Cerclage Wire Fixation Research Articles

A Comparison of the Efficacy of Cannulated Screws against Modified Tension Band Wire in the Management of Slightly Displaced Fractures of the Patella: A Novel Technique.

The study aimed to compare the outcomes of Open Reduction and Cannulated Screw Fixation (ORCF) and Open Reduction and Tension Band Wire Fixation (ORTF) for treating minimally displaced patellar fractures, with the intention to discern the more efficacious surgical method in terms of various clinical and radiographic parameters. The research was a retrospective controlled trial encompassing 63 patients, culminating in a final data set of 52 patients with transverse patellar fractures with less than 8 mm of displacement. Patients were assessed postoperatively at three, six, and twelve months using measures such as the Lysholm score, Visual Analog Scale (VAS) for pain, and goniometry for active knee extensions and flexion. Statistical analyses were performed using SPSS version 22.0. Results indicated superior clinical outcomes for the ORCF group at twelve months post-treatment, with notable higher Lysholm scores and lower VAS scores for pain at three-, six-, and twelve-month intervals. The ORCF group also demonstrated improved flexion and range of motion, with an average fracture healing time of 2.65 months and significantly lower complication rates, compared to the ORTF group. The ORCF method, leveraging headless compression screws and cerclage wire fixation, emerges as a promising approach for managing minimally displaced transverse patellar fractures, potentially offering improved clinical results and patient satisfaction in comparison to the traditional ORTF method. Further expansive and diverse studies are warranted to substantiate these findings.

Effectiveness of laser welding in cerclage wiring fixation: a biomechanical study.

Cerclage wiring is a common orthopedic procedure for fracture fixation. However, previous studies reported wiring-related perioperative complications, such as wire loosening or breakage, with an incidence rate of up to 77%. Recently, the use of laser welding on medical implants was introduced to connect biomedical materials. This study used laser technology to weld between wires after conventional cerclage fixation. We hypothesized that the laser welding could significantly increase the biomechanical properties of cerclage wiring fixation. Twenty-five wiring models underwent biomechanical tests in five cerclage wiring configurations (five models per group), namely, (1) single loop, (2) single loop with laser welding, (3) double loop, (4) double loop with one-side laser welding, and (5) double loop with two-side laser welding. Characteristics such as load to failure, mode of failure, and wiring failure were compared between groups. The biocompatibility for a 316L stainless steel wire with laser welding was evaluated via an in vitro hemolysis test. Mean load to failure of the double loop with one-side and two-side laser welding groups were 3,596 ± 346 N and 3,667 ± 240 N, which were significantly higher than for the double-loop group (2,919 ± 717 N) (p = 0.012 and p = 0.044, respectively). Conversely, no significant difference was shown in the comparison of the mean load to failure between the single loop and the single loop with laser-welded cerclage wire (1,251 ± 72 N, 1,352 ± 122 N, and p = 0.12). Untwisted wire and wire breakage were the most common mode of failure. All welding specimens revealed non-hemolytic effects from in vitro hemolysis test. Laser welding on cerclage wiring significantly increases the biomechanical property of double cerclage wire fixation. However, further biocompatibility tests and clinical studies are still recommended.

Figure of eight suturing technique with fiber wire for patella fracture: a novel approach

Modified tension band wiring (TBW) is the most commonly used technique for the management of patella fractures. However, all patella fractures are not-amenable to TBW. Tension band wiring, inter-fragmentary screw fixation, and the combination of cerclage wiring and screw fixation are used for internal fixation of these fractures. Surgical treatment is recommended for fractures that either disrupt the extensor mechanism or have greater than 2 to 3 mm of step-off and greater than 1 to 4 mm of displacement. In this series, we present ten cases managed with open reduction and internal fixation with figure of eight suturing technique using fiber wire. This series included ten patients with fractured patella and managed with open reduction and internal fixation with Tension band wiring with fiber wire. Patient demographics, fracture type, time to union, functional outcome, and complications were recorded. Patients were followed up for minimum of 6 months. All fractures went on to unite with average fracture healing time of 13.8 weeks. Mean Lysholm score and Bostman score were 85 and 27 respectively. Nine patients had excellent to good outcomes. One patient had poor outcome because of knee stiffness. Open reduction and internal fixation with figure of eight suturing technique using fiber wire are an efficient method for the management of severely comminuted and multi-fragmentary patella fractures with minimum complications.

