1
|
Van Nguyen L. Iatrogenic femoral artery injury due to cerclage wiring for diaphyseal femoral fracture: A case report and review the literature. Int J Surg Case Rep 2024; 119:109765. [PMID: 38759400 PMCID: PMC11127558 DOI: 10.1016/j.ijscr.2024.109765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE During femoral fracture osteosynthesis, the superficial femoral artery can be incarcerated in the cerclage wiring. We report a case that had an iatrogenic superficial femoral artery injury due to cerclage wiring during femoral osteosynthesis. CASE PRESENTATION I reported a 57-year-old patient presented with a fracture at the distal third of the left femur. He had undergone a femoral nailing and a cerclage wiring. Four hours postoperative, his left leg was colder, and his dorsalis pedis and posterior tibial pulse were absent. A CTA revealed his left superficial femoral artery entrapment by cerclage wire. After cerclage removal, the superficial femoral artery and vein had normal flow. The dorsalis pedis and posterior tibial pulse could be palpated. One day following, there was no compromising of blood flow, sensation, or motor-nerve function. CLINICAL DISCUSSION Cerclage wiring in the proximal half of the femur was less risk to the femoral artery than in the distal part. The SFA entrapment into a femoral cerclage wire requires an urgent diagnosis and treatment. A missed diagnosis could lead to necrosis of the lower extremity and even death. CONCLUSION Our case shows that the superficial femoral artery can be incarcerated in the cerclage wiring during osteosynthesis. Cerclage wiring in the proximal half of the femur was less risk to the femoral artery than in the distal part. We recommend using a suitable cerclage passer precautionary in any femur fracture, particularly in the distal third of the femur. LEVEL OF EVIDENCE A case report.
Collapse
Affiliation(s)
- Luong Van Nguyen
- Institute of Trauma and Orthopaedics, 108 Central Military Hospital, No. 01 Tran Hung Dao Street, Hanoi, Viet Nam.
| |
Collapse
|
2
|
Oh SH, Suh YS, Eghan-Acquah E, Yurevich KM, Won SH, Baek MJ, Lee SJ, Choi SW. Unstable Vancouver B1 periprosthetic femoral fracture fixation: A biomechanical comparison between a novel C-shaped memory alloy implant and cerclage wiring. J Int Med Res 2024; 52:3000605241240946. [PMID: 38534086 PMCID: PMC10981230 DOI: 10.1177/03000605241240946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/04/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND To compare the biomechanical stability of a novel, C-shaped nickel-titanium shape memory alloy (SMA) implant (C-clip) with traditional cerclage wiring in the fixation of a Vancouver B1 (VB1) periprosthetic femoral fracture (PFF). METHODS In total, 18 synthetic femoral fracture models were constructed to obtain unstable VB1 fracture with an oblique fracture line 8 cm below the lesser trochanter. For each model, the distal portion was repaired using a 10-hole locking plate and four distal bi-cortical screws. The proximal portion was repaired using either three, threaded cerclage wirings or three, novel C-shaped implants. Specimens underwent biomechanical testing using axial compression, torsional and four-point bending tests. Each test was performed on three specimens. RESULTS The C-clip was statistically significantly stronger (i.e., stiffer) than cerclage wiring in the three biomechanical tests. For axial compression, medians (ranges) were 39 (39-41) and 35 (35-35) N/mm, for the C-clip and cerclage wiring, respectively. For torsion, medians (ranges) were, 0.44 (0.44-0.45) and 0.30 (0.30-0.33) N/mm for the C-clip and cerclage wiring, respectively. For the four-point bending test, medians (ranges) were 39 (39-41) and 28 (28-31) N/mm; for the C-clip and cerclage wiring, respectively. CONCLUSION Results from this small study show that the novel, C-shaped SMA appears to be biomechanically superior to traditional cerclage wiring in terms of stiffness, axial compression, torsion and four-point bending, and may be a valuable alternative in the repair of VB1 PFF. Further research is necessary to support these results.
