Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2011; 78(3):190-199 | DOI: 10.55095/achot2011/031

Cerclage, Evolution and Potential of a Cinderella Technology. An Overview with Reference to Periprosthetic FracturesCurrent concepts review

S. M. PERREN¹, A. FERNANDEZ DELL'OCA², M. LENZ³, M. WINDOLF⁴

¹ Institute for Health and Biomedical Innovation (IHBI), Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland, 4059, Australia

² Chief of Traumatology, British Hospital, Montevideo, Uruguay

³ AO Research Institute Davos, Davos, Switzerland

⁴ AO Research Institute Davos, Davos, Switzerland

Periprosthetic fractures are increasingly frequent. The fracture may be located over the shaft of the prosthesis, at its tip or below (21). The treatment of explosion fractures is difficult because the shaft blocks the application of implants, like screws, which need to penetrate the medullary cavity.
The cerclage, as a simple periosteal loop, made of wire or more recently cable, does not only avoid the medullary cavity. Its centripetal mode of action is well suited for reducing and maintaining radially displaced fractures. Furthermore, the cerclage lends itself well for minimally invasive internal fixation.
New insight challenges the disrepute of which the cerclage technology suffered for decades. The outcome of cerclage fixation benefits from an improved understanding of its technology, mechano-biology and periosteal blood supply. Preconceived and generally accepted opinions like "strangulation of blood supply" need to be re-examined.
Recent mechanical evaluations (22) demonstrate that the wire application may be improved but cable is superior in handling, maintenance of tension and strength.
Beside the classical concepts of absolute and relative stability a defined stability con-dition needs consideration. It is typical for cerclage. Called "loose-lock stability" it specifies the situation where a loosened implant allows first unimpeded displacement changing abruptly into a locked fixation preventing further dislocation.

Published: June 1, 2011  Show citation