Role of Open Cerclage Wires Used in Patients with Comminuted Fractures of Femoral Shaft Treated with Intramedullary Nails

Abstract

IntroductionThe role of open cerclage wiring in comminuted femoral shaft fracture treatment with intramedullary nails remains unclear. Here, we analyzed the effect of open cerclage wiring and the risk factors for nonunion after interlocking nailing in comminuted femoral shaft fracture treatment. We hypothesize that open cerclage wiring is applicable to patients with severe comminuted femoral shaft fractures without affecting bone healing.Patients and MethodsThis retrospective cohort study used data of consecutive patients who underwent interlocking nail fixation of a comminuted femoral shaft fracture between January 1, 2009, and December 31, 2016. First, eligible patients were divided into wire and no wire groups according to the surgical technique used and their union rate was recorded. The patients were then divided into union and nonunion groups and their perioperative data were analyzed.ResultsIn total, 71 comminuted femoral shaft fractures treated with interlocking nail fixation were included: 38 fractures (53.5%) augmented with the open wiring technique and 33 reduced with closed or mini–open wound without wiring. The wire group demonstrated significant improvements in fracture reduction compared with the no wire group, whereas no significant difference was observed in the union rate between the wire and no wire groups (p = 0.180). Moreover, 46 (65%) of 71 fractures united smoothly, and no significant difference was observed in any perioperative data between union and nonunion groups.DiscussionAugmented open cerclage wiring is indicated for comminuted femoral shaft fractures treated with intramedullary nails, even when the fragments are large or far displaced. Thus, open cerclage wiring can be used for fracture treatment, without decreasing the union rate.