Collapse
Affiliation(s)
- Seog-Hyun Oh
- Department of Biomedical Engineering, Inje University, Gimhae, 50834, 197 Inje-ro, Gimhae-si, Gyeongsangnam-do, Republic of Korea
| | - Yu-Sung Suh
- Department of Orthopedic Surgery, Soonchunhyang University College of Medicine, Seoul, 04401, 59 Daesagwan-ro, Yongsan-gu, Seoul, Republic of Korea
| | - Emmanuel Eghan-Acquah
- Department of Biomedical Engineering, Inje University, Gimhae, 50834, 197 Inje-ro, Gimhae-si, Gyeongsangnam-do, Republic of Korea
| | - Kollerov Mikhail Yurevich
- Department of Materials Science and Materials Technology, Moscow Aviation Institute, 121552, Kom.1, Dom 5, Orshanskaya Str. Moscow, Russia
| | - Sung-Hun Won
- Department of Orthopedic Surgery, Soonchunhyang University College of Medicine, Seoul, 04401, 59 Daesagwan-ro, Yongsan-gu, Seoul, Republic of Korea
| | - Min Jung Baek
- Department of Obstetrics and Gynecology, Bundang CHA Hospital, Seongnam, 13496, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Sung-Jae Lee
- Department of Biomedical Engineering, Inje University, Gimhae, 50834, 197 Inje-ro, Gimhae-si, Gyeongsangnam-do, Republic of Korea
| | - Sung-Woo Choi
- Department of Orthopedic Surgery, Soonchunhyang University College of Medicine, Seoul, 04401, 59 Daesagwan-ro, Yongsan-gu, Seoul, Republic of Korea
| |
Collapse
|
3
|
Tao X, Yang Q. Use of minimally invasive cerclage wiring for displaced major fragments of femoral shaft fractures after intramedullary nailing promotes bone union and a functional outcome. J Orthop Surg Res 2022; 17:533. [PMID: 36503506 PMCID: PMC9743699 DOI: 10.1186/s13018-022-03439-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Femoral shaft fractures caused by high energy trauma can be very challenging due to the large variability in fracture morphology and poor functional outcomes. Displaced major fragments of femoral shaft fractures are difficult to manage after closed reduction and intramedullary nailing (IMN). The minimally invasive cerclage wiring (CW) procedure has become an optimal tool for major fragment resetting and stabilization after IMN. However, arguments continue for the potential risk of arterial injury, blood supply disruption, and delayed bone union or non-union with the CW procedure. The surgical algorithm for treating femoral shaft fractures with displaced major fragments remains controversial. Thus, emphasis is placed on whether the CW procedure can promote the bone union rate and improve functional outcomes without significant complications. METHODS We performed a retrospective study on all patients of femoral shaft fractures with displaced major fragments between June 2015 and August 2019 in our trauma centre. Eligible patients were included and stratified into the CW group and IMN group. Demographics, radiological data, callus formation, union time, and functional outcomes were critically compared between the two groups. RESULTS Thirty-seven patients were included in the present study according to our inclusion/exclusion criteria, of whom 16 (43.2%) were stratified into the CW group, and 21 (56.8%) into the IMN group. The modified radiographic union score for femorae (mRUSH) in the CW group and IMN group was significantly different (11.94 ± 1.29 vs. 7.95 ± 0.74, 6 months; 15.88 ± 0.50 vs. 10.33 ± 0.91, 12 months) (p < 0.0001). The mean union time was significantly different between the CW and IMN groups (7.9 ± 3.2 months vs. 20.1 ± 8.48 months) (p < 0.0001). Bone union at 12 months differed significantly between the CW and IMN groups (15 vs. 5) (p < 0.05). The Harris Hip Score in the CW group was significantly higher than that in the IMN group (88.19 ± 4.69 vs. 76.81 ± 5.26, 12 months; 93.19 ± 4.68 vs. 87.57 ± 5.38, 24 months) (p < 0.01). The Hospital for Special Surgery Knee Score was significantly different between the CW and IMN groups (78.50 ± 5.65 vs. 67.71 ± 4.65, 12 months; 89.50 ± 5.05 vs. 75.81 ± 8.90, 24 months) (p < 0.0001). CONCLUSIONS Minimally invasive CW is an optimal supplement for IMN in the treatment of femoral shaft fractures with displaced major fragments. As illustrated, the benefits of CW potentially include promotion of the bone union rate and improvement in functional outcomes.
