Does auxillary cerclage wiring result in more complications?

Abstract text (incl. references and figure legends)

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 w105 m) with the diagnosis of AOA1 to A3 fractures were included. The mean age of patients was 76.4 ± 15.6 years. The complications in the cerclage patients resulted in no vascular injuries and only three surgical revisions. Once in the sense of a postoperative torsional deviation, once in the seroma and once in the case of a postoperative hematoma. Prolonged dissection without the need for intervention was described in six other patients. 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).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). The intra- and postoperative complications with and without the use of auxillary cerclages were determined on the basis of X-rays and patient data (reports, ward entries). 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.

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