Cerclage Wire Fixation Research Articles

Cerclage Clamping Using Cerclage Passer for Reduction of Anterior and Posterior Column Fracture

Purpose: Both column and T-shaped acetabular fractures are frequently presented with difficulty in reduction. Incomplete reduction may cause traumatic arthritis in the hip joint, resulting in inferior clinical outcomes. The purpose of this study is to introduce our wiring technique and to report the clinical and radiological outcomes of such technique. Materials and Methods: Eight patients who underwent our proposed technique for having acetabular fracture with displaced quadrilateral plate between March 2013 and December 2014 were enrolled. All patients were followed-up more than 1 year. The wire passer was set up from an anterolateral aspect of the iliac crest to the greater sciatic notch, between the abductor muscle and the periosteum. The quadrilateral plate of acetabular fracture was reduced with wiring. Internal fixation was added to the pelvic brim. An analysis of the clinical and radiological outcomes was performed. Results: Reduction was performed within the 3 mm intra-articular step-off in all patients. The mean duration of union was 11.8 weeks (9–15 weeks). Five patients (62.5%) showed excellent results, and radiologically, three patients (37.5%) showed good results, and seven patients (87.5%) showed better than good results. Conclusion: The cerclage wiring fixation technique using a large cerclage passer instrument can be a useful and safe reduction method in some cases of acetabular fractures.

Tibial tubercle osteotomy with absorbable suture fixation in revision total knee arthroplasty: a report of 23 cases

Tibial tubercle osteotomy (TTO) is a well-known technique for improving exposure in difficult total knee arthroplasty (TKA). We have performed 23 revision TKAs with TTO. The tibial tubercle was fixated with only absorbable sutures afterwards. The aim of this study is to report on the clinical results and complications of this procedure. We retrospectively evaluated 23 patients (mean age 69.6years, range 43-84years) who underwent TTO with only absorbable suture fixation. Clinic charts were reviewed to identify any complications that occurred. Obvious proximal migration and union of the tibial tubercle was evaluated on the postoperative radiographs. Knee Society scores and SF-36 were assigned at latest follow-up. The mean follow-up was 16.1months (1-43). Two patients died of causes unrelated to surgery. In one case a fracture of the TTO occurred. No obvious migration of the osteotomy was detected. In two cases there was partial consolidation of the osteotomy, but without clinical consequences of pain or extension lag. In five patients a tibial plateau fracture occurred intraoperative which allowed partial weight bearing during 6weeks. These fractures were not related to the surgical technique of the TTO. In 15 out of 23 patients a Knee Society Score could be assigned. The mean total knee score (maximum 200 points) after revision was 99.5 (17-166) (clinical KSS 52.1, functional KSS 47.3) at latest follow-up. SF-36 scores could be assigned to 16 patients; the mean SF-36 (maximum 100) was 88 (range 74-98). Tibial tubercle osteotomy with only absorbable suture fixation is a reliable and simple method of fixation and provides adequate stability. It is a straightforward surgical technique which is less time-consuming and expensive compared with screw and cerclage wire fixation and no hardware removal will be necessary. Therefore, this method is a beneficial technique for the enhancement of surgical exposure in difficult revision TKA.

Reconstruction et synthèse première du volet fémoral, avant réimplantation de la tige fémorale, dans les reprises de prothèses totales de hanches : technique du Fit-Complet

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.

Update on the treatment of metacarpal fractures

Although most metacarpal fractures can be treated nonoperatively with closed reduction and immobilization, some incongruent, displaced, or unstable fractures will need operative stabilization. Acceptable operative techniques include Kirschner wire, intramedullary rod, cerclage wire, intraosseous wire, interfragmentary screw, plate, or external fixation. There have been multiple clinical and biomechanical studies evaluating the outcomes of these various operative options with satisfactory results. Current studies have focused on the treatment of metacarpal shaft fractures, mainly on the topic of dorsal plating constructs. This article serves to provide a review of the most recent articles regarding the operative treatment of metacarpal fractures.