Collapse
Affiliation(s)
- Xingguang Tao
- grid.413087.90000 0004 1755 3939Department of Orthopedics, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Qingpu District Central Hospital Shanghai, No. 1158, East Gongyuan Road, Qingpu District, 201700 Shanghai, People’s Republic of China
| | - Qing Yang
- grid.413087.90000 0004 1755 3939Department of Orthopedics, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Qingpu District Central Hospital Shanghai, No. 1158, East Gongyuan Road, Qingpu District, 201700 Shanghai, People’s Republic of China
| |
Collapse
|
4
|
Schopper C, Luger M, Hipmair G, Schauer B, Gotterbarm T, Klasan A. The race for the classification of proximal periprosthetic femoral fractures : Vancouver vs Unified Classification System (UCS) - a systematic review. BMC Musculoskelet Disord 2022; 23:280. [PMID: 35321671 PMCID: PMC8944079 DOI: 10.1186/s12891-022-05240-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Periprosthetic femoral fractures (PFFs) represent a major cause for surgical revision after hip arthroplasty with detrimental consequences for patients. The Vancouver classification has been traditionally used since its introduction in 1995. The Unified Classification System (UCS) was described in 2014, to widen the spectrum by aiming for a more comprehensive approach. The UCS also aimed to replace the Vancouver classification by expanding the idea of the Vancouver classification to the whole musculoskeletal apparatus. After introduction of the UCS, the question was raised, whether the UCS found its place in the field of analysing PFFs. Therefore, this systematic review was performed to investigate, the use of the UCS compared to the established Vancouver classification. Methods Medline was searched for reports published between 1 January 2016 and 31 November 2020, without language restriction. Included were original articles, irrespective of the level of evidence and case reports reporting on a PFF and using either the Vancouver or the UCS to classify the fractures. Excluded were reviews and systematic reviews. Results One hundred forty-six studies were included in the analysis. UCS has not been used in a single registry study, giving a pooled cohort size of 3299 patients, compared to 59,178 patients in studies using the Vancouver classification. Since 2016, one study using UCS was published in a top journal, compared to 37 studies using the Vancouver classification (p=0.29). During the study period, the number of yearly publications remained stagnant (p=0.899). Conclusions Despite valuable improvement and expansion of the latter UCS, to date, the Vancouver system clearly leads the field of classifying PFFs in the sense of the common use. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05240-w.
Collapse
Affiliation(s)
- Clemens Schopper
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| | - Matthias Luger
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria.
| | - Günter Hipmair
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| | - Bernhard Schauer
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| | - Antonio Klasan
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| |
Collapse
|
5
|
Nakamura Y, Tada K, Murai A, Tsuchiya H. Iatrogenic sciatic nerve injury due to cerclage wiring for proximal periprosthetic femoral fracture: A rare case report. JPRAS Open 2022; 32:54-60. [PMID: 35309281 PMCID: PMC8924316 DOI: 10.1016/j.jpra.2022.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022] Open
Abstract
Cerclage wiring is used to reinforce the stability of fractures and optimize plate fixations for femoral fractures such as periprosthetic fractures. However, cerclage wiring requires attention to neurovascular structures to prevent injuries. We have presented a case of iatrogenic sciatic nerve injury after osteosynthesis with cerclage wiring. A 71-year-old woman underwent osteosynthesis with cerclage wiring for a proximal periprosthetic femoral fracture. Immediately after the operation, the patient developed motor and sensory disorders, particularly in the sciatic nerve area, leading to a suspicion of nerve injury. Consequently, reoperation showed that the right sciatic nerve was strangulated by the cerclage wire, but the nerve was functional. Since the sciatic nerve was partially continuous and retained sensation to some extent, strangulation release was performed. Subsequently, both sensory and motor disorders improved. This case suggests that attention should be given to not only the blood vessels in the anterior region but also the sciatic nerve in the posterior region when performing cerclage wiring for femoral fractures.