A Double Cerclage and Tension band Wiring Technique Fixation for Comminuted Patellar Fractures

Background: When the patella is fractured it should be repaired and patellectomy should be avoided as much as possible even in comminuted fractures. In comminuted patellar fractures, a combination of cerclage wiring and tension band fixation is confirmed to provide good mechanical stability. The objective of the present work was to find out the effectiveness of comminuted patellar fracture fixation with combined cerclage and tension band wiring technique. Method and patient: Forty- six patients underwent surgical stabilization for comminuted patellar fracture between year 1996 to 2016. All fractures were classified as 34-C3 according to the Orthopedic Trauma Association Classification. All the patients were underwent open reduction- internal fixation with combined Cerclage and tension band wiring technique. Result: Fracture healing was occurred within an average of 3- 5 months, while in bilateral cases it was 4 - 8 months. Full range of knee movements was seen in 42 (91.3 %) cases and knee flexion more than 120º was seen in 4 (8.7 %) cases. Quadriceps power was normal in 44 (95.6 %) cases, but 2 cases had quadriceps power of grade-IV. No extensor lag and no quadriceps atrophy were seen in any cases. Forty four (95.6 %) patients could squat fully and two (4.3 %) patients could squat up to half of the normal level. All patients were able to climb up and down stairs without any problem. Most patients have no subjective complaints like pain, difficulty in walking, difficulty in squatting and climbing. The clinical results after operation were evaluated by the clinical grading scales of Böstman including range of movement, pain, work, atrophy, assistance in walking, effusion, giving way, and stair-climbing during follow-up. There were no significant complications, such as infection, knee stiffness, and non-union or implant failure in any of the cases. The average follow-up period was 8 months (Ranged 6 – 18 months). Conclusions: This study had concluded that combined Cerclage and tension band wiring technique was a successful surgical treatment for comminuted fractures of the Patella.

Biomechanical comparison of screw vs. cerclage refixation in orthogeriatric lesser trochanteric fractures: a cadaveric study

PurposeOsteoporosis-related proximal femur fractures continue to increase significantly due to demographic change. This study was designed to evaluate the biomechanical stability of two different fixation methods (cerclage vs. screw) for refixation of a trochanter minor fragment in the pertrochanteric fractures in cadaveric bones.MethodsArtificial bones (n = 14) and human bones (n = 16) were treated with a DHS and the trochanter minor fragment was reduced by cerclage wiring or direct screw fixation. After preloading the simulated iliopsoas with 10 N, a tensile test was performed, ending with either a 70% loss of strength or avulsion of the fragment. The mean values of the avulsion force and the surface strain were recorded.ResultsAll tensile tests showed no significant differences between refixation using a direct screw or wire cerclage, for both artificial bones and human specimens. Absolute values showed higher avulsion forces after direct screw fixation than refixation with a wire cerclage. The surface tension of specimens treated with direct screw fixation was lower than that of specimens treated with wire cerclage. An opposite effect was seen in artificial bones. Both effects were not statistically significant.ConclusionBased on the equal stability after lag screw placement compared to cerclage wiring, we promote the placement of a lag screw into the lesser trochanter fragment in pertrochanteric femur fractures when using a dynamic hip screw.Level of evidenceLevel III.

Stabilization of Vancouver B Periprosthetic Femur Fractures With Cerclage Wiring: A Retrospective Chart Review.

Background: While biomechanical and clinical studies detailing the equivalence and, sometimes, the superiority of cerclage wiring fixation compared to plate fixation in select fractures (Vancouver B1 and C) exist, no studies exist detailing outcomes after cerclage wiring fixation in all Vancouver B fracture types. This study explores whether there is a difference in clinical outcomes between Vancouver B fractures fixed with cerclage wiring and those without.Methods: This retrospective multicenter study reviewed 295 patients from 2007 to 2018 with periprosthetic femur fractures. Vancouver B periprosthetic fractures stabilized utilizing cerclage wiring were identified and compared against fractures stabilized without cerclage wiring, with 33% being B1, 48.4% B2, and 18.6% B3 fractures. Demographics, injury details, fracture classification, surgical details, fracture union, and postoperative complications were recorded for each patient.Results: A majority of our patients were females (65.9%) and were older than 71 years of age (65.6%) without diabetes (63.3%) or smoking history (92.2%). Sixty-nine patients progressed to fracture union (76.7%), two (2.2%) to delayed union, and 19 (21.1%) to nonunion. There was no difference in the union rate (p = 0.98) or time to union (p = 0.91) between the fixation methods. Finally, there was no difference in the infection rate (p = 0.81), re-fracture rate (p = 0.87), or re-operation rate (p = 0.75) between the fixation methods.Conclusion: Periprosthetic femur fractures are common injuries, most commonly occurring after low-energy mechanisms in the elderly female population. While the Vancouver fracture pattern helps to guide the surgical construct used for fixation, the use of cerclage wires does not impact bony union in these injuries. Interestingly, increasing age and female gender were associated with increased union rates. Surgeons should individually consider each patient's demographic as well as fracture type when deciding which construct will achieve stable fixation that allows for fracture healing.

