Does Cerclage wiring with Intramedullary Nailing in  Subtrochanteric Fractures Improve the Final Outcome?

Authors

Rajendra Annappa1 , Surendra Umesh Kamath2 , Sunil Lakshmipura Krishnamurthy3, Sharan Mallya4 , Krithika Kamath5 , Pooja Kundapur Suresh6

Subtrochanteric fractures, cerclage wiring, complications of subtrochanteric fractures

Treatment of subtrochanteric fractures is challenging due to anatomical and biomechanical factors. Many

methods have been suggested to achieve and maintain fracture reduction during operative fixation for

subtrochanteric fractures. Open reduction and intramedullary fixation, clamp assisted reduction without

cerclage wires and fracture reduction cables are suggested methods. We conducted a retrospective study

to look for the results of subtrochanteric fractures managed by intramedullary fixation with or without

cerclage wires. We reviewed all cases of subtrochanteric fractures operated with intramedullary fixation with

long proximal femoral nail with or without cerclage wire fixation. All available data from patient’s records

available in medical records department were retrieved and evaluated. Statistical analysis were performed

using SPSS software (v16). There were 86 cases of subtrochanteric fractures operated with intramedullary

fixation at our Hospitals over a period of 5 years. Quality of fracture reduction of fractures are assessed good

reduction was seen more often in cerclage group 64%. Cerclage wiring was done in 14 cases. Nonunion was

seen in 8 cases overall, 3 in cerclage group and 5 in non Cerclage group. Implant failure was seen in 3 cases

in no cerclage group and 2 cases of cerclage group. We conclude that anatomical reduction is the key factor

for successful outcomes. Closed reduction with good to acceptable reduction had better results. Cerclage

wiring should be considered in selected cases where reduction is poor after open reduction.

1 Associate Professor, 2Professor and Head, 3Senior Resident,4Assistant Professor, 5Medical student, Department

of Orthopaedics, 6 Associate Professor, Department of Pathology, Kasturba Medical College, Mangalore, Manipal

Academy of Higher Education, Manipal, India