Collapse
|
6
|
Buso C, Zanini P, Titotto S. Bioinspired design proposal for a new external bone fixator device. Biomed Phys Eng Express 2022; 8. [PMID: 35100569 DOI: 10.1088/2057-1976/ac5092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/31/2022] [Indexed: 11/11/2022]
Abstract
The article presents a new medical device through an authorial and interdisciplinary approach. It consists of a flexible external fixator, whose flexible property may bring advantages over rigid mechanisms. Its design was inspired by the DNA biological mechanism of condensation, while the modeling was based on the pseudo-rigid modeling technique. From the models obtained, this study conducted prototyping and computational tests to obtain a proof-of-concept of the bioinspired theory and dynamic functioning effectiveness. The prototyping relied on hot glue manufacturing and the computational simulations consisted of linear static analysis. The experimental analysis concluded that the prototype with fewer beams and thinner beams delivered better results in all three parameters: flexibility, height variation and rotation arc. In the computational analysis, among the design models with the variation of the number of beams, the model with 8 beams performed better. Concerning thickness variation, the one whose beams measured 8mm in thickness showed better results. Among the models with length variation, the design made with 100 mm long beams better equilibrated the parameters.
Collapse
Affiliation(s)
- Carla Buso
- 4D Printing and Biomimetics (4DB) Research Group, Universidade Federal do ABC, Av. dos Estados, 5001 - Bangú, Santo Andre, SP, 09210-170, BRAZIL
| | - Plinio Zanini
- 4D Printing and Biomimetics (4DB) Research Group, Universidade Federal do ABC, Av. dos Estados, 5001 - Bangú, Santo Andre, SP, 09210-170, BRAZIL
| | - Silvia Titotto
- 4D Printing and Biomimetics (4DB) Research Group, Universidade Federal do ABC, Av. dos Estados, 5001 - Bangú, Santo Andre, 09210-170, BRAZIL
| |
Collapse
|
7
|
Fixation of intraoperative proximal femoral fractures during THA using two versus three cerclage wires - a biomechanical study. BMC Musculoskelet Disord 2022; 23:40. [PMID: 34996409 PMCID: PMC8742345 DOI: 10.1186/s12891-021-04956-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 12/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Intraoperative proximal femoral fractures (IPFF) are relevant complications during total hip arthroplasty. Fixation using cerclage wires (CW) represents a minimally-invasive technique to address these fractures through the same surgical approach. The goal of treatment is to mobilise the patient as early as possible, which requires high primary stability. This study aimed to compare different cerclage wire configurations fixing IPFF with regard to biomechanical primary stability. Methods Standardised IPFF (type II, Modified Mallory Classification) were created in human fresh frozen femora and were fixed either by two or three CW (1.6 mm, stainless steel). All cadaveric specimens (n = 42) were randomised to different groups (quasi-static, dynamic) or subgroups (2 CW, 3 CW) stratified by bone mineral density determined by Dual Energy X-ray Absorptiometry. Using a biomechanical testing setup, quasi-static and dynamic cyclic failure tests were carried out. Cyclic loading started from 200 N to 500 N at 1 Hz with increasing peak load by 250 N every 100 cycles until failure occurred or maximum load (5250 N) reached. The change of fracture gap size was optically captured. Results No significant differences in failure load after quasi-static (p = 0.701) or dynamic cyclic loading (p = 0.132) were found between the experimental groups. In the quasi-static load testing, all constructs resisted 250% of the body weight (BW) of their corresponding body donor. In the dynamic cyclic load testing, all but one construct (treated by 3 CW) resisted 250% BW. Conclusions Based on this in vitro data, both two and three CW provided sufficient primary stability according to the predefined minimum failure load (250% BW) to resist. The authors recommend the treatment using two CW because it reduces the risk of vascular injury and shortens procedure time. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04956-5.
Collapse
|
8
|
Camacho-Carrasco P, Renau-Cerrillo M, Campuzano-Bitterling B, Martinez-de-la-Mata J, Vives-Barquiel M. A modified cable wiring technique with C-shaped passer through a mini-open approach to assist reduction in femoral fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1407-1413. [PMID: 34532756 DOI: 10.1007/s00590-021-03119-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/07/2021] [Indexed: 11/26/2022]
Abstract
Femur fractures reduction can be technically challenging due to the deforming forces exerted by the muscles causing displacement of the fracture fragments. Cerclage wiring is one of the reduction techniques frequently performed, allowing anatomical reduction of the fragments and a more stable fixation when an accurate closed reduction is not possible. We describe a modified cerclage wiring through a minimally invasive technique, using a conventional cannulated C-shaped passer.