Serklaj Kablolamada Farklı Subtrokanterik Kemik Kırılma Açılarının Biyomekanik Karşılaştırılması: Sonlu Eleman Çalışması

Cerclage wires are regularly hired as fixation gear to resource reposition, enhance alignment and growth fixation stability. In specific femoral shaft, subtrochanteric and periprosthetic fractures gain from cerclage fixation. Also in supracondylar femoral shaft fractures, extra cord cerclages proved to be extra than only a reposition device and accelerated the general power of the osteosynthesis construct. This study tests for the stabilizing effect of different bone fracture angles in with cerclage. Cerclage fixation of a oblique fractures were tested with fracture angles (45°, 55°, 65°). Construct stiffness and displacements were investigated under static loads and compared to the different bone fracture angles. With each of the tested bone fractures, stiffness wasn't significantly for a compare angles. Most reduction in fracture gap movement was achieved by 65° fracture angle, followed by 55° and 45° fractures. 
 All cerclage wire fixation were generally superior with reduced fracture movements whereas in 65 degree fracture showing the greatest stabilizing effect. Cerclage wire application has emerged as a potential therapeutic for subtrochanteric fractures.

Treatment of comminuted patellar fractures using modified cerclage wiring

ABSTRACT Background: Comminuted patellar fracture is still challenging. It is essential to restore the articular cartilage with rigid internal fixation. Objective: to assess the outcome of modified cerclage wiring fixation in patients with comminuted patellar fracture. Patients and methods: This study was done in orthopedic surgery department at Al-Azhar University Hospitals, during the period from December 2019 to November 2020. A total of 15 patients with comminuted fracture of patella were maneged by modified cerclage wiring. 12 patients were males (80.0%) and 3 patients were females (20.0%). Their age was 18-64 (average 38.87±14.80) years. All patients had unilateral patellar fractures. The fractures were closed in 12 patients (80.0%) and open in 3 patients (20.0%). We followed up our patients for at least 6 months. Bostman grading score was the main clinical outcome indicator. Results: The fracture union occurred radiologically about 2-3.5 months (mean 2.70±0.46 months). 2 cases had self-limited postoperative superficial infection. No postoperative complications such as fragment re-displacement, implants breakage, , painful hardware and non-union were observed. Clinical outcomes according to grading score of Bostman were satisfactory and the average score was 28.13±1.73 (range 24-30) points. 12 patients had excellent results with an average score of 28.8 ± 0.71 (range 28-30) points and 3 patients had good results with an average score of 25.33±1.53 (range 24-27) points. All patients had knee flexion 110-140 (mean 127.33±9.61) degrees. Conclusion: Modified cerclage wiring fixation offers a new technique in comminuted patellar fracture treatment with satisfactory results and minimal complications.

Cerclage wire fixation of trochanteric osteotomies in complex hip revision: our experience and comparison with cable-plate fixation.

