Circumferential Wiring Research Articles

THREE YEARS FOLLOW UP REPLANTATION IN HEAVY SMOKER PATIENT: CASE REPORT

Tooth avulsion is different from all other dental injuries due to the extracorporeal situation with varying duration and degree of contamination of the teeth and the patient's systemic conditions. In a heavy-smoker patient, wound healing could be interrupted. Extra-alveolar handling, good replantation, and educating the patient could be the key to successful treatment of tooth avulsion, especially in a heavy smoker. The aim of this study is to discuss an avulsed tooth case that has been successfully treated by replantation in a heavy smoker. A 39-year-old female patient was refered to Siloam Hospital due to a dental trauma injury. The patient was in good general health, but she was a heavy smoker. Intraoral examination revealed that the maxillary left permanent central incisor was avulsed after the patient fell off in her bathroom. Replantation is a treatment of choice in this case. The avulsed tooth was stored in a saline solution. On one visit, root canal treatment was done on the avulsed tooth extra orally soon after the patient was refered to the AE department at Siloam Hospital. The avulsed tooth was replanted and fixed using an Erich arch bar to the previous position by finger pressure. Fix the Erich bar as far as possible to the distal and mesial of the avulsed tooth using circumferential wire in every single tooth. We decided to put the Erich bar from 15 to 25. The following oral hygiene cleaning, dietary instructions, and education to reduce or stop smoking during the healing process were given. Extra-alveolar handling, good replantation, good fixation, and adequate oral hygiene education are the keys to treating a tooth avulsion, even in a heavy smoker.

Achieving Rapid Healing and Low Complication Rates in Patellar Fracture Fixation: The Benefits of Cerclage and Figure-of-Eight Configuration.

Background and objective Patellarfractures account for around 1% of all fractures. Conservative treatment is advised in patients without any incompatibility of articular surfaces or those with intact extensor mechanisms. More than a 2-mm articular gap due to fracture warrants surgical intervention. Tension band wiring (TBW) is a commonly used practice for fixation, However, there is still controversy about its effectiveness and complications arising due to the hardware. Modification of this technique by using K-wires has been considered a method of choice, but this technique is associated with complications due to K-wires. The Pyrford technique is a method for patellar fracture fixation by circumferential cerclageand anterior TBW. We employed the figure-of-eight configuration over the circumferential wire. This study aimed to analyze the outcomes ofTBW of the patella without K-wires by assessing the rate of complication and functional outcomes. Materials and methods A total of 38 patientswithOTA 34C type, simple and comminuted type of patella fractures aged between22 and 70 years were treated with circumferential cerclage and figure-of-eight TBW.All patients underwent patellar fixation with cerclage and through direct purchase of SS wire via quadriceps and patellar tendon. Patients were followed up for one to three years. We analyzed differences in the range of motion, fracture reduction, fracture healing time, Bostman score for knee function, and complications. Results The mean age of the patients was 45 years. After TBW without K-wires, fracture healing and functional outcomes were satisfactory according to patient feedback and clinocoradiological examinations. Of note, 35 out of 38 patients (92%) had gained up to 90 degrees of active flexion at the end of one week. One patient (2.42%) developed a superficial infection. All fractures had achieved union at the end of 16 weeks. Malunion or nonunion was not noted in any of the cases. There was no case of implant removal. The average Bostman score at the 12-month follow-up was 28.5 ±1.5. The incidence of complications due to K-wire was nullified. Conclusion Based on our findings, the described method leads to better functional outcomes, decreasing hardware-related complications, and can be used in simple as well as comminuted fractures. The fracture healing and functional outcomes and rate of complications were satisfactory.

Multi-planar fixation of displaced, multi-fragmentary patella fractures in elderly patients with anterior locking plates and cerclage wires: preliminary results.