Collapse
Affiliation(s)
- Pilar Camacho-Carrasco
- Orthopaedic and Traumatology Department, Hospital Clínic de Barcelona, Calle Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Marina Renau-Cerrillo
- Orthopaedic and Traumatology Department, Hospital Clínic de Barcelona, Calle Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Borja Campuzano-Bitterling
- Orthopaedic and Traumatology Department, Hospital Clínic de Barcelona, Calle Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | | | - Marian Vives-Barquiel
- Orthopaedic and Traumatology Department, Hospital Clínic de Barcelona, Calle Villarroel 170, 08036, Barcelona, Catalonia, Spain.
| |
Collapse
|
9
|
Wang TH, Chuang HC, Kuan FC, Hong CK, Yeh ML, Su WR, Hsu KL. Role of open cerclage wiring in patients with comminuted fractures of the femoral shaft treated with intramedullary nails. J Orthop Surg Res 2021; 16:480. [PMID: 34364374 PMCID: PMC8348994 DOI: 10.1186/s13018-021-02633-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/24/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction The role of open cerclage wiring in comminuted femoral shaft fracture treatment with intramedullary nails remains unclear. Here, we analyzed the effect of open cerclage wiring and the risk factors for nonunion after interlocking nailing in comminuted femoral shaft fracture treatment. We hypothesized that open cerclage wiring can be applied in patients with severe comminuted femoral shaft fractures without affecting bone healing. Patients and methods This retrospective cohort study used data from consecutive patients who underwent interlocking nail fixation of a comminuted femoral shaft fracture between January 1, 2009, and December 31, 2016. First, eligible patients were divided into the wire and no wire groups according to the surgical technique used, and their union rate was recorded. The patients were then divided into the union and nonunion groups, and their perioperative data were analyzed. Results In total, 71 comminuted femoral shaft fractures treated with interlocking nail fixation were included: 38 fractures (53.5%) augmented with the open wiring technique and 33 reduced with closed or mini-open techniques without wiring. The wire group demonstrated significant improvements in fracture reduction compared with the no wire group, whereas no significant difference was observed in the union rate between the wire and no wire groups (p = 0.180). Moreover, 46 (65%) of 71 fractures achieved union smoothly, and no significant difference was observed in any perioperative data between the union and nonunion groups. Discussion Augmentation with open cerclage wiring is indicated for comminuted femoral shaft fractures treated with intramedullary nails, even when the fragments are large or greatly displaced. Thus, open cerclage wiring can be used for fracture treatment without decreasing the union rate.
Collapse
Affiliation(s)
- Tzu-Hao Wang
- Department of Orthopaedics, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan, R.O.C.,Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, R.O.C.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung, Tainan, Taiwan, R.O.C
| | - Hao-Chun Chuang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, R.O.C.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung, Tainan, Taiwan, R.O.C
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, R.O.C.,Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan, R.O.C.,Division of Traumatology, National Cheng Kung University Medical Center, Tainan, Taiwan, R.O.C.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung, Tainan, Taiwan, R.O.C
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, R.O.C.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung, Tainan, Taiwan, R.O.C
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan, R.O.C
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, R.O.C.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung, Tainan, Taiwan, R.O.C
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, R.O.C.. .,Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan, R.O.C.. .,Division of Traumatology, National Cheng Kung University Medical Center, Tainan, Taiwan, R.O.C.. .,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung, Tainan, Taiwan, R.O.C..
