More than a reposition tool: additional wire cerclage leads to increased load to failure in plate osteosynthesis for supracondylar femoral shaft fractures

Christopher Bliemel,Dan Anrich,Daphne Eschbach,Martin Bäumlein,Tom Knauf,Antonio Klasan,Florian Debus,Steffen Ruchholtz,Ludwig Oberkircher

doi:10.1007/s00402-020-03586-1

Abstract

IntroductionSurgical treatment of supracondylar femoral fractures can be challenging. An additional wire cerclage is a suggested way to facilitate fracture reduction prior to plate osteosynthesis. Denudation to the periosteum remains a problematic disadvantage of this procedure.This study analyzed the effect of an additional wire cerclage on the load to failure in plate osteosynthesis of oblique supracondylar femoral shaft fractures.Materials and methodsOn eight pairs of non-osteoporotic human femora (mean age 74 years; range 57–95 years), an unstable AO/OTA 32-A2.3 fracture was established. All specimens were treated with a polyaxially locking plate. One femur of each pair was randomly selected to receive an additional fracture fixation with a wire cerclage. A servohydraulic testing machine was used to perform an incremental cyclic axial load with a load to the failure mode.ResultsSpecimens stabilized with solely plate osteosynthesis failed at a mean load of 2450 N (95% CI: 1996–2904 N). In the group with an additional wire cerclage, load to failure was at a mean of 3100 N (95% CI: 2662–3538 N) (p = 0.018).Compression deformation with shearing of the condyle region through cutting of screws out of the condylar bone was the most common reason for failure in both groups of specimens. Whereas axial stiffness was comparable between both groups (p = 0.208), plastic deformation of the osteosynthesis constructs differed significantly (p = 0.035).ConclusionsAn additional wire cerclage significantly increased the load to failure. Therefore, an additional cerclage represents more than just a repositioning aid. With appropriate fracture morphology, a cerclage can significantly improve the strength of the osteosynthesis.

Highlights

Surgical treatment of supracondylar femoral fractures can be challenging
The mean compressive forces leading to failure were 2450 N in the group with solely angular stable plate osteosynthesis and 3100 N in the group with a combination of angular stable plate osteosynthesis supported by an additional wire cerclage
This biomechanical study analyzed the stability-enhancing effect of a wire cerclage in angular stable plate osteosynthesis for supracondylar femoral shaft fractures

Summary

Introduction

Surgical treatment of supracondylar femoral fractures can be challenging. An additional wire cerclage is a suggested way to facilitate fracture reduction prior to plate osteosynthesis. Axis, and rotation are of major importance in comminuted distal femoral fractures, in two-part fractures, a good fracture repositioning with adequate support of the fragments is advantageous to obtain a proper fracture healing and satisfying clinical results [4] In this context, in addition to a polyaxially angular stabile plate, the prior use of a wire cerclage for an initial anatomical reduction of extra-articular two-part spiral or oblique distal femoral fractures has been shown to be beneficial [5, 6] (Fig. 1). Despite this above-named positive effect of a wire cerclage as a tool for an anatomical fracture reduction, denudation of the periosteum and disturbance of the blood supply in the fracture region remain problematic drawbacks of this procedure posing an increased risk for nonunion [7].

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Results

Conclusion