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

• Published in: European journal of orthopaedic surgery & traumatology Vol. 33; no. 4; pp. 739 - 749
• Main Authors: Hantouly, Ashraf T., Salameh, Motasem, Toubasi, Ahmad A., Salman, Loay A., Alzobi, Osama, Ahmed, Abdulaziz F., Ahmed, Ghalib
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01-05-2023; Springer Nature B.V
• Subjects: Bone Nails; Bone surgery; Bone Wires; Data collection; Fracture Fixation, Internal; Fracture Fixation, Intramedullary - methods; Fractures; General Review; Hip Fractures - surgery; Hip joint; Humans; Medicine; Medicine & Public Health; Meta-analysis; Orthopedics; Premature birth; Retrospective Studies; Surgical Orthopedics; Sutures; Transplants & implants; Traumatic Surgery; Treatment Outcome; Subtrochanteric fractures; Intramedullary nail; Intertrochanteric; Femur; Reverse oblique fractures; Cerclage
• ISSN: 1432-1068; 1633-8065; 1432-1068
• DOI: 10.1007/s00590-022-03240-z

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.