| |
Collapse
|
10
|
Surgical outcomes of minimally invasive cerclage clamping technique using a pointed reduction clamp for reduction of nonisthmal femoral shaft fractures. Injury 2021; 52:1897-1902. [PMID: 33867151 DOI: 10.1016/j.injury.2021.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND We modified the general application method of the pointed reduction clamp, focusing on the function of encompassing the fracture site, and applied it to femoral shaft fractures. The purpose of the present study is to describe the minimally invasive cerclage clamping technique (MICC) and compare radiological and clinical results of MICC with that of percutaneous cerclage wiring (PCW). MATERIALS AND METHODS A retrospective comparative study was performed in two institutions from 2010 to 2019. Patients aged ≥18 years with acute femoral shaft fractures that were treated with intramedullary nailing and reduced using MICC or PCW were included. Patients with open fractures, atypical fractures, and follow-up less than 12 months were excluded. A total of 68 patients were finally included and divided into two groups based on the reduction technique each patient underwent. We then compared radiological and clinical results between the two groups, including coronal and sagittal alignment, time for union, and complications. RESULTS The average time needed for the technique in the MICC group was shorter than that in the PCW group (7.1±4.6 min vs. 11.5±4.8 min, P < 0.001). There was no significant difference in the quality of reduction or alignment between the two groups. The mean union time was not different between the two groups (24.1±8.7 weeks vs. 24.1±8.6 weeks, P = 0.990). The MICC group had one nonunion patient and the PCW group had one postoperative infection patient. There were no cases of major neurovascular injury such as femoral artery injury or sciatic nerve palsy. CONCLUSIONS MICC, using a pointed reduction clamp for nonisthmal femoral shaft fractures, demonstrated satisfactory reduction and favorable surgical outcomes with intramedullary nailing. We believe that MICC can be a reliable and safe reduction method for femoral shaft fractures.
Collapse
|
11
|
Anthropometric Factors on Safe Distances between Popliteal Vessels to the Femur for Cerclage Wiring of the Distal Femoral Fracture: A Magnetic Resonance Imaging Study. ACTA ACUST UNITED AC 2020; 56:medicina56120655. [PMID: 33260736 PMCID: PMC7761162 DOI: 10.3390/medicina56120655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/16/2020] [Accepted: 11/26/2020] [Indexed: 11/23/2022]
Abstract
Background and Objectives: The proximity of the popliteal vessels in the distal femur may increase the risk of iatrogenic vascular injury during cerclage wiring. In this study, the closest location and distance of the popliteal vessels to the femur was examined using magnetic resonance imaging (MRI). The associations between anthropometric factors and the distance that would guide the placement of wires safely during surgery were also identified. Materials and Methods: We reviewed adult knee magnetic resonance images and recorded: (1) the relation and the shortest horizontal distance (d-H) from the femoral cortex to the popliteal vessels in axial images and (2) the vertical distance (d-V) from the adductor tubercle to the axial level of the d-H values in coronal images. The effects of anthropometric factors (sex, age, body height, body weight, body mass index, thigh circumference, femoral length and femoral width) on these distances were analysed. Results: Analysis of 206 knee magnetic resonance images revealed that the closet locations of popliteal vessels were at the posteromedial aspect of the femur. The d-H and d-V were 7.38 ± 3.22 mm and 57.01 ± 11.14 mm, respectively, and were both shorter in women than in men (p < 0.001). Multivariate analysis identified thigh circumference and femoral length as the most influential factors for the d-H and d-V, respectively (p < 0.001). Linear regression demonstrated a strong positive linear correlation between the thigh circumference and the d-H and between the femoral length and the d-V (Pearson’s r = 0.891 and 0.806, respectively (p < 0.001)). Conclusions: The closet location and distance of the popliteal vessels to the femur provide useful information for wire placement during distal femoral fracture surgery while minimising the risk of vascular injury. Given that patients with a smaller thigh circumference and a shorter femoral length are more likely to have a smaller d-H and a shorter d-V, respectively, cautious measures should be taken in such cases.