String‐Of‐Pearls Locking Plate and Cerclage Wire Stabilization of Periprosthetic Femoral Fractures after Total Hip Replacement in Six Dogs

To report use of, and outcome after, string-of-pearls (SOP™) plate and multiple cerclage wire fixation for treatment of periprosthetic femoral fractures (PFF) associated with total hip replacement (THR) in dogs. Case series. Dogs (n=6) with PFF after THR. Clinical records (2005-2010) and radiographic evaluations of dogs that had PFF associated with THR, treated with a SOP™ plate and cerclage wires were retrospectively reviewed. Clinical and radiographic postoperative assessments were performed 4, 12, and 24 weeks postoperatively. Telephone follow-up was performed >12 months postoperatively. Three fractures occurred intraoperatively and 3 occurred postoperatively. One SOP™ failed at 2 weeks necessitating revision using 2 parallel SOP™ implants. One dog was euthanatized because of quadriceps muscle tie-down at 6 weeks. Other dogs were free of lameness with full range of motion of the stifle and hip joints at final clinical examination, and positive outcomes were maintained at >12 month telephone questionnaire. There was no evidence of implant failure and positive evidence of fracture healing at final radiographic follow-up. Stabilization resulted in bone healing in 5 dogs; failure in 1 dog may be attributable to technical error. Optimal technical guidelines for use of the SOP™ in this circumstance are unknown, particularly where fracture configuration varies.

Does Interfragmentary Cerclage Wire Fixation in Clavicle Shaft Fracture Interfere the Fracture Healing?

138 통신저자:신 용 운 서울시 노원구 상계 7동 761-1 인제대학교 의과대학 상계백병원 정형외과학교실 Tel:02-950-1032ᆞFax:02-934-6342 E-mail:woonysos@hanmail.net 본 논문의 요지는 2009년도 대한정형외과학회 추계학술대회에서 발표되었음. 본 논문은 2009년도 인제대학교 학술연구조성비 보조에 의한 것임. 접수: 2010. 11. 22 심사(수정): 2011. 1. 6 게재확정: 2011. 3. 4 Address reprint requests to:Yong-Woon Shin, M.D. Department of Orthopedic surgery, Sanggye Paik Hospital, Inje University College of Medicine, 761-1, Sanggye 7-dong, Nowon-gu, Seoul 139-707, Korea Tel:82-2-950-1032ᆞFax:82-2-934-6342 E-mail:woonysos@hanmail.net 쇄골 간부 분쇄골절의 수술적 치료 시 환 강선 고정은 골절의 유합을 방해하는가?

Management of fractures of the pedicle after instrumentation with transpedicular screws

Fracture of a pedicle is a rare complication of spinal instrumentation using pedicular screws, but it can lead to instability and pain and may necessitate extension of the fusion. Osteosynthesis of the fractured pedicle by cerclage-wire fixation and augmentation of the screw fixation by vertebroplasty or temporary elongation of the fixation, allows stabilisation without sacrifice of the adjacent healthy segment. We describe three patients who developed a fracture of the pedicle in the most caudal instrumented vertebra early after lumbar spinal fusion. During revision surgery the pedicles were reduced and secured by a soft cerclage wire bilaterally. Fusion was obtained at the site of the primary instrumentation and healing of the pedicles was achieved. Cerclage wiring of the fractured pedicle seems to be safe and avoids permanent extension of the fusion without the sacrifice of an otherwise healthy segment.

Surgical treatment for non-union of the mid-shaft clavicle using a reconstruction plate: Scapular malposition is related to poor results

A retrospective study was performed to evaluate the use of an AO reconstruction plate in open reduction and internal fixation for non-union of the mid-shaft clavicle, examining the relationship between the position of the scapula and final functional results and whether perioperative variables such as clavicular reconstruction ratio and period of non-union influence the position of the scapula. From January 1998 to January 2005, data on 21 people with symptomatic non-union of the mid-shaft clavicle were collected; 17 non-unions were atrophic and 4 were hypertrophic. Initially, treatment was conservative with a figure-of-eight bandage in 19 cases, and cerclage wire fixation in 2 cases. The follow-up period was 65.7 (24–108) months. Outcome analyses included standard clinical follow-up, plain radiography, the Constant–Murley scoring and subjective assessment. All non-unions united well in 13.6 (11–27) weeks. All patients were satisfied with their surgical results. Greater age and longer period of non-union resulted in a larger amount of scapular malposition, which related to poor functional results.

