Cerclage wiring is a very simple technique that has been widely used since the advent of the surgical treatment of fractures. Different researches have shown the use of various cerclage technologies with a wide range of promising results. The growing number of periprosthetic fractures has led to a resurgence of interest in this simple technique. When cerclages function as implants, they can be used alone or in conjunction with a protective device such as external or internal splints (such as plates, nails, prosthetic rods, or a combination). This article provides an overview of the available literature on cerclage placement technique, sizing, removal, and hip replacement.
What is Cerclage Wire?
Usually, orthopedic wires are commonly used in small animal fracture repair to hold the bone fragments together through static inter-fragmentary compression. Reconstruction can be achieved by compressing the individual pieces together, as in inter-fragment wiring, or cerclage wiring, where a wire is wound around a ligament of fragments in a stable anatomical shape and forcing the pieces together.
The orthopedic wire is a non-reactive stainless steel alloy that is much more ductile than the stainless steel alloy used to make bone plates or posts. There are three main types of cerclage wiring, full cerclage wiring, semi-cerclage wiring, and tension tape wiring, which is a specialized form of semi-cerclage.
Cerclage Wire Technique
The Cerclage placement technique helps achieve a stable reposition of femoral fractures, which can then be completed with a nail or plate. The minimally invasive technique and instruments offer the advantage of minimally dissecting soft tissue, and the procedure gives excellent results without any significant complications.
Cerclage placement is an effective surgical method for treating young intertrochanteric fractures of the femur that cannot be repaired with closed maneuvers. The wire helps support reduced fractures, facilitates deployment and nailing, reduces intraoperative complications, and does not interfere with fracture healing. Cerclage pins are used to stabilize proximal femoral fractures after nail placement in cementless total hip arthroplasty. The damage was stabilized by 1, 2, or 3 wires placed are either perpendicular to the femoral neck