Cerclage Band Research Articles

Comparison of the short and medium term efficacy of ortholox UHMWPE sternal cerclage band system and figure-of-8 wire sternum closure technique in patients at risk for sternal dehiscence

Aim: In this retrospective study, it was aimed to compare the short and medium term efficacy of Sternal Cerclage Band System and Figure-of-8 wire closure technique in open heart surgery patients with risk for sternal dehiscence. Material and Methods: In total, 320 open heart surgery patients with risk for sternal dehiscenceattempting to Kahramanmaraş Sütçü Imam University Medical Faculty Hospital between 28.12.2017 and 11.12.2021were subjected to this restrospective study. Since the study is retrospective, randomization and randomization procedures are not in question.The patients included in the study were divided into 2 groups as Steel Wire (standard procedureFigure 8 wiretechnique), and the Sternal Cerclage (sternum was closed with the Ortholox® Sternal Cerclage Band System). Baseline characteristics and outputs of patient groups were compared. Results: Age and body mass index (BMI) means were significantly higher in Cerclage Band group (p<0.05). 53.8% of Cerclage Band group and 38.1% of Steel Wire group had obesity, and the difference was significant (p<0.05). Diabetes mellitus (DM) rate was 36.3% in Steel Wire group and 48.4% in Cerclage Band with statistically significant differences (p<0.05). In Cerclage Band group, 42.5% of patients were smoker, whereas 3.8% of Steel Wire group were smokers (p<0.05). Length of hospital stay, sternal stability and infection after surgery rates were similar between patient groups with statistically insignificant differences (p>0.05). Conclusion: Although there are differences between Cerclage Band and Steel Wire, results and outputs were similar, and showed that Sternal Cerclage Band System is a safe and useful technique in open heart surgery patients with risk for sternal dehiscence.

The Effect of Cerclage Banding Distally to a Clamshell Fracture Pattern in Total Hip Arthroplasty-A Biomechanical Study.

As currently there is no existing biomechanical work on the topic of interest, the aim of the current study was to investigate the effect of cerclage banding distally to an intraoperatively occurring proximal periprosthetic femoral clamshell fracture versus a non-fractured femur after total hip arthroplasty. A diaphyseal anchoring stem was implanted in twenty paired human cadaveric femora, assigned to a treatment and a control group. In the treatment group, each specimen was fitted with a cerclage band placed 3 mm distally to a clamshell fracture, created with an extent of 40% of the anchoring length of the stem. The resulting fragment was not treated further. The contralateral specimens were left with the stems without further fracture creation or treatment. All constructs were tested under progressively increasing cyclic axial loading until failure. Relative bone-implant movements were monitored by motion tracking. Number of cycles and the corresponding load at stem loosening, defined as 1 mm displacement of the stem along the shaft axis, were 31,417 ± 8870 and 3641.7 ± 887 N in the control group, and 26,944 ± 11,706 and 3194.4 ± 1170.6 N in the treatment group, respectively, with no significant differences between them, p = 0.106. From a biomechanical perspective, cerclage banding distally to an intraoperative clamshell fracture with an extent of 40% of the anchoring length of the stem demonstrated comparable resistance against hip stem loosening versus a non-fractured femur. It may therefore represent a valid treatment option to restore the full axial stability of a diaphyseal anchoring stem. In addition, it may be considered to keep the medial wall fragment unfixed, thus saving operative time and minimizing associated risks.

Biomechanical testing of different fixation techniques for intraoperative proximal femur fractures: a technical note

ABSTRACT Intraoperative proximal femoral fractures (IPFF) represent a rare but challenging complication of total hip arthroplasties. They usually occur as a longitudinal split. This pilot trial aimed to compare the biomechanical primary stability of different fixation techniques for IPFF. Standardised longitudinal medial split fractures of the proximal femur (type II, Modified Mallory Classification) were created in artificial osteoporotic and non-osteoporotic composite femora after implantation of a cementless femoral stem. Five different fixation techniques were compared: cerclage band, cerclage wiring with one or two wires, and lag screw fixation with one or two lag screws. A quasi-static loading protocol was applied and failure loads were evaluated. The observed median failure loads were 4192N (3982N – 5189N) for one cerclage band, 4450N (3577N – 4927N) for one cerclage wire, 5016N (4175N – 5685N) for two cerclage wires, 6085N (5000N – 8907N) for one lag screw, and 4774N (4509N – 8502N) for two lag screws. Due to the wide range of failure loads within the experimental groups, there were no observable differences between the groups. All fixation techniques provided sufficient primary stability in osteoporotic and non-osteoporotic composite bones. Further cadaveric studies with larger sample sizes may be needed to confirm the results presented here.