Osteotomy of the greater trochanter is a commonly used procedure in complex revision hip arthroplasty in order to achieve a wide exposure to the femoral stem and acetabular components. There is no clinical evidence in favour of a specific fixation method. The aim of this study was to compare cable-plate with figure-of-eight cerclage wire fixation in patients requiring a trochanteric "slide" osteotomy. In a retrospective study, 51 greater trochanteric "slide" osteotomies in complex acetabular revision arthroplasties were included. Patients were divided into 2 groups: 28 hips were fixed with 1 of 2 cable-plate systems (Dall-Miles staple, Stryker or Cable-Ready plate, Zimmer) and 23 with a figure-of-eight cerclage wire.Consolidation, osteolysis, migration of greater trochanter, bursitis of the trochanteric area, Trendelenburg gait and removal of osteosynthesis material were studied at 6 months follow-up. Both groups showed good union rates. The lysis rate was similar with 32% in the cable-plate group versus 29% in the cerclage wire group (p = 0.084). 43% of the hips with cable-plate and 22% of the cerclage wire had trochanteric migration (p = 0.297). Pain at the greater trochanter was less frequent in the cerclage wire group (9%) as compared to the cable-plate group (43%) (p = 0.007). Implant removal was more frequent in the cable-plate group (4 vs. 0 patients). Trendelenburg gait was found in 3 patients in the cerclage wire group as compared to 10 in the cable-plate group (p = 0.054). The cerclage wiring had superior clinical outcomes with similar radiographic results. The authors recommend the use of figure-of-eight cerclage wire when fixing a greater trochanteric "slide" osteotomy in complex revision hip arthroplasty.

Arthroscopic Reduction and Fixation by Cerclage Wire Loop for Tibial Spine Avulsion in Adults: Short-term Results.

Background:Several arthroscopic techniques for the treatment of avulsion tibial spine fractures have been described in the literature.Purpose:To evaluate the outcomes of the arthroscopically assisted stainless steel wiring technique in the treatment of avulsed tibial spine in adults.Study Design:Case series; Level of evidence, 4.Methods:This retrospective study involved 28 patients (28 knees), 16 to 42 years of age, with tibial spine avulsion fracture that was treated using arthroscopic reduction and cerclage wire fixation by a single surgeon between March 2015 and August 2018. The degrees of avulsion in these patients were type II (n = 12), type III (n = 10), and type IV fractures (n = 6). Clinical assessment included International Knee Documentation Committee (IKDC) objective score (which noted swelling), range of knee movement, Tegner activity scale, Lachman test, and pivot-shift test compared with the normal opposite knee.Results:The mean follow-up period was 24.1 months (range, 18-30 months). The mean IKDC score was 93.7 (range, 88.5-98.9); the IKDC score was normal in 22 patients and nearly normal in 6 patients. The Lachman test was grade 1 in 25 patients and grade 2 in 3 patients, whereas the pivot-shift test was grade 0 in 26 patients and grade 1 in 2 patients. All patients achieved their preinjury Tegner activity levels. Radiological assessment showed healing in all patients within a mean of 12 weeks after surgery.Conclusion:The outcomes of all patients were satisfactory; fixation by cerclage wiring permitted reduction of tibial spine fragment anatomically to its fracture bed, provided stable fixation in displaced tibial spine avulsion, and allowed for early rehabilitation and weightbearing because of stable fixation.

Does Cerclage wiring with Intramedullary Nailing in Subtrochanteric Fractures Improve the Final Outcome?

Treatment of subtrochanteric fractures is challenging due to anatomical and biomechanical factors. Many methods have been suggested to achieve and maintain fracture reduction during operative fixation for subtrochanteric fractures. Open reduction and intramedullary fixation, clamp assisted reduction without cerclage wires and fracture reduction cables are suggested methods. We conducted a retrospective study to look for the results of subtrochanteric fractures managed by intramedullary fixation with or without cerclage wires. We reviewed all cases of subtrochanteric fractures operated with intramedullary fixation with long proximal femoral nail with or without cerclage wire fixation. All available data from patient’s records available in medical records department were retrieved and evaluated. Statistical analysis were performed using SPSS software (v16). There were 86 cases of subtrochanteric fractures operated with intramedullary fixation at our Hospitals over a period of 5 years. Quality of fracture reduction of fractures are assessed good reduction was seen more often in cerclage group 64%. Cerclage wiring was done in 14 cases. Nonunion was seen in 8 cases overall, 3 in cerclage group and 5 in non Cerclage group. Implant failure was seen in 3 cases in no cerclage group and 2 cases of cerclage group. We conclude that anatomical reduction is the key factor for successful outcomes. Closed reduction with good to acceptable reduction had better results. Cerclage wiring should be considered in selected cases where reduction is poor after open reduction.