The purpose of this study was to evaluate the outcomes of displaced, multi-fragmentary patella fractures in elderly patients treated with anterior plating and cerclage wires. Between 2018 and 2020, patients aged at least 60years old undergoing anterior plating and circumferential wiring for displaced, multi-fragmentary patella fractures with a minimum of 12months follow-up were included. Fragments were reduced and circumferentially stabilized by loop wires, followed by multi-planar fixation with an anterior locking plate and multi-directional screws. Postoperative outcomes were evaluated with the Böstman scores and range of motion. Patients were also asked about symptomatic hardware as well as satisfaction with postoperative outcomes. Sixteen patients with an average age of 71.8 ± 9.3years old were followed up for an average follow-up was 25.1 ± 8.2months. At the latest follow-up, the average Böstman scores were 27.2 ± 3.4, and active knee flexion was 123 ± 14°. Two patients complained pinpoint implant irritation and underwent implant removal. Another underwent implant removal due to cultural reasons. Fifteen patients were satisfied with the operative outcomes, and one was unsatisfied due to intermittent patellofemoral pain. Cerclage wire breakage was noted in nine patients on postoperative radiographs, but none elicited pinpoint pain. No wound complications, infections, nonunion or loss of reduction were observed. Anterior locking plates and cerclage wires in tandem provide reliable multi-planar fixation for displaced, multi-fragmentary patellar fractures in elderly patients and resulted in favorable clinical outcomes.

Analysis on Influencing Factors of Recurrence after Indirect Inguinal Hernia Laparoscopic Surgery.

This paper aims to analyze the recurrence of indirect inguinal hernia in children after laparoscopic surgery and investigate the influencing factors that may lead to recurrence so as to guide the prevention and treatment of postoperative recurrence of this kind of disease in the future. The data of 260 children with indirect inguinal hernia treated by laparoscopic surgery and followed up in our hospital from July 2019 to July 2021 were selected. A self-designed questionnaire was used to collect the basic data. The recurrence was analyzed, and the influencing factors of recurrence were analyzed by univariate analysis and multivariate analysis. Among 400 children after indirect inguinal hernia laparoscopic surgery, an occurrence was observed in 15 children, and the recurrence rate was 5.77%. Univariate analysis showed that the age and course of disease were not correlated with recurrence after indirect inguinal hernia laparoscopic surgery (P > 0.05). Being male, bilateral lesions, exact high ligation, loose hernia back wall peritoneum, deciduous ligature, incorrect ligation of the fascia of musculus obliquus externus abdominis, large inguinal hernia, circumferential wiring, and too early off-bed activity were the influencing factors of recurrence after indirect inguinal hernia laparoscopic surgery (P < 0.05). Logistic multivariate regression analysis showed that being male, bilateral lesions, loose hernia back wall peritoneum, deciduous ligature, incorrect ligation of the fascia of musculus obliquus externus abdominis, large inguinal hernia, and too early off-bed activity were the influencing factors of recurrence after indirect inguinal hernia laparoscopic surgery (OR>1, P < 0.05). Exact high ligation and circumferential wiring were protective factors of recurrence after indirect inguinal hernia laparoscopic surgery (OR>1, P < 0.05). After indirect inguinal hernia laparoscopic surgery, recurrences were affected by many factors, such as gender, site of pathological changes, and loose hernia back wall peritoneum. For these children with risk factors, reasonable intervention should be taken to reduce recurrence; exact high ligation and circumferential wiring are the protective factors. If permitted, the children meeting related indications can be treated by high ligation or circumferential wiring to reduce the risk of recurrence after indirect inguinal hernia laparoscopic surgery.

Management of Patella Fractures Non-amenable to Tension Band Wiring: Series of Nine Cases with Review of Literature.

Introduction:Patella fractures account for about 1% of all musculoskeletal injuries. 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. In this series, we present nine cases managed with open reduction and internal fixation using non-absorbable braided polyester suture (Ethicon Ethibond Excel 5-0) with circumferential stainless-steel wiring.Case Series:This series included nine patients with fractured patella and managed with open reduction and internal fixation with non-absorbable sutures and circumferential wiring. Patient demographics, fracture type, time to union, functional outcome, and complications were recorded. Patients were followed up for minimum of 6 months (11.6 ± 3.7 months). All fractures went on to unite with average fracture healing time of 13.8 weeks. Mean Lyshom and Bostman score were 83 and 25.6, respectively. Seven patients had excellent to good outcome. One each had fair and poor outcomes. One patient developed superficial infection and knee stiffness.Conclusion:Open reduction and fixation with non-absorbable sutures augmented with circumferential wiring are an efficient method for the management of severely comminuted and multi-fragmentary lower pole patella fractures with minimum complications.