Fixation of Comminuted Patellar Fracture with Combined Cerclage and Tension Band Wiring Technique

In comminuted patellar fractures, a combination of cerclage wiring and tension band fixation is said to provide good mechanical stability. This is a retrospective review of four patients treated with this method. All fractures described herein were classified as 45-C3 (based on Orthopaedic Trauma Association classification) and were fixed with a 1.25mm cerclage wire and tension band wire proximally looped through the quadriceps tendon and distally through the patellar ligament in a figure-of-eight configuration. The average follow-up period was 10 months. The Activity of Daily Living Scale (ADLS) of the Knee Outcome Survey was used to assess symptoms and functional capability of the knee. In all the cases, fracture union was achieved at an average of 11 weeks. The average ADLS score was good (92.5 %). Full range of knee motion was achieved by end of the third postoperative month. None of the patients had complications, such as infection and implant failure.

Open Reduction and Cerclage Wire Fixation for Long Oblique/Spiral Fractures of the Proximal Phalanx of the Fingers

Fifteen cases of long oblique/spiral fractures of the shaft of the proximal phalanx of the fingers treated by open reduction, cerclage wire fixation and immediate postoperative mobilisation were studied prospectively. Twelve patients presented early (within 24 hour of injury) and the remaining three cases were treated initially elsewhere by closed reduction and percutaneous oblique K-wire fixation with failure of the fixation. The latter three patients presented to our clinic late (10-14 days after injury). Following internal fixation with cerclage wires, no cases of infection, complex regional pain syndrome (CRPS) Type 1, fracture re-displacement, wire migration or extrusion were noted. One patient complained of a palpable wire which was removed 4 months after surgery. All fractures united and all patients returned to work at a mean of 8 (range 7-11) weeks after surgery. Twelve patients obtained a full range of motion (total active motion-TAM = 260 degrees ) and the remaining three patients had a mild (5-15 degrees ) flexion contracture of the proximal interphalangeal joint. Cerclage wire fixation is an acceptable technique of fixation for these fractures.

Long oblique/spiral mid-shaft metacarpal fractures of the fingers: treatment with cerclage wire fixation and immediate post-operative finger mobilisation in a wrist splint

The cerclage wire technique of internal fixation for displaced long oblique/spiral metacarpal shaft fractures has not gained popularity for two reasons: many believe that wire migration is a real possibility and that the fixation technique is not rigid enough to allow immediate postoperative finger mobilisation. In this report, the authors review the results of 19 cases of long oblique/spiral mid-shaft metacarpal shaft fractures of the fingers treated by cerclage wires and immediate postoperative mobilisation of all finger joints. The study included 17 men and two women with a mean age of 35 (range 18-45) years. After a mean follow-up of 8 weeks, all patients regained full range of motion of the fingers and no complications were noted. It is concluded that cerclage wire fixation of long oblique/spiral mid-shaft metacarpal fractures requires neither scoring of the bone (a technique recommended by other authors to prevent wire migration) nor finger immobilisation and that the technique consistently achieves good functional results.

(i) Comminuted patellar fractures

Summary Purpose of review This article reviews current best practice for the diagnosis and treatment of comminuted patellar fractures. Recent findings Patellar fractures make up about 1% of all fractures. As a rule, fractures of the patella are caused by direct trauma to the knee. A transverse fracture is the most common fracture type. Open reduction and internal fixation is the treatment of choice for the majority of displaced patellar fractures. Treatment must achieve anatomic reduction of the articular surface and reestablish the continuity of the extensor mechanism. Tension-band wiring, interfragmentary screw fixation and a combination of cerclage wiring and screw fixation are the most accepted techniques for stabilisation. Partial or total patellectomy is generally indicated when the patella is so severely comminuted that an accurate reduction and reconstruction of the retropatellar joint surface cannot be achieved. Summary Different methods of stabilisation for patellar fractures are used, depending mainly on the fracture pattern and the amount of displacement. The aims of operative treatment are basically accurate reduction and stable fixation that allows early mobilisation.

