Cerclage wires or cables for the management of intraoperative fracture associated with a cementless, tapered femoral prosthesis: results at 2 to 16 years.
ABSTRACT Initial stability is critical for fixation and survival of cementless total hip arthroplasty. Occasionally, a split of the calcar occurs intraoperatively. A review of 1,320 primary total hip arthroplasties with 2-year follow-up, performed between August 1985 and February 2001 using the Mallory-Head Porous tapered femoral component, revealed 58 hips in 55 patients with an intraoperative calcar fracture managed with single or multiple cerclage wires or cables and immediate full weight bearing. At 7.5 years average follow-up (range, 2-16 years), there were no revisions of the femoral component, radiographic failures, or patients with severe thigh pain, for a stem survival rate of 100%. Average Harris hip score improvement was 33.8 points. Fracture of the proximal femur occurs in approximately 4% of primary THAs using the Mallory-Head Porous femoral component. When managed intraoperatively with cerclage wire or cable, the mid- to long-term results appear unaffected with 100% femoral component survival at up to 16 years.
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ABSTRACT: The purpose of this study was to review the survivorship, radiologic and clinical outcomes of reverse shoulder arthroplasty (RSA) used for the treatment of 3-part and 4-part proximal humeral fractures in the elderly.Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 08/2014; · 1.93 Impact Factor
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ABSTRACT: Introduction We describe percutaneous cerclage wiring and minimally invasive plate osteosynthesis (MIPO) for periprosthetic femoral shaft fractures. Step 1: Preoperative Planning and Assessment of the Length, Alignment, and Rotation of the Extremity A well-developed preoperative plan and assessment of the length, alignment, and rotation of the extremity are critical. Step 2: Prepare the Tunnel After making the appropriate incision, use the tunneling device anterior and posterior to the femur to create a soft-tissue tunnel. Step 3: Insert and Connect the Cerclage Passer Insert the cerclage passer carefully by keeping it in close contact with the bone. Step 4: Insert the Cerclage Wire and Remove the Wire Passer The cerclage wire may be incrementally inserted according to the direction on the passer to prevent kinking. Step 5: Place and Fix the Submuscular Plate Verify the alignment and length of the plate with intraoperative images and precontour the plate to fit the lateral aspect of the femur as necessary. Step 6: Closure and Postoperative Rehabilitation Encourage an immediate range of motion to aid in postoperative recovery. Results In our original study, ten patients with a Vancouver type-B1 periprosthetic femoral shaft fracture (mean age, seventy-four years; range, forty-seven to eighty-four years) were treated with the described percutaneous cerclage wire and MIPO techniques. Indications Contraindications Pitfalls & ChallengesJBJS Essent Surg Tech. 07/2014; 4(3):e13.
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ABSTRACT: Objective: To compare the in vitro biomechanical effects of single loop cerclage wires, intramedullary pin and the combination thereof as applied to an oblique mid-diaphyseal osteotomy of canine tibiae. Methods: Three groups of nine bones with long oblique osteotomies were repaired with the following methods: 1) Three single loop cerclage wires and a transcortical skewer pin, 2) intramedullary pinning with a smooth Steinmann pin, and 3) a combination of both methods. The repaired constructs were tested in a single cycle four-point-bending test to failure. Load displacement curves were drawn and the following parameters were calculated or extrapolated: Stiffness, load at yield, and force resisted at 2 mm actuator displacement. The latter was determined to demonstrate the difference in the amount of energy absorbed between the different groups. Results: The stiffness and force resisted at 2 mm displacement of the groups with cerclage wires were significantly higher than the group with an intramedullary pin alone (p ≤0.05). The differences in stiffness (p = 0.15) and force required at 2 mm displacement (p = 0.56) between cerclage wires and the combination of cerclage wires and intramedullary pins were not significant. Clinical relevance: Cerclage wire repair results in higher stiffness than repair with an intramedullary pin. When cerclage wires are combined with an intramedullary pin, the intramedullary pin does not provide protection to the cerclage wire repair and the wires or the bone under the wires has to fail before the pin resists significant load.Veterinary and Comparative Orthopaedics and Traumatology 12/2013; 27(2). · 1.03 Impact Factor