Percutaneous Cerclage Wiring Combined with Cephalomedullary Nailing for Irreducible Subtrochanteric Fractures

Abstract

Objective To explore the surgical method, operation essentials and the clinical effect of the treatment of irreducible subtrochanteric femoral fractures by percutaneous cerclage wiring and Cephalomedullary nail. Method From February 2016 to October 2019, 17 cases of irreducible subtrochanteric femoral fractures (SFFs) treated via a minimally invasive wire system and intramedullary nail fixation were reviewed retrospectively. Ten male and seven female patients were involved. The average age was 59.88 ± 16.13 years, ranging from 41 to 94 years. Among the patients, seven were injured in traffic accidents, five fell from a standing height, and five injured themselves from falling. The cases were classified based on the Seinsheimer classification. Specifically, five cases were type IIIA, five cases were type IIIB, one case was type IV, and six cases were type V. According to the AO/OTA classification, 10 cases were 32B3, and seven cases were 32C3. During surgery, the patients were placed on a traction bed andattempted closed reduction. For those patients whose closed reduction failed confirmed by fluoroscopy, we performed a small anterolateral incision through which a self‐made minimally invasive percutaneous wire introducer (passer; patent Z: 2016 2 1002800.8) was employed for temporary fixation with a wire. A double‐stranded steel wire was introduced into a self‐made wire traction and lifting device (patent ZL 2020 2 0205658.7), the wire was pulled vertically and firmly fixed. Then an long InterTan nail was used for the fixation. The following information was recorded: (i) length of the invasive incision, (ii) blood loss on the third day after surgery, (iii) operation time; and (iv) maximum displacement and angulation of the fracture ends of the x‐rayed front and side fractures before and after surgery and the maximum displacement and formation of the three‐dimensional CT‐scanned fracture ends in the coronal plane, sagittal plane, and cross section before and after surgery. Result A total of 15 of the 17 patients were followed for 12 to 24 months. The 15 patients recovered, but one died from pulmonary infection 1 year after surgery. In the postoperative X‐ray and three‐dimensional CT observation reduction treatment, fracture displacement was less than 5 mm, each plane angle was less than 10 degrees, and postoperative fracture healing time was 3 to 14 months, with an average of 4.19 ± 4.04 months. The postoperative Harris hip function score ranged from 66 to 95 points, with an average of 80.81 ± 9.67 points. In terms of clinical outcomes, 11 cases were excellent, four cases were satisfactory, and one case was fair. Conclusion For refractory subtrochanteric fractures, percutaneous wiring combined with Cephalomedullary nail fixation is a minimally invasive, rapid, and effective method, which can achieve satisfactory results in clinical practice and is worth promoting.

Finite‐Element Analysis of a Novel Cephalomedullary Nail for Restricted Sliding to Reduce Risk of Implant Failure in Unstable Intertrochanteric Fractures

“…21 Cerclage cable is the most common medial support reconstruction technique in cephalomedullary nailing for trochanteric fractures, 22 but whether cerclage can improve fixation is still controversial. 23,24 Ceynowa et al confirmed that medial wall reconstruction with a cerclage cable does not improve axial stability of the fixation through biomechanical study. 25 Cement augmentation for trochanteric fractures is considered viable to limit the excessive sliding by enhancing the implant anchorage within the head and neck fragment and lead to promote patient early mobilization.…”

“…Some techniques are available to enhance cephalomedullary nailing for unstable trochanteric fractures to reduce the risk of implant failure by restoring mechanical conduction of the medial femur and limiting excessive sliding 21 . Cerclage cable is the most common medial support reconstruction technique in cephalomedullary nailing for trochanteric fractures, 22 but whether cerclage can improve fixation is still controversial 23,24 . Ceynowa et al .…”

“… 21 Cerclage cable is the most common medial support reconstruction technique in cephalomedullary nailing for trochanteric fractures, 22 but whether cerclage can improve fixation is still controversial. 23 , 24 Ceynowa et al . confirmed that medial wall reconstruction with a cerclage cable does not improve axial stability of the fixation through biomechanical study.…”