nailing Journal of Clinical Medicine cable cerclage tibia shaft comminuted fracture intramedullary nailing biomechanics |
| title | Cerclage Wiring Improves Biomechanical Stability in Distal Tibia Spiral Fractures Treated by Intramedullary Nailing |
| title_full | Cerclage Wiring Improves Biomechanical Stability in Distal Tibia Spiral Fractures Treated by Intramedullary Nailing |
| title_fullStr | Cerclage Wiring Improves Biomechanical Stability in Distal Tibia Spiral Fractures Treated by Intramedullary Nailing |
| title_full_unstemmed | Cerclage Wiring Improves Biomechanical Stability in Distal Tibia Spiral Fractures Treated by Intramedullary Nailing |
| title_short | Cerclage Wiring Improves Biomechanical Stability in Distal Tibia Spiral Fractures Treated by Intramedullary Nailing |
| title_sort | cerclage wiring improves biomechanical stability in distal tibia spiral fractures treated by intramedullary nailing |
| topic | cable cerclage tibia shaft comminuted fracture intramedullary nailing biomechanics |
| url | https://www.mdpi.com/2077-0383/12/5/1770 |
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