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Published in: European Journal of Orthopaedic Surgery & Traumatology 4/2023

Open Access 21-03-2022 | General Review

The role of cerclage wiring in the management of subtrochanteric and reverse oblique intertrochanteric fractures: a meta-analysis of comparative studies

Authors: Ashraf T. Hantouly, Motasem Salameh, Ahmad A. Toubasi, Loay A. Salman, Osama Alzobi, Abdulaziz F. Ahmed, Ghalib Ahmed

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 4/2023

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Abstract

Purpose

Subtrochanteric and reverse oblique intertrochanteric fractures are challenging and often difficult to reduce. While intramedullary nailing (IMN) is considered the standard treatment, achieving anatomic reduction prior to fixation is essential. This study aimed to assess the impact of cerclage wiring with IMN on the outcomes and complication rate in treating subtrochanteric and reverse oblique intertrochanteric fractures.

Methods

This meta-analysis was conducted in line with PRISMA guidelines. The primary outcome was the time to union. The secondary outcomes were operative time, blood loss, quality of reduction, reduction alignment (if in varus), complications and reoperations. PubMed, Cochrane, Web of Science and Google Scholar were searched till July 2021. Articles that compared intramedullary nailing (IMN) versus intramedullary nailing and cerclage wiring (IMN-C) in the treatment of subtrochanteric and reverse oblique intertrochanteric fractures were included. The risk of bias was assessed using the Newcastle–Ottawa scale.

Results

This meta-analysis included 415 patients with subtrochanteric and reverse oblique intertrochanteric fracture from six comparative studies. Our findings showed that IMN-C was significantly associated with higher mean duration of surgery and blood loss. However, IMN-C had significantly lower mean time to union compared to IMN alone. In addition, IMN-C had lower pooled prevalence of varus reduction and overall complications.

Conclusion

This study showed that the use of cerclage wiring is associated with lower time to union, lower prevalence of varus reduction and overall complications. Therefore, cerclage wiring augmentation is a safe technique with low complication rate and may be advised whenever open reduction is needed in the management of subtrochanteric and reverse oblique intertrochanteric fractures.
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Literature
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go back to reference Codesido P, Mejía A, Riego J, Ojeda-Thies C (2017) Subtrochanteric fractures in elderly people treated with intramedullary fixation: quality of life and complications following open reduction and cerclage wiring versus closed reduction. Arch Orthop Trauma Surg 37(8):1077–1085. https://doi.org/10.1007/s00402-017-2722-yCrossRef Codesido P, Mejía A, Riego J, Ojeda-Thies C (2017) Subtrochanteric fractures in elderly people treated with intramedullary fixation: quality of life and complications following open reduction and cerclage wiring versus closed reduction. Arch Orthop Trauma Surg 37(8):1077–1085. https://​doi.​org/​10.​1007/​s00402-017-2722-yCrossRef
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go back to reference Wähnert D, Lenz M, Schlegel U, Perren S, Windolf M (2011) Cerclage handling for improved fracture treatment. A biomechanical study on the twisting procedure. Acta Chir Orthop ET Traumatol Cechoslov 78(3):208–214 Wähnert D, Lenz M, Schlegel U, Perren S, Windolf M (2011) Cerclage handling for improved fracture treatment. A biomechanical study on the twisting procedure. Acta Chir Orthop ET Traumatol Cechoslov 78(3):208–214
Metadata
Title
The role of cerclage wiring in the management of subtrochanteric and reverse oblique intertrochanteric fractures: a meta-analysis of comparative studies
Authors
Ashraf T. Hantouly
Motasem Salameh
Ahmad A. Toubasi
Loay A. Salman
Osama Alzobi
Abdulaziz F. Ahmed
Ghalib Ahmed
Publication date
21-03-2022
Publisher
Springer Paris
Published in
European Journal of Orthopaedic Surgery & Traumatology / Issue 4/2023
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-022-03240-z

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