A comparative study of tension band wire and circumferential wiring for patellar fractures

&lt;b&gt;Aim:&lt;/b&gt; To compare tension band wire and circumferential wiring for patellar fractures. &lt;b&gt;Materials &amp; Methods:&lt;/b&gt; One hundred twenty adult patients in age ranged 18- 50 years of either gender was randomly divided into groups viz. group 1 treated with tension band wire and group 2 with circumferential wiring for patellar fractures. Reich and Rosenberg scale, rage of motion and complications were recorded in both groups and compared. &lt;b&gt;Results:&lt;/b&gt; At 4 weeks in group 1 and group 2, restriction of last \(10^{0}- 20^{0}\) was seen in 24 and 27, restriction of \(20^0-50^0\) was seen in 14 and 13, restriction \(&gt;50^0\) was observed in 22 and 20. At 8 weeks, no restriction was seen in 8 and 9, restriction of last \(10^0- 20^0\) was seen in 38 and 39, restriction of \(20^0-50^0\) was seen in 10 and 9, restriction &gt;500 was seen in 4 and 3. At 12 weeks, no restriction was seen in 15 and 20, restriction of last \(10^0- 20^0\) was seen in 35 and 32, restriction of \(20^0-50^0\) was seen in 8 and 7 and restriction \(&gt;50^0\) was seen in 2 and 1 in group 1 and 2 patients respectively. A significant difference was observed (P&lt; 0.05). &lt;b&gt;Conclusion:&lt;/b&gt; Both techniques for the management of patellar fractures were equally effective in achieving functional outcome.

A comparative study of tension band wiring versus circumferential wiring in the management of patellar fractures

Introduction: Patellar fractures constitute about 1% of all skeletal injuries resulting from either direct or indirect trauma. The subcutaneous location of the patella makes it vulnerable to direct trauma, whereas violent contraction of the quadriceps results in indirect fractures of the patella. Any improper and inadequate treatment would inevitably lead to a great deal of disability which would be most perceptibly felt in a country like India, where squatting is an important activity in daily life. Materials and Methods: This prospective study was carried out at the Department of Orthopaedics, KBNIMS, Kalaburagi. In this study, 40 patients(23 males and 17 females; mean age 42.7 years) with Patellar fractures were admitted at Khaja Banda Nawaz Institute of Medical Sciences Hospital, Kalaburagi and examined according to protocol. Associated injuries were noted. Clinical and radiological investigations were carried out to get fitness for surgery. Patients underwent Tension Band Wiring or CircumferentialWiring for the sustained fracture. Patients were followed up at 4 weeks, 8 weeks, 12 weeks till fracture union and once at 1 year after surgery using Reich and Rosenberg criteria. Results: There was no significant difference regarding the mean age, gender, and mechanism of the fractures in patients treated by two methods of TBW and CW. 1 case of superficial infection and 3 cases of joint stiffness were noted after CW and 1 case of superficial infection and 2 cases of joint stiffness had occurred after TBW. 60% excellent, 25% good, 5% fair and 10% poor results were observed after Circumferential Wiring and 65% excellent, 15% good, 15% fair and 5% poor results after TBW. Patients of both groups showed an appreciable and statistically significant improvement in functional outcome at 3 months follow-up period as evidenced by Reich and Rosenberg Criteria that reveals no major difference. Furthermore, the difference in improvement between the two groups was not statistically

Surgical Management of Comminuted Midshaft Clavicle Fractures Using Reconstruction Plate and Circumferential Wiring: Does the Circumferential Wiring Interfere with the Bone Union?

Surgical Management of Comminuted Midshaft Clavicle Fractures Using Reconstruction Plate and Circumferential Wiring: Does the Circumferential Wiring Interfere with the Bone Union?

Application of Plate and Circumferential Wiring with Resin to Bilateral Mandibular Fractures in a Calf: Case Report

Application of Plate and Circumferential Wiring with Resin to Bilateral Mandibular Fractures in a Calf: Case Report

Traumatic tracheostomy in a dog

A two-year-old, mixed breed, female intact dog was referred for further investigation and treatment of a chronic non-healing wound in the cervical region. The wound was secondary to a circumferential wire collar injury. Clinical examination revealed a cervical tracheal transection resembling a traumatic tracheostomy. The dog underwent closure of the tracheostomy by tracheal resection and anastomosis in a split-cartilage technique. No serious postsurgical complications were observed apart from short-term coughing. Eighteen months after surgery, the dog was reported to be free of clinical signs of respiratory disease.