Cerclage Wire and Lag Screw Fixation of the Lateral Malleolus in Supination and External Rotation Fractures of the Ankle

Wound dehiscence and exposed lateral hardware can occur after open reduction internal fixation of lateral malleolus. The bulk of a lateral plate and the minimum soft tissue over the lateral malleolus may contribute to this situation. The objective of this study was to evaluate a series of patients with lateral malleolar fractures treated with operative reduction using minimal hardware. We wanted to observe whether there was any loss of reduction and whether there were any incidences of soft tissue disruption. Fifty-two patients with long spiral fracture of the lateral malleolus in a supination-external rotation injury were treated with two or three 3.5-mm lag screws inserted 1 cm apart and 1 or 2 circlage wires. Less rigid fixation was supplemented with a below-the-knee plaster cast. All patients were followed up until clinical and radiological evidence of fracture healing at 6, 10, and 14 weeks postoperatively. By 10 weeks, all patients were full weight bearing, although most patients still limped. At 14 weeks' follow-up, there were no infections or wound dehiscences. All patients were able to return to their activities of daily living. All the fractures had united without loss of original position. Two fractures of the posterior bone spikes seen during surgery united uneventfully. Long spiral fractures of the lateral malleolus of the ankle can be treated successfully with 2 or 3 lag screws and circlage wires without compromising the outcome of the fracture healing.

Dorsal Fracture–Dislocation of the Proximal Interphalangeal Joint: A Comparative Study of Percutaneous Kirschner Wire Fixation Versus Open Reduction and Internal Fixation

Nineteen patients with a dorsal fracture-dislocation of the proximal interphalangeal joint of a finger were treated with either closed reduction and transarticular Kirschner wire fixation (eight cases) or open reduction and internal fixation, using either one or two lag screws (six cases) or a cerclage wire (five cases). At a mean follow-up of 7 (range 6-9) years, most patients reported satisfactory finger function, even though some of the injuries healed with proximal interphalangeal joint incongruency (seven cases) or subluxation (four cases). Those treated by open reduction complained of more "loss of feeling" in the affected finger and those specifically treated by cerclage wire fixation reported more cold intolerance and had a significantly larger fixed flexion deformity (median, 30 degrees : range 18-38 degrees ) and a smaller arc of motion (median, 48 degrees : range 45-60 degrees ) at the proximal interphalangeal joint, despite having the best radiological outcomes. Closed reduction and transarticular Kirschner wire fixation produced satisfactory results, with none of the eight patients experiencing significant persistent symptoms despite a reduced arc of proximal interphalangeal joint flexion (median=75 degrees ; range 60-108 degrees ). The results of this relatively simple treatment appear at least as satisfactory as those obtained by the two techniques of open reduction and internal fixation, both of which were technically demanding.

Cerclage Wire Fixation of Navicular Body Fractures - A Treatment Based on Mechanism of Injury

Cerclage Wire Fixation of Navicular Body Fractures - A Treatment Based on Mechanism of Injury

Dynamic confirmation of fixation techniques of the tibial tubercle osteotomy.

The tibial tubercle osteotomy is gaining popularity for revision total knee arthroplasty; however, the potential for tubercle displacement has been a concern. This study compared the mechanical behavior of the tibial tubercle osteotomy after screw and cerclage wire fixation. Tibial tubercle osteotomy was done on 40 tibias from cadavers with equal numbers fixed by either screws or wires. Specimens were loaded cyclically to simulate straight leg raises and then loaded to failure with the patellar tendon oriented 0 degrees or 25 degrees from the tibial axis. Tibial tubercle osteotomy cyclic displacement was greater for wire constructs at 25 degrees than all other constructs. Failure loads were greater for screw constructs at 25 degrees than both wire constructs. Screw constructs failed at 1429 +/- 348 N (0 degrees) and at 1925 +/- 982 N (25 degrees). Wire constructs failed at 1072 +/- 260 N (0 degrees) and at 893 +/- 293 N (25 degrees). Bone mineral density correlated positively with failure loads. Straight leg raise (400 N) and knee extension (250 N) against gravity during rehabilitation should be feasible with either screw or wire fixation after tibial tubercle osteotomy. Special care should be taken for the large patient and patients with decreased bone density.

