title: Combination of low-contact cerclage wiring and osteosynthesis in the treatment of femoral fractures.
abstract: OBJECTIVE
  Objectives were (1) to evaluate results after cerclage wiring technique for femoral primary and periprosthetic fracture (PPF); (2) to report the incidence of complications and their treatment; (3) to analyze possible prognostic factors.
  
  
  METHODS
  We analyzed 54 patients treated with different techniques associated with low-contact cerclage wires for femoral fracture. Fractures were stratified according to AO, Vancouver or Rorabeck classification. Cerclage was used as an exclusive implant in four PPFs or combined with internal devices in 50 cases. Comorbidities were assessed using Charlson Comorbidity Index. The Glasgow Outcome Scale was used to compare activities of daily living pre/postoperatively.
  
  
  RESULTS
  Cerclage wires with three or four spacers were used in 22 and 32 cases, respectively. Nine patients died within 6 months. Mean follow-up of the remaining 42 patients was 10.5 months. Fracture healing was achieved in 38/42 patients (71 %), with a mean time to callus formation of 57 days and to radiographic union of 3 months (1.5-9 months). Four patients had nonunion. Survival to major complications was 92 and 70 % at 1 and 2 years, respectively, significantly better in cerclage wires with three spacers than those with four spacers (p = 0.0188). No other statistical correlations were found.
  
  
  CONCLUSIONS
  Cerclage wiring in difficult femoral fractures offers minimally invasive reduction and fixation technique, low cost and early holding. We reinforce the concept of "reduce with cerclage cables first, then nail" for displaced long subtrochanteric fractures and support the use of cerclage wiring for challenge PPF using low-contact wires.
  
  
  METHODS
  Therapeutic study, Level IV.
authors.affiliation: Department of Orthopedics, Rizzoli Orthopedic Institute, University of Bologna, Via Pupilli, 1, 40136, Bologna, Italy. andrea.angelini83@yahoo.it.|Department of Orthopedics and Traumatology, Civilian Hospital of Lugo (AUSL Romagna), Lugo, Italy. andrea.angelini83@yahoo.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Angelini
authors.affiliation: Department of Orthopedics and Traumatology, Asur Marche Area Vasta 5, Ascoli Piceno, Italy.
authors.forename: Concetto
authors.initials: C
authors.lastname: Battiato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D001864:Bone Wires; D005260:Female; D005264:Femoral Fractures / Q000503:physiopathology / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000503:physiopathology / Q000601:surgery; D011475:Prosthesis Failure; D055815:Young Adult
keywords: Femur; Intramedullary nailing; MIPO; Osteosynthesis; Percutaneous treatment; Periprosthetic fractures