Management of unusual metallosis and failed elbow replacement in rheumatoid female: a case report

&lt;p class="abstract"&gt;42 years old female who was operated for rheumatoid arthritis elbow right side with revision of total replacement. Her elbow was primarily replaced 10 years before this surgery. She had severe metallosis and breakage of ulnar stem, loosening of cement (ulnar). Humerus stem was well fixed. Massive metal debris in soft tissue was removed. humerus side cement and stem were removed by splitting the bone. Revision stem was fixed with cement and circumferential wiring. On 6 yrs following surgery, patient is doing well in terms of pain relief and range of motion around elbow. She is doing almost all activities of daily life. Early detection and removal primary implant are the need of hour to save the ill effects of metallosis and bone resorption.&lt;/p&gt;

Surgical Management with Self-Locking Pins and Circumferential Wiring for Treating Comminuted Patella Fractures Achieved Seiza-Style Sitting

Surgical fixation of comminuted patella fractures is technically challenging. Despite the fact that tension band wiring or screw fixation are the most common surgical procedures, these surgical techniques have crucial limitations for laterally scattered fragments. We demonstrate two cases with comminuted patella fractures undergoing surgical fixation with self-locking pin and circumferential wiring, confirming the rigid fixation achieving deep knee flexion. After midline longitudinal skin incision, 2.0 mm stainless pins (AiMedic MMT, Tokyo, Japan) were inserted radially to penetrate each fragment and 1.2 mm stainless wire was circumferentially looped and self-locked in the holes on the pins, which satisfied rigid fixation. Any restrictions in range of motion and weight bearing were required postoperatively and 3- to 6-month postoperative cares achieved seiza-style sitting with deep knee flexion.

Suturing and wiring a novel technique for Osteosynthesis of inferior pole patella fracture: A prospective comparative study

Background: Osteosynthesis and partial patellectomy with patellar tendon repair are accepted procedures for inferior pole fracture of patella. Fractures of lower end of patella are usually avulsion injuries due to forceful flexion of knee against contracted quadriceps muscle. Multiple small fragments attached to patellar tendon make the management difficult. We conducted a prospective study of clinical and radiological outcome of inferior pole of patellar fractures treated with patellar tendon repair with non absorbable Ethibond and circumferential wiring. We compared the results with those of mid patellar fractures treated with modified tension band wiring technique. Materials: We included all patients with lower pole patella fractures, presented to our department from 2012 to 2015. We included patients with fracture 34 A1 (b) (extra articular lower pole) and 34C1.3 (complete articular distal 3rd fracture). These fractures were fixed with Ethibond 5 by making transosseous longitudinal drill holes and supplemented with circumferential stainless steel wires. Bostman scoring system was used to analyze and assess clinical results. We compared the results with midpatellar fractures treated by tension band wiring at the end of follow up period. Results: We recruited 21 patients with inferior pole patella fractures. Independent T Test was used to compare the means of Bostman scoring, flexion and loss of extension of knee joint between two groups of patients. Anterior knee pain and implant loosening was found more prevalent in midpatellar fracture treated by tension band wiring technique and required implant removal. There was no significant difference between two groups of patients. Conclusion: Lower pole patella fracture can be successfully treated by this novel technique of fixation with less number of complications. Comminuted lower pole fractures which otherwise needed excision may be preserved with this technique.

Treatment of displaced transverse fractures of the patella: modified tension band wiring technique with or without augmented circumferential cerclage wire fixation

BackgroundDisplaced transverse fractures of the body of the patella are usually associated with disruption of extensor mechanism and should be fixed surgically. The most common method is a tension band wiring (TBW) technique. Some surgeons concurrently employ an augmented circumferential cerclage wiring (ACCW) technique to help fracture stabilization and aid in fracture healing; however, its role and effect on the treatment outcomes is unclear.MethodsWe performed a STROBE-compliant retrospective observational cohort study on all cases of acute closed patella fracture that were treated at our institution between 2006 and 2012. Of 185 episodes, 72 (38.9%) were eligible for this study according to our inclusion/exclusion criteria. We classified these subjects with AO/OTA type 34-C1.1 or 34-C2 lesions into two groups for analyses: fractures treated with modified TBW and ACCW (group 1, n = 27) and those treated with modified TBW alone (group 2, n = 45). Plain radiographs were used to evaluate radiographic outcomes and the effect of potential risk factors on fixation failure was analyzed by subgroup comparisons.ResultsOur results revealed that there were no significant differences in the rates of fixation failure (P = 0.620), nonunion (P = 0.620), and revision surgery (P = 0.620) between the groups. Although not statistically significant, there was a trend towards a positive risk association between fixation failure and age distribution > 60 years (10.0% vs. 0.0%, P = 0.124; OR = 8.0, P = 0.168) and > 70 years (9.4% vs. 2.5%, P = 0.321; OR = 4.0, P = 0.237) and the superficial level of the K-wires (12.0% vs. 1.5%, P = 0.117; OR = 6.3, P = 0.121). Regarding those modified TBW patients concurrently treated with an ACCW, the potential risk association between fixation failure and the superficial level of the K-wire was prone to increase further (28.6% vs. 0.0%, P = 0.060; OR = 18.6, P = 0.071).ConclusionsConcurrent application of an ACCW might be needless and not efficacious to help fracture stabilization and healing in patients having been treated with modified TBW for displaced transverse fractures of the body of the patella. Adherence to correct surgical technique such as putting the K-wires at the proper level and securing control of the both ends of the K-wires may be more important and help in improving outcomes.