Collapse
|
12
|
Surgical outcomes of simple distal femur fractures in elderly patients treated with the minimally invasive plate osteosynthesis technique: can percutaneous cerclage wiring reduce the fracture healing time? Arch Orthop Trauma Surg 2020; 140:1403-1412. [PMID: 32108255 DOI: 10.1007/s00402-020-03385-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Achieving adequate reduction is difficult when performing minimally invasive plate osteosynthesis (MIPO) in elderly patients with simple distal femur fracture. This study aimed to evaluate the elderly patients who had undergone percutaneous wiring-assisted reduction with MIPO for simple distal femur fractures to determine the effect of this technique on reduction quality and fracture union. MATERIALS AND METHODS Between January 2009 and September 2017, 56 patients (56 femurs) with displaced simple distal femur fractures treated with MIPO at three trauma centers were finally enrolled. The MIPO technique with percutaneous cerclage wire reduction was performed in 25 patients (Group A). Among them, 12 patients had a simple spiral metaphyseal fracture (Group A*). In comparison, MIPO without percutaneous cerclage wire reduction was performed in 31 patients (Group B). Among them, seven patients had a simple spiral metaphyseal fracture (Group B*). Medical records containing surgical records were retrospectively reviewed to investigate demographic data, comorbidities, complications, operative time, and fluoroscopic time. Radiographs were evaluated for assessing the quality of the reduction and fracture union. RESULTS The mean fracture union time of Group A* was 21.7 weeks, which was significantly shorter than that of Group B* (28.6 weeks). The mean coronal and sagittal angulation in Group A* was 0.6° and 0.7°, respectively, which were significantly lesser than those in Group B* (2.4° and 3.2°, respectively). Mean translation in Group A* was 1.43 mm, which was significantly shorter than that in Group B* (3.81 mm). Nonunion occurred in two patients in Group B. CONCLUSION Surgical treatment of simple spiral distal femur fractures with percutaneous cerclage wiring-assisted reduction and the MIPO technique in elderly patients resulted in better reduction and faster union time. Therefore, this technique could be a good solution if used in accordance with the indication.
Collapse
|
13
|
Does auxiliary cerclage wiring provide intrinsic stability in cephalomedullary nailing of trochanteric and subtrochanteric fractures? INTERNATIONAL ORTHOPAEDICS 2020; 45:1329-1336. [PMID: 32918572 PMCID: PMC8102450 DOI: 10.1007/s00264-020-04795-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/01/2020] [Indexed: 12/28/2022]
Abstract
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 women and 105 men) with the diagnosis of AO/OTA A1 to A3 fractures were included. The mean age of patients was 76.4 ± 15.6 years. According to the AO/OTA classification, 72 A1 fractures, 124 A2 fractures, and 64 A3 fractures were found. In 72 patients with auxiliary cerclage wiring three A1 fractures, 27 A2 fractures and 42 A3 fractures were assessed. 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). 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). 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 especially in comminuted trochanteric and subtrochanteric fractures. Trial registration number DRKS00020550, 01/30/2020, retrospectively registered.
Collapse
|
14
|
Panagopoulos A, Lachanas I, Kouzelis A, Kokkalis ZT, Tyllianakis M. Neurovascular Bundle Entrapment and Through Knee Amputation After Cerclage Cabling of Distal Femoral Peri-implant Fracture: A Case Report. JBJS Case Connect 2020; 10:e0194. [PMID: 32224654 DOI: 10.2106/jbjs.cc.19.00194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report the case of an 82-year-old woman with diabetes, arteriosclerosis, chronic heart failure, and hypertension treated with an anatomical locking plate and multiple cables for a spiral-wedged periprosthetic fracture of the distal femur which was complicated by direct occlusion of the femoral artery and crush of the sciatic nerve, resulting in leg necrosis and, ultimately, through-knee disarticulation despite early recognition and arterial repair. CONCLUSIONS Neurovascular injury is a potential complication of cerclage cables placement around the femoral shaft during complex fracture fixation. Devastating complications cannot always be corrected despite early vascular intervention.
Collapse
Affiliation(s)
- Andreas Panagopoulos
- Department of Orthopaedics, University Hospital, Patras Medical School, Patras, Greece
| | - Ioannis Lachanas
- Department of Orthopaedics, General Army Hospital of Athens, Patras, Greece
| | - Antonis Kouzelis
- Department of Orthopaedics, University Hospital, Patras Medical School, Patras, Greece
| | - Zinon T Kokkalis
- Department of Orthopaedics, University Hospital, Patras Medical School, Patras, Greece
| | - Minos Tyllianakis
- Department of Orthopaedics, University Hospital, Patras Medical School, Patras, Greece
| |
Collapse
|