The benefit of wire cerclage stabilisation of the medial hinge in intramedullary nailing for the treatment of subtrochanteric femoral fractures: a biomechanical study

Müller, T.; Topp, Tobias; Kühne, Christian; Gebhart, Gershon; Ruchholtz, Steffen; Zettl, Ralph

doi:10.1007/s00264-010-1204-4

Cited by 61 publications

(42 citation statements)

References 22 publications

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“…Besides the use of fracture table, indirect reduction of the fracture can be achieved with the supplement of circumferential wire. 19,20 Unlike cephalomedullary nail, PF-LCP allows circumferential wire without additional incision. Cerclage wiring is an alternative technique to achieve reduction in difficult fractures 21,22 From recent cadaveric study, cerclage wiring resulted in only minimal disruption of femoral blood supply 23 .…”

Section: In Ordermentioning

confidence: 99%

The outcome in early Cases of Treatment of Subtrochanteric Fractures with Proximal Femur locking Compression Plate

Gunadham¹,

Jampa²,

Suntornsup³

et al. 2014

MOJ

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The objective of this study was to evaluate the outcome in early treatment of subtrochanteric fractures with proximal femur locking compression plate (PF-LCP).The patients included in this study were those with subtrochanteric fractures (AO type 32A-C) treated with PF-LCP (Synthes) between Jan 2009 and Jun 2011. The patient characteristics and details of clinical conditions were obtained from records. Clinical and radiographic follow-ups were done at one, two, four and 6 months intervals, and at one year. The primary outcome studied included fracture union and functional ambulatory status. Twenty-six patients were included in the study, 19 of whom were male with a mean age of 42.4 years. Fourteen patients (53.9%) had sustained AO type 32B fractures, the majority in motor vehicle accidents. Twenty-two fractures (84.6%) achieved union, while sixpatients (23.1%) had complications such as broken plate, varus collapse, and broken screw. Four patients (15.4%) underwent a second operation. At the end of the follow-ups, 25 patients (96.2%) were community ambulators. We conclude that PF-LCP is an effective alternative treatment for subtrochanteric fractures when properly performed.

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Section: In Ordermentioning

confidence: 99%

The outcome in early Cases of Treatment of Subtrochanteric Fractures with Proximal Femur locking Compression Plate

Gunadham¹,

Jampa²,

Suntornsup³

et al. 2014

MOJ

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“…In his study all fractures healed and there was no implant-related complications. In an experimental study, Gontze et al [10] compared the laudability of osteosynthesis of unstable per and subtrochanteric fractures and found that the PFN could bear the highest loads of all devices. Simmermacher et al [11] in a clinical multicenter study with 191 subtrochanteric fractures treated with PFN reported technical failures of the PFN after poor reduction, malrotation or wrong choice of screws in 5% of cases.…”

Section: Discussionmentioning

confidence: 99%

Functional outcome of comminuted unstable subtrochanteric fractures treated by proximal femoral nail [PFN]

Va¹,

Mohammed²

2017

Int. J. Orthop. Sci.

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Background: Subtrochanteric fractures are often difficult to treat and may well be associated with a mortality of more than 20%. The subtrochanteric region is the site of very high mechanical stresses, the medial and posteromedial cortices were subject to high compressive forces whereas the lateral cortex experiences high tensile forces. Operative management is the treatment of choice to achieve the goals of early rehabilitation and optimal functional recovery. The purpose of the present study is to evaluate functional outcome of the subtrochanteric fractures -both high energy and low energy -treated by PFN. Functional as well as anatomical results were evaluated with regard to pain, limping, activities, deformity and range of movements. The present study was done with the hope to find out a solution for the treatment of unstable comminuted subtrochanteric fractures. Materials and Methods: A total of 24 patients with subtrochanteric fractures presenting in the Department of Orthopaedics from August 2015 to August 2016 were treated by closed intramedullary nailing using PFN and the peroperative and postoperative complications and the functional outcome were studied. All the data was arranged in a tabulate form and analyzed using SPSS software. Chi square test was applied as a test of significance. Probability value of less than 0.05 was considered significant. Result: Out of the 24 patients 16 (66.66%) were males and 8 (33.34%) were females. Most of the cases came under. Type IB (62.50%) and Type IA (20.84%). There were 8.3% cases each of Type II A and Type II B. In this study, 14 cases (58.34%) were locked proximally and distally with 2 screws each. In 4 cases (16.66%), 2 proximal screws and 1 distal screw, in 2 cases of intertrochanteric fracture, only 2 proximal screws were used. Average duration taken for union in this study was 4.5 months (Ranges from 3 months to 7.5 months). 22 (90%) united by 6 months. There were no cases of infection. No shortening in 10 cases. Less than 1 cm shortening in 9 cases and 3.2 cm shortening in one case was found. Proximal screw penetration was noted in one case (RT type II A) at the time of 3 months follow up. Conclusion: PFN is a safe, effective and patient friendly device useful for the treatment of all subtrochanteric fractures irrespective of their comminution. Early mobilization and rehabilitation is possible since it is a closed intramedullary procedure.

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“…Dear Editor, I have read the article "The benefit of wire cerclage stabilisation of the medial hinge in intramedullary nailing for the treatment of subtrochanteric femoral fractures: a biomechanical study" with the great interest [1]. In their article, the authors argue that osteosynthesis frequently fails and a higher rate of nonunion is found in the subtrochanteric region of the femur.…”

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confidence: 99%

“…In their article, the authors argue that osteosynthesis frequently fails and a higher rate of nonunion is found in the subtrochanteric region of the femur. As I understand from their article, this nonunion is due to fracture distraction (commonly seen after intramedullary nailing) in the subtrochanteric region, and they believe that supporting the medial column with cerclage wiring can resolve this problem [1]. They concluded that "a mini-open approach to difficult fractures could be helpful in reducing the fracture with a clamp and is sometimes essential.…”

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confidence: 99%

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Cerclage cable in fracture: frustration or necessity?

Cebesoy

Subaşı

Işık

2011

International Orthopaedics (SICOT)

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The benefit of wire cerclage stabilisation of the medial hinge in intramedullary nailing for the treatment of subtrochanteric femoral fractures: a biomechanical study

Abstract: Purpose Reduction and intramedullary fixation of subtrochanteric fractures is often challenging. Osteosynthesis frequently fails and a higher rate of non-unions is found.

Cited by 61 publications

References 22 publications

The outcome in early Cases of Treatment of Subtrochanteric Fractures with Proximal Femur locking Compression Plate

The outcome in early Cases of Treatment of Subtrochanteric Fractures with Proximal Femur locking Compression Plate

Functional outcome of comminuted unstable subtrochanteric fractures treated by proximal femoral nail [PFN]

Cerclage cable in fracture: frustration or necessity?

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