Proximal femur segmental resection for the management of prosthetic tip fracture: An innovative procedure

Fractures at the tip or just below the tip of a total hip replacement (THR) prosthesis are treated with a longer prosthetic stem, a longer stem with distal interlocking, a THR combined with a locking compression plate (LCP), and unicortical locking screws in proximal fragment with or without circumferential wiring or cables. As LCP remains weaker construct chances of failure are more and in cases with a failed LCP with THR, one may have to opt for a limb preservation system as an alternate to LCP. None of these techniques were possible in this 40 year patient and we had to opt for some innovation to help him. We are reporting an innovative technique where a proximal femur segmental resection was done for the management of prosthetic tip fracture continuing with the same THR stem.

Outcome of Inferior Patellar Pole Avulsion Fractures

Introduction: The optimal treatment for inferior pole patella avulsion fractures has still been a topic of debate. The options include (a) internal fixation of the pole fragment and (b) resection of the avulsed fragment and repair of the patellar ligament to the patella. We present the comparative outcomes for patients with displaced inferior pole patella treated by resection and transosseous Ethibond® Krackow suture repair of patellar ligament with open reduction and internal fixation with modified tension band wiring and circumferential wiring.&#x0D; &#x0D; Methods: During a three year period between August 2013 and September 2016, twenty consecutive patients with distal pole fractures of the patella were prospectively enrolled in this study. These patients were divided into two groups. Group-T patients were treated with open reduction and internal fixation with modified tension band wire and group-R patients by resection of the avulsed fragment and reattachment of the patellar ligament to the patella with #5 Ethibond®. Data entry and analysis was done by using SPSS version 20. Anatomical and functional outcome were compared.&#x0D; &#x0D; Results: Consecutive 20 patients were treated either with resection lower patellar pole (n=10) or with open reduction internal fixation with tension band wiring (n=10). Demographics were matched in two groups. Group-T required a longer hospital stay (U=13.5, p=0.005). Complications were seen more often in Goup-T compared to Group-R (p=0.005). Group-R had better scores (Bostman score U=6, p=0.001; SFMA U=7.5, p=0.001) and range of movement (p&lt;0.05).&#x0D; &#x0D; Conclusion: Resection of the avulsed fragment and reattachment of the patellar ligament to the patella had better outcome according to the Bostman and SFMA dysfunction score, shorter hospital stay, and less complications as compared to open reduction and internal fixation with tension band wire and circumferential wiring.

Patella fractures in cats with persistent deciduous teeth — Knees and Teeth Syndrome (KaTS)

Most patellar fractures are seen in young female and male cats aged between 1–3 years. Many affected cats have a history of persistent or retained deciduous teeth, and in some cats their permanent teeth also do not erupt properly. The patellar fractures are usually unilateral at first presentation but become bilateral within 3–9 months. Pin and tension band wire fixation is associated with a high complication rate and often results in further fragmentation of the patella. A technique that does not involve inserting an implant into the sclerotic patella, such as circumferential wiring, tension band without a pin, or a tibial quadriceps repair may be beneficial, but conservative treatment can yield equally good results and is inevitably associated with a lower complication rate. Further work is needed before definitive statements can be made regarding the best treatment for this condition, as there are too low numbers or too many variables in the published retrospective studies. Many affected cats will fracture other bones as they age. An underlying bone or connective tissue disease is suspected in cats with patellar fractures and persistent deciduous teeth, and for ease of discussion and case recruitment the disease has been termed knees and teeth syndrome or KaTS.

Cementless total hip arthroplasty for patients previously treated with femoral osteotomy for hip dysplasia: the incidence of periprosthetic fracture.