A new method for cerclage wire fixation to maximal pre-tension with minimal elongation to failure

Objective. To develop and test a new cerclage wire tightening technique, yielding reproducibly maximal pre-tension, load to failure and minimal elongation to failure of the wire junction. Design. Laboratory bench study. Background. Cerclage wire fixation is difficult to perform by hand with reproducible quality and tightening tension, which are required for optimal performance. Methods. With the new technique, 1, 1.25 and 1.5 mm steel wires were passed through a 9 × 18 mm steel tube, grasped using a modified ASIF wire-tightener and tightened by twisting until spontaneous failure of the wires in the tube. These fixations were compared to wires pre-tightened by hand to controlled high or low pre-tension using the simple twist, the knot twist and twist secured against untwisting, loaded to failure on a testing machine. The tests assessed pre-tension, ultimate failure load and elongation to failure. Results. Wire twists performed with the new technique were always perfectly symmetrical and may be tightened to maximal pre-tension without weakening of the wire. The twist secured against untwisting combined high stiffness with high failure load. The knot twist elongates to an unacceptable degree, unlike the secured twist. The simple twist untwists under little tension. Conclusions. The new technique allows to obtain maximal pre-tension and thus minimal elongation to failure of simple wire twists, without having to worry about breaking the wire at the base of the twist due to over-tightening. Relevance Cerclage wire fixation is an effective and cheap method to perform osteosynthesis. For adequate performance, maximal pre-tension, symmetrical twisting and high load to failure are necessary. The here presented technique combines all of these pre-requisites in a simple fashion.

Treatment of an intraoperative patellar fracture during revision total knee arthroplasty

An intraoperative vertical patellar fracture occurred through a central osteolytic defect during removal of a metal-backed patellar component. The fracture was treated successfully with cerclage wire fixation and implantation of a cemented patellar component. Copyright 2002, Elsevier Science (USA). All rights reserved.

Treatment of complex proximal humeral fractures with minimally invasive fixation of the humeral head combined with flexible intramedullary wire fixation - introduction of a new treatment concept.

The treatment of three- or 4-part proximal humerus fractures is still a matter of scientific discussion. The following study presents the results of a combined procedure using limited invasive fixation techniques for reconstruction of the humerus head and retrograde intramedullary wiring with elastic nails for the treatment of displaced three- or 4-part fractures. A prospective study of 24 patients with 3-part and 4-part fractures was performed from September 1995 to December 1998. Combined biologic fixation for reconstruction of the humerus head, including intramedullary wiring, was utilized. Fracture reduction was performed in an open soft-tissue-preserving technique through a limited lateral approach. Fixation of the head fragments was performed using screw and/or cerclage wire fixation. The reconstructed humerus head was stabilized to the shaft with intramedullary wires, with retrograde insertion 2 cm above the olecranon fossa. Supportive fixation of the head fragments was achieved using fully threaded cancellous screws. At the 1-year postoperative follow-up, 40% of the 18 patients had excellent results using the Neer and Constant score. Forty-five percent had satisfactory and 15% unsatisfactory results. The initial results of this study reveal that a combination of limited internal fixation of the humerus head and retrograde elastic intramedullary wiring provide stable fixation with limited soft-tissue destruction. This approach has been shown to be especially useful for the combined treatment of three- or four-part fractures of the humeral head.

Twist knot cerclage wire: the appropriate wire tension for knot construction and fracture stability

Objective. The aim was to find the best wire tension in order to permit a reliable first twist and simultaneously provide the best stability of fracture fixation from the twist knot cerclage wire. Design. Wires at different distal tensions, looped around the fracture, were measured during twist and compared with the yield strength of the wire. Then, the fracture stability of the twist knot cerclage wire was determined from the pull-out strength. Methods. In order to measure wire tension during twist knot construction, an instrument was designed using the tension load cell of a universal testing machine, a 15 ° oblique osteotomy femoral shaft and 1.25 mm diameter wire. A wire tensioner and a pair of extraction grips were then used for measuring the pull-out strength of the cerclage wire fixation. Result. Three wire tensions (160, 200 and 240 N) were used as looped wire for the first twist knot construction. The 200 N tension cerclage wire provided the best fracture stability. Conclusion. It was found that 200 N was the best wire tension for the construction of a twist knot cerclage wire.