Surgical management in treating periprosthetic femoral fractures after hip arthroplasty

Objective To observe the clinical outcomes of the surgical management of periprosthetic femoral fractures following hip arthroplasty. Methods Twelve consecutive patients (6 male and 6 female) with the average age of 66.4±15.0 years old (35 to 86 years old) undergoing surgical operation for periprosthetic femoral fractures between September 2009 and May 2016 were followed up at our center. Nine cases were fractured secondary to the primary hip arthroplasty while the others were patients with earlier revision surgery. The previous fixations of femoral components of 10 cases were cementless while the other two were cemented fixation. The enrolled patients were determined as Vancouver type B1 (n=2), type B2 (n=7), type B3 (n=1) and type C (n=2) respectively. The occurrences of the fractures were observed at 3 weeks to 17 years post-operation (average 9.0±7.0 years). The patients were treated individually according to different Vancouver types. Type B1 patients received simple cerclage fixation, as well as revisions with long-stem femoral implants and cerclage band were chosen for type B2 patients. In addition to the treatment for type B2 patients, allogenic cortical bone graft was also required for type B3 patients. Open reduction with locking plate internal fixations were options for patients with Vancouver type C fractures. The following-up included the X-ray images of the hips, Harris hip score and the visual analogue scale (VAS) for the pain of fracture site. The unions of the fractures were determined by both X-ray images and pain intensity of the fracture sites. Results The mean follow-up period was 41.6±26.0 months (range, 12-92 months), without patient lost to follow up. VAS scores were 0, implying the clinical union of the fractures. One patients received multiple debridement post-operatively due to the periprosthetic infection. The VAS score of this patient was 6 at the follow up and the X-ray image indicated the nonunion of the fracture. The fracture union rate was 91.7% (11/12). The Harris hip score was 23-92 (mean score, 74.8±18.8), excellent for 2 cases, good for 6 cases, fair for 3 cases and poor for 1 case. The excellent and good rate was 66.7% (8/12). Post-operative complications were observed in 4 patients (33.3%, 4/12). One drainage tube was misplaced and sutured subcutaneously required a further exploration surgery. One periprosthetic infection occurring post-operatively induced the nonunion of the fracture. Aseptic loosing of femoral stem was observed in 2 cases and subsequent revision surgeries were conducted. Conclusion High incidence of complications is observed after the surgical treatment of periprosthetic femoral fractures following hip arthroplasty. Individually customized management regarding to the Vancouver type of periprosthetic femoral fractures leads to the clinical fracture union in 91.7% of the patients in this case series. The excellent and good rate of the hip function in the early and mid-term stage after operation is 66.7%. Key words: Femur; Periprosthetic fractures; Arthroplasty, replacement, hip; Fracture fixation, internal

Using titanium cerclage band to teat intra- and post-operative femoral fracture in total hip arthroplasty

To discuss the treatment and clinical result of using titanium cerclage band to teat intra- and post-operative femoral fracture in total hip arthroplasty. From August 1999 to September 2007, twenty-two patients who suffered from intra-and post-operative femoral oblique fracture in total hip arthroplasty were reviewed among 2186 consecutive total hip arthroplasty patients performed by one surgeon. There were 12 fractures occurred intraoperative and 10 fractures postoperative. There are 9 primary and 13 revision total hip arthroplasty patients including 10 men and 12 women. All fractures are classified as Vancouver B1 type in 15 cases and B2 type in 7 cases. Two to five titanium cerclage bands had been used to fix the fracture followed by open reduction with 13 cases using 2 cerclage bands and 7 cases using 3 bands and 1 case using 4 bands and 1 case using 5 bands. Whether change the original stem or not depended on the classification of fractures and stability of stems. There were 15 cases of type B1 and 1 case of type B2 without changing stems and 6 cases of type B2 changing to revision stems of the same series of original stems. All fractures showed successfully union for 12 - 20 weeks (average 18 weeks) after operation. The average Harris score of the hip improved to 90 points (80 to 95 points) at an average 6.5 years follow-up (4 to 11 years) and the average range of motion of the hip got to 120° (105° - 135°). Femoral prostheses were well-fixed without any subsidence or lucent lines or loosening. All patients were satisfied with the results with well-fixed and good alignment of femoral stem. Strong fixation of the fractures and good initial stability of femoral stem can be obtained using titanium cerclage bands to fix the intra- and post-operative femoral oblique fracture. Original stems should be changed to revision stems in case of type B2 and be retained in case of type B1.

Locking Compression Plate and Cerclage Band for Type B1 Periprosthetic Femoral Fractures: Preliminary Results at Average 30-Month Follow-Up

We present results of 12 type B1 periprosthetic femoral fractures treated with locking compression plate and cerclage band from January 2003 to June 2007. The average follow-up was 30.1 months. Twelve fractures united in an average period of 4.8 months. The mean Harris hip score was 84.4. One patient presented with loosening of proximal screws at 5 months. This patient was treated nonoperatively as she had radiographic evidence of fracture union. One patient with delayed union required 9 months to heal. Unfortunately, 1 month later, she sustained a type C fracture during a slipping injury and treated with cast immobilization. The fracture united after 4 months. None had complications of loss of reduction, plate break, and wound infection.

Translocation of a cerclage band into the endocervical canal after preconception transabdominal cervico‐isthmic cerclage

A 34-year-old woman, who had a history of five spontaneous losses and failures of two McDonald purse-string cerclages, underwent a transabdominal cervico-isthmic cerclage (TCC). She became pregnant 17 months after TCC. At 35 weeks of gestation, she was admitted to our hospital due to preterm labor and delivered a healthy female baby (2270 g) by cesarean section. After delivery of the newborn infant, we found a migration of about one third of the cerclage band into the endocervical canal. Two years later, she had one further pregnancy, reached 33 weeks of gestation, and delivered a 1450 g male baby by cesarean section due to a preterm labor without any signs of infection. Although it could have been a case of pure coincidence, we take a chance to speculate that the migration of the cerclage band into the endocervical canal might have been the reason for the preterm labor, and it must have been removed at her first cesarean section and replaced by a new cerclage band for her next pregnancy.

Patellar fractures treated by fixation with silk suture cerclage and tensile band

目的 探讨丝线环扎加张力带固定治疗髌骨骨折的方法与疗效.方法1990年1月～2004年12月对109例髌骨骨折采用丝线环扎加张力带固定术,术后早期指导患者进行膝关节功能锻炼.结果本组患者经6～18个月的随访,按陆裕朴等功能评定标准:优65例,良39例,可5例,优良率为95.4%.结论丝线环扎加张力带固定治疗髌骨骨折,方法简便易行,固定牢靠,术后一般不需外固定,可早期进行膝关节功能锻炼,不需二次手术,疗效满意。

Ulnar septic pseudoarthrosis: Treatment with osteosynthesis and structural autograft

A 69 years old woman sustained a forearm injuryafter a casual fall onto her outstretched left hand.Radiograph studiesshowed an equivalent Monteggiatype II fracture-dislocation of the left forearm witha fracture of the radial head. (Fig. 1 A and B). Thepatient was operated on the day of admission withopen reduction and plate fixation of the ulna atanother institution. The radial head fracture wasmanaged nonoperatively.Two weeks after surgery, X-rays showed promptloosening of the ulnar synthesis (Fig.2). The patientwas re-operated, the ulnar osteosynthesis wasremoved and a new reduction and synthesis wasdonewithKirschner wires and cerclage band wiring;the head of the radius was excised (Fig. 3). In thefollowing four months, X-rays taken did not showevidence of ulnar fracture healing. After this time anew intervention was performed, the cerclage wireand K-wires were removed, the soft and osseoustissues debrided and refreshened and a new synth-esis carried out with a long cancellous screw andcerclage wire (Fig. 4). This third operation wascomplicated with the development of infectionsymptoms and purulent drainage from the incisionwound. A staphylococcus aureus methicillin sensi-tive was grown in the culture samples taken.The osteosynthesis material was removed againremoved in theatre and an exhaustive debridmentof the soft tissues and the devitalised bone carriedout,afterwhicharosaryofgentamicinpolymethyl-meatcrylate beads was left in place. The patientfollowed and intravenous antibiotic therapy withteicoplanin and ciprofloxacin for six weeks, afterwhich the gentamicin cement beads whereremoved in theatre and bone and soft tissue sam-plestakenformicrobiologyculture.Nomicroorgan-ism grew in the samples taken and three monthslater a bone scan with monoclonal antibodylabelled leucocytes did not show any increaseduptake over the affected area.

Experimental Use of Polyamide Bands in Combination with Intramedullary Pinning for Repair of Oblique Femoral Fractures in Rabbits

To evaluate the use of polyamide bands, manufactured for securing electrical cables, for repair of oblique femoral fractures in rabbits. Experimental study. Twelve nulliparous, 21-25-week-old, California female rabbits. Rabbits were divided into 3 groups (n=4) and studied for 14, 28, or 56 days. A Z-shaped mid-diaphyseal femoral osteotomy was repaired with a 2.5 mm intramedullary pin and a polyamide 6.6 cerclage band. Healing was evaluated at intervals by physical examination, limb use, femoral radiographs, and callus histology. Rabbits had early limb use with good wound healing. From the 1st day, movement of the hip and stifle joints was satisfactory. Radiographically, fractures were healed at 28 days. Histologically, there was no foreign body reaction and bone healing was normal. Nylon cerclage band application was accomplished easily, maintained reduction, and resulted in good healing and limb use. Sterilized nylon bands, manufactured for electrical use, can be used for cerclage in rabbits.

Enhancement of bone formation in rabbits by recombinant human growth hormone.

We studied the effect of human recombinant growth hormone on diaphyseal bone in 40 adult rabbits. The diaphyseal periosteum of one femur in each animal was mechanically stimulated by a nylon cerclage band. The bands induced an increase in bone formation, bone mineral content, and maximum torque capacity of the diaphyseal bone at 1 and 2 months. Growth hormone enhanced the anabolic effect of the cerclage bands on bone metabolism, evidenced by a further increase in torsional strength of the femurs.

Effect of circumferential bands on cortical vascularity and viability

Wire cerclage devices do not restrict cortical vascularity; however, bands, because they are flat and wide, have been implicated as the cause of fracture nonunion by disruption of cortical vascularity. This experiment evaluated the effect of cerclage bands on the cortical vascularity of bones that had not been fractured. Stainless-steel bands of four sizes (2.5, 5.0, 7.5, and 10.0 mm wide) and nylon bands of five sizes (2.5, 3.6, 4.8, 7.6, and 9.0 mm wide) were applied 1 cm apart to both femoral diaphyses of four mature dogs. In two additional dogs, 18-gauge cerclage wires were applied 5 mm apart on one femur and nylon bands were applied immediately adjacent to one another on the other femur to cover 3 cm of the length of each femoral diaphysis. These six dogs were euthanatized and perfused 7 days postoperatively and specimens were studied by microangiography and correlated histology. Two additional dogs were studied 4 and 15 weeks after application of nylon and metal bands. There was no evidence of complete cortical devascularization under any size or type of cerclage appliance at any time interval. Numerous examples of vessels traversing the cortex directly beneath all the cerclage appliances were observed. Cerclage devices, even when flat and wide, do not restrict cortical vascularity when applied to intact bones.

Knot strength of cerclage bands and wires.

I compared the knot strength of loop- and twist-knotted cerclage wires, and Parham and CPC bands, using a knot-slip resistance test. Two twist-knot devices and one loop-knot device were used to apply cerclage wires, and a band clamp was used to apply bands to a 5-cm-diameter split circular jaw mounted on a tensile testing machine. For all the wire sizes tested, the twisted knot provided greater resistance to knot failure than did the loop knot. Knot resistance increased with increase in wire size for all the devices tested. Neither band produced knot-slip resistance as great as 1.2-mm twist-knotted wire.

An in-vitro study of nylon cerclage bands

An in-vitro study to investigate the effect of immersion in saline and bovine serum on the dimensional characteristics and strength of nylon cerclage bands is described. After four days immersion at 37°C, a 2% increase in length and a 37% reduction in buckle strength was observed, which raises doubts as to the suitability of this material for cerclage fixation of fractures distal to an implant.

Mechanical behaviour of cerclage material consisting of silicon rubber

Silicon rubber specimens of circular or rectangular cross-section (cross-section area between ca. 2 and 7 mm2) are used as cerclage bands. A series of commercial cerclage elements was investigated for mechanical characteristics, such as stress-strain behaviour and modulus of elasticity, using a tensile-testing machine. Large differences in these properties exist among the various specimens. Moreover, time-dependent effects, such as stress-relaxation, retardation, and creep, were analysed by the present investigations. One has to take into consideration that the initial length and stress of the cerclage band vary significantly with time after the operation.