Percutaneous cerclage wiring for type 34-C patella fracture in geriatric patients

PurposeThis study was to retrospectively evaluate clinical outcomes of geriatric patients with patella fracture treated by percutaneous cerclage wiring and to introduce the surgical technique. MethodsFrom January 2009 to December 2015, fifty-seven consecutive geriatric patients of type 34-C patellar fracture underwent closed reduction and percutaneous cerclage wiring fixation in our hospital. Visual Analog Scale (VAS) score, Levack score system, WOMAC test form of pain, stiffness and function, and knee joint range of motion (ROM) were applied for functional evaluation. ResultsFifty-three patients were followed up for a mean period of 36 months (12 to 82 months). All fractures were unioned, no wound infection, second displacement of fracture fragment or wire migration was found. Wire breakage happened in one case at six months post-operation. Thirteen patients had hardware removed, nine cases for implant irritation at the knot and four cases for no specific reason. No patient developed postoperative knee stiffness, and range of motion was 128.6° (110–140). The average VAS score of emotional knee function was 87.5 (65–99) preinjury and 78.1 (53–95) at the last follow-up. 86.8% (46/53) patients considered that they regained more than 80% of their knee function. The average Levack score was 10.0 (6–12), which included thirty-five evaluations of “excellent” and eighteen of “good”. The average WOMAC score was 21.3 (13–37). ConclusionsPercutaneous cerclage wiring fixation is a viable option for type 34-C patella fracture in geriatric patients.

A Double Tension Band Technique for Patellar Fractures—A New Concept

Amongst the many known techniques used for the management of fractures of the patella, the tension band wire fixation is a reliable treatment modality and has given consistently good results. In transverse patellar fractures, a combination of cerclage wiring and tension band fixation gives a good mechanical stability and an environment conducive to healing. The fracture described herein is classified as 45-C1 (based on Orthopaedic Trauma Association classification) of the right knee of a forty three years old male patient. It was fixed with three vertical 1.5 mm K wires and double cerclage wire looped proximally through the quadriceps tendon and distally through the patellar ligament in a double figure-of-eight configuration. The average follow-up period was 7 months. The Activity of Daily Living Scale (ADLS) of the Knee Outcome Survey was used to assess symptoms and functional capability of the knee. The fracture union was achieved at an average of 10 weeks. Full range of knee motion was achieved by end of the third postoperative month. No complications, such as infection and implant failure were noted. The technique aims to stress the advantage of giving a balanced fixation addressing the bony elements (the fractured ends) as well as the soft tissue (the extensor apparatus).

Monofilament Cerclage Wiring Fixation with Locking Plates for Distal Femoral Fracture: Is it Appropriate?

Purpose:We aimed to determine the efficacy of cerclage wiring by comparing the clinical and radiological results between internal fixation with locking plates after distal femoral fracture reduction with or without cerclage wiring.Materials and Methods:One hundred and one patients who received open reduction internal fixation for distal femoral fractures of oblique, spiral, and spiral wedge type between 2007 and 2014 were reviewed retrospectively. Only locking plate fixation was performed in 46 patients, and locking plate fixation with additional cerclage wiring was performed in 55 patients (Group CW). Demographic, clinical, and radiologic factors were evaluated in both the groups. Age, gender, bone mineral density, bone graft, and the presence of concomitant fractures were measured as demographic factors. The range of motion of knee joint, Lysholm knee score, visual analog scale score, procedure time, and C-arm time were measured as clinical factors preoperatively and at the final followup. We also evaluated the duration of bone union and knee joint alignment radiologically.Results:There were no demographic differences between the two groups. Furthermore, there were no statistically significant differences between the two groups in terms of clinical and radiological parameters. However, the procedure time used was significantly longer in Group LP than in Group CW (108.4 vs. 95.2 min; P = 0.027). The C-arm time was longer in Group LP (2.8 vs. 1.2 s; P = 0.017).Conclusions:Open reduction and locking plate fixation with additional cerclage wiring is a useful method for the reduction of complicated distal femoral fractures, without increased complications such as nonunion.Level of Evidence:Level III, retrospective cohort design, treatment study.