Femur deformities can make stem fixation difficult in total hip arthroplasty (THA). We report the clinical results of cementless THA using a press-fit stem in patients who had previously undergone femoral osteotomy for hip dysplasia. The subjects included 66 hips in 64 patients, with the mean follow-up period of 7.3years. THA was performed at a mean period of 17.1years after intertrochanteric femoral osteotomy. Valgus osteotomy was performed in 42 hips, and varus osteotomy in 24. Clinical results were evaluated by using the Merle d'Aubigne-Postel score. Implant survival was determined with revision as the end point, and any related complications were investigated. The Merle d'Aubigne-Postel score improved from 9.4 to 16.1 at the final follow-up, without any implant loosening. However, periprosthetic femoral fractures were observed in four hips (6.0%), one intra-operatively and three within three weeks after THA. Among these cases, three hips previously had varus osteotomy (12.5%) and one hip had valgus osteotomy (2.3%). Two hips were revised with full porous stems and circumferential wiring. The five and ten year cumulative survivorship rates were 97% (range, 88.8-99.3%) and 97% (88.8-99.3%), respectively. Although the use of a press-fit cementless stem yielded acceptable results in most of the patients, perioperative femoral fracture was a major complication especially in the patients previously treated with intertrochanteric varus osteotomy. Careful planning and implant selection could be emphasized for these cases.

Two Cases of Mandibular Fractures in Child Treated by Open Reduction and Internal Fixation with a Titanium plate

In the treatment of mandibular fracture in child, avoiding any damage to uneruptal tooth bud, and growth and development of mandible bone are considered exceptionally.Therefore, reduction and fixation by splint and circumferential wiring is performed generally. However, in the case of displaced fracture, open reduction and internal fixation(ORIF) should be applied. On the other hand, the case of condylar fracture needs the jaw opening exercise early to prevent mandibular ankylosis. For that reason, in the case of condylar and mandibular body fracture, it is important to perform ORIF of mandibular body fracture as soon as possible. We report two cases of mandibular fracture (midline and bilateral condyle) in 3 years-old and 10 months boy and 1 years-old and 9 months girl. We planed the operation in reference to CT scans to avoid uneruptal tooth bud and ORIF of midline fracture with a titanium plate was performed. The titanium plate was removed after 6 month, for preventing growth and development of mandible bone. Postoperative causes have been uneventful. e-228 Case 1: 3 years-old and 10 months boy fell from a height of 2 meters. ORIF of midline fracture with a titanium plate was performed on December 3rd, 201X. Case2: 1 years-old and 9 months girl fell from bicycle driving by her mother. ORIF of midline fracture with a titanium plate was performed on September 29th, 201X. As they did not need intermaxillary fixation, they could open the mouth and take ordinary diet at early stage of the post operation. Conclusions: In the treatment of mandibular fracture in child, we made a plan of the plating position and the size of screw in reference to CT scans, and ORIF of mandibular fracture with a titanium plate was performed safety.

Percutaneous cerclage wiring followed by intramedullary nailing for subtrochanteric femoral fractures: a technical note with clinical results

Although intramedullary nailing is an ideal treatment for subtrochanteric femoral fractures, it is technically challenging in fractures extending into the nail entry area and/or involving the lesser trochanter. Although the application of circumferential wire may facilitate reduction in these situations, its use remains controversial due to possible blood supply disturbances to underlying bone. In the present study, we evaluated complex subtrochanteric fractures treated by percutaneous cerclage wiring followed by intramedullary (IM) nailing for anatomical fracture reduction and union. Twelve patients (mean age 48.3 years) with an unstable subtrochanteric fracture were prospectively treated. Indications of percutaneous cerclage wiring followed by IM nailing were a fracture extending proximally into the nail entry area deemed difficult to treat by anatomical reconstruction by IM nailing or a fracture with long oblique or spiral component. One or two cerclage wires were percutaneously applied for the temporary reduction of main fragments, and then, a cephalo-medullary or a reconstruction nail was fixed. We assessed radiologic results (union time, alignment), functional results, and complications. All 12 cases healed, without a bone graft, at an average of 19.1 weeks after surgery (range 16-24). In 11 cases, acceptable alignment was achieved (mean, valgus 0.3° extension 0.6°) with minimal leg-length discrepancy; the other exhibited 1 cm of shortening. All patients were able to return to pre-injury activity levels, and median Merle d'Aubigne score was 16.9 (15-18). No infection or implant-related complication was encountered to latest follow-up (minimum 12 months postoperatively). Temporary reduction by percutaneous wiring offers a means of satisfactory nailing in difficult subtrochanteric femoral fractures, and affords anatomical reconstruction and favorable bony union.