Supplemental cerclage wiring in angle stable plate fixation of distal tibial spiral fractures enables immediate post-ope
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ORIGINAL ARTICLE
Supplemental cerclage wiring in angle stable plate fixation of distal tibial spiral fractures enables immediate post‑operative full weight‑bearing: a biomechanical analysis Sabrina Sandriesser1,2 · Stefan Förch3 · Edgar Mayr3 · Falk Schrödl4 · Christian von Rüden1,2,5 · Peter Augat1,2 Received: 20 July 2020 / Accepted: 15 September 2020 © The Author(s) 2020
Abstract Purpose Distal tibial fractures generally require post-operative weight-bearing restrictions. Especially geriatric patients are unable to follow these recommendations. To increase post-operative implant stability and enable early weight-bearing, augmentation of the primary osteosynthesis by cerclage is desirable. The purpose of this study was to identify the stabilizing effects of a supplemental cable cerclage following plate fixation of distal tibial spiral fractures compared to solitary plate osteosynthesis. Methods In eight synthetic tibiae, a reproducible spiral fracture (AO/OTA 42-A1.1c) was stabilized by angle stable plate fixation. Each specimen was statically loaded under combined axial and torsional loads to simulate partial (200 N, 2 Nm) and full (750 N, 7 Nm) weight-bearing. Tests were repeated with supplemental cable cerclage looped around the fracture zone. In a subsequent stepwise increased dynamic load scenario, construct stiffness and interfragmentary movements were analyzed. Results With supplemental cable cerclage, construct stiffness almost tripled compared to solitary plate osteosynthesis (2882 ± 739 N/mm vs. 983 ± 355 N/mm; p
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