The Use of Extended Trochanteric Osteotomy in 2-Stage Reconstruction of the Hip for Infection

BackgroundThe effect of extended trochanteric osteotomy (ETO) with immediate cerclage wire fixation on the scene of chronic periprosthetic joint infection on infection eradication and the osteotomy healing remains unclear. MethodsOne hundred seventeen patients who underwent two-stage revision total hip arthroplasty for chronic periprosthetic joint infection were enrolled in the study. The minimum follow-up was 2 years. Of these, 48 patients had underwent ETO and immediate cerclage wire fixation during the first-stage surgery, while 69 did not undergo ETO or any other osteotomy. In addition, 18 patients had underwent ETO in the second-stage reimplantation surgery. Repeated debridement, curative rate of infection, and complications were compared between the 2 groups. Meanwhile, osteotomy healing between the first and second osteotomy were also compared. ResultsThe repeated debridement rate and curative rate of infection were 2.1% and 95.8% in the ETO group, compared with 13.0% and 82.6% in the non-ETO group; there were significant difference between the 2 groups in these parameters (P = .037 and .030, respectively). Meanwhile, osteotomy healing rate was 93.8% in first-stage surgery with infection scene and 100% in second-stage surgery without infection; no significant difference was detected in osteotomy healing rate and time to healing (P = .278 and .803, respectively). The rate of complication was similar in both groups. ConclusionsETO combined with immediate cerclage wire fixation does not appear to reduce the rate of infection eradication. There was no harmful effect on complication rate and osteotomy healing.

Supplementary Technique for Unstable Clavicle Shaft Fractures: Interfragmentary Wiring and Temporary Axial K-Wire Pinning.

BackgroundTreatment of unstable clavicle fractures remains a challenge for orthopedic surgeons, but the evolution of treatment strategies has allowed for reliable results with minimal complications. Although several surgical options exist, open reduction with plating remains the treatment of choice for clavicle fractures. The purpose of this study is to determine an easy way to achieve successful preplating reduction while minimizing surrounding soft tissue damage during treatment of midshaft fractures of the clavicle.MethodsA retrospective study included all consecutive adult patients operated on by a single surgeon for acute displaced clavicular midshaft fracture between January 2010 and October 2014. Hybrid technique with interfragmentary cerclage wiring, temporary axial K-wire pinning, or their combination was used in all patients. The demographic data and clinical outcomes, including operation time, union time, restoration of anatomy, shoulder functional score, and complications were evaluated.ResultsThere were 54 male and 19 female patients, with an average age of 39.3 years (range, 18 to 77 years) for males and 58.3 years (range, 39 to 77 years) for females. They were followed up for 24 months (range, 12 to 44 months). All patients had reliable bone union after surgery using interfragmentary cerclage wiring and temporary axial K-wire fixation; fracture union was obtained at an average of 11.7 weeks (range, 8 to 21 weeks) postoperatively. Additionally, there was no postoperative loss of fracture reduction or plate loosening. At the final follow-up, all patients had regained excellent functional outcomes.ConclusionsThe cognizant effort to achieve anatomic reduction without surrounding soft tissue insult before definitive plating allows excellent radiologic and functional outcomes. Interfragmentary cerclage wiring and temporary axial K-wire pinning can overcome difficulties associated with unstable clavicle fractures to allow proper fracture reduction. In this article, we introduce a concise technique for achieving the desired outcomes reliably and efficiently when treating unstable clavicle midshaft fractures.

Risk factors and prevention of periprosthetic femoral fractures around the Corail stem during primary total hip arthroplasty

Objective To investigate the causes and prevention of intraoperative periprosthetic femoral fractures around the Corail stem associated with primary total hip arthroplasty (THA). Methods A retrospective cohort study was made on 18 patients (18 hips) developing intraoperative periprosthetic femoral fractures around the Corail stem during primary THA between January 2010 and March 2016. There were 7 male and 11 female patients, with the age range of 42-81 years (mean, 57.6 years). At the time of diagnosis, six hips presented with inflammatory arthropathy, five avascular necrosis of the femoral head, four developmental dysplasia of hip, and three femoral neck fractures. Local problems were identified in 14 hips (77.8%), principally osteoporosis in 11 hips (61%). Fifteen periprosthetic femoral fractures were recognized intraoperatively and were treated with cerclage wires. Three intraoperatively occult fractures were observed on the postoperative radiograph, including one fracture treated non-operatively, one by wire cerclage fixation and one by open reduction internal fixation. Factors related to intraoperative fractures were analyzed. Harris score and Beals and Tower's criteria were used for clinical and radiological assessment respectively. Results Osteoporosis, inflammatory arthropathy, anatomical abnormity of the proximal femur, excessive pursuit of the degree of interference fit between prosthesis and cortical bone, and inappropriate choice of prosthesis size were the main causes of femur fractures during primary THA. Mean follow-up was 32 months. Union was obtained in all patients in a mean of 4.7 months. No prosthesis loosening and infection occurred. Mean Harris hip score was 91.2 points at the final follow-up. Radiological assessment showed excellent results in 16 hips and good results in two hips. Conclusions Rigidity in patient selection and master of surgery techniques are the key to preventing periprosthetic femoral fractures. Once the periprosthetic femoral fractures happens and the type is stable, cerclage wire fixation is a simple and satisfactory technique that is adequate for both implant and fracture stability. Key words: Arthroplasty, replacement, hip; Periprosthetic proximal femoral fracture; Risk factors

Complications of porous-coated press-fit cementless total hip replacement in dogs.

To report postoperative complications using a commercially available porous-coated press-fit cementless total hip replacement (THR) system in dogs. Medical records were reviewed for client-owned dogs with hip pathologies requiring THR. A minimum of six-week postoperative orthopaedic examination and orthogonal pelvic radiographs were used to assess outcome and complications in the perioperative period. Referring veterinarian medical records, phone interviews with clients, or both were used to assess long-term functional outcome and complications. Bilateral THR was performed in 36 dogs, and unilateral in 147 dogs, making a total of 219 THR procedures in 183 dogs. A total complication rate of 31.1% (68/219) was observed. A catastrophic complication was observed in 8.2% (n = 18), a major complication in 9.6% (n = 21), and a minor complication in 13.2% (n = 29) of procedures. The most common complications were intra-operative femoral fissure (n = 46), diaphyseal femoral fracture (n = 15), and coxofemoral luxation (n = 9). Full return to function was achieved in 88.1% of procedures with a median follow-up period of 42 months. Porous-coated press-fit cementless collarless total hip replacements have a high complication rate. The majority of complications occur intra-operatively or perioperatively, with few complications occurring beyond 12 weeks postoperatively. Both fissure fractures and diaphyseal femoral fractures carry a favourable prognosis with immediate cerclage wiring and plate fixation, respectively.

Biomechanical evaluation of adjunctive cerclage wire fixation for the prevention of periprosthetic femur fractures using cementless press-fit total hip replacement

Periprosthetic femoral fractures are a common complication associated with cementless press-fit total hip arthroplasty. The use of prophylactic cerclage wire fixation has been advocated to reduce this complication. The objective of this study was to evaluate whether a double loop cerclage wire, used as adjunctive fixation, increased the peak torsional load to failure in femora implanted with press-fit cementless stems. Peak torsional load to failure was compared between femora without adjunctive fixation and femora receiving a 1 mm double loop cerclage wire placed proximally to the lesser trochanter. Femora treated with adjunctive cerclage wire fixation failed at 20% greater peak torque (P = 0.0001). In conclusion, a double loop cerclage wire may aid in the prevention of periprosthetic fractures associated with press-fit cementless femoral stems.

Modified Labial Button Technique for Maintaining Occlusion After Caudal Mandibular Fracture/Temporomandibular Joint Luxation in the Cat.

Maxillofacial trauma in cats often results in mandibular symphyseal separation in addition to injuries of the caudal mandible and/or temporomandibular joint (TMJ). Caudal mandibular and TMJ injuries are difficult to access and stabilize using direct fixation techniques, thus indirect fixation is commonly employed. The immediate goals of fixation include stabilization for return to normal occlusion and function with the long-term objective of bony union. Indirect fixation techniques commonly used for stabilization of caudal mandibular and temporomandibular joint fracture/luxation include maxillomandibular fixation (MMF) with acrylic composite, interarcade wiring, tape muzzles, and the bignathic encircling and retaining device (BEARD) technique. This article introduces a modification of the previously described "labial reverse suture through buttons" technique used by Koestlin et al and the "labial locking with buttons" technique by Rocha et al. In cases with minimally displaced subcondylar and pericondylar fractures without joint involvement, the labial button technique can provide sufficient stabilization for healing. Advantages of the modified labial button technique include ease of application, noninvasive nature, and use of readily available materials. The construct can remain in place for a variable of amount of time, depending on its intended purpose. It serves as an alternative to the tape muzzle, which is rarely tolerated by cats. This technique can be easily used in conjunction with other maxillomandibular repairs, such as cerclage wire fixation of mandibular symphyseal separation. The purpose of this article is to demonstrate a modified labial button technique for maintaining occlusion of feline caudal mandibular fractures/TMJ luxations in a step-by-step fashion.