Does auxiliary cerclage wiring provide intrinsic stability in cephalomedullary nailing of trochanteric and subtrochanter
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ORIGINAL PAPER
Does auxiliary cerclage wiring provide intrinsic stability in cephalomedullary nailing of trochanteric and subtrochanteric fractures? Julia Rehme 1 & Alexander Woltmann 1 & Andreas Brand 2,3 & Christian von Rüden 1,2,3 Received: 18 June 2020 / Accepted: 1 September 2020 # The Author(s) 2020
Abstract Purpose The aim of this study was to assess functional and radiological results following cephalomedullary nailing with and without use of auxiliary cable cerclages in a large series of trochanteric and subtrochanteric femoral fractures. Methods In a retrospective study of prospectively collected data between January 2014 and March 2019, a total of 260 consecutive patients (155 women and 105 men) with the diagnosis of AO/OTA A1 to A3 fractures were included. The mean age of patients was 76.4 ± 15.6 years. According to the AO/OTA classification, 72 A1 fractures, 124 A2 fractures, and 64 A3 fractures were found. In 72 patients with auxiliary cerclage wiring three A1 fractures, 27 A2 fractures and 42 A3 fractures were assessed. In the patient group with auxiliary cerclages, fracture healing according to the Radiographic Union Score for Hip (RUSH) within one year after surgery was assessed in 68 out of 72 patients (healing rate 94%). The mean RUSH in the group with cerclages was 28.7 ± 2.2 points and was 28.5 ± 2.2 points in the group without cerclages (p = 0.72). In 91 patients available for a complete follow-up, mean functional outcome according to the Lower Extremity Functional Scale (LEFS) was 65.3 ± 17.2 points in the group with cerclages versus 58.4 ± 21 points in the group without cerclages (p = 0.04). Conclusion The additional use of cerclages provides intrinsic stability and enables axial alignment and medial cortical support during anatomical fracture reduction and cephalomedullary nail insertion. In the current study, this technique resulted in significantly better functional long-term outcomes than without cerclages. Therefore, it can be recommended as a useful supportive tool especially in comminuted trochanteric and subtrochanteric fractures. Trial registration number DRKS00020550, 01/30/ 2020, retrospectively registered. Keywords Trochanteric fracture . Cephalomedullary nail . Cable cerclage wiring . LEFS . RUSH . Intrinsic stability . Long-term outcome
Introduction The proximal femoral fracture is a typical injury to the elderly [1]. A fracture can be demonstrated with increasing age, especially following minor trauma [2, 3]. Due to the demographic change, an increasing incidence of these fractures may be * Christian von Rüden [email protected] 1
Department of Trauma Surgery, BG Unfallklinik Murnau, Professor Küntscher Str. 8, 82418 Murnau, Germany
2
Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
3
Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
expected in the future. Basically, trochanteric fractures include two-fragment Arbeitsgemeinschaft für Osteosynthesefragen (AO)/Orthopaedic Trauma Association (OTA) type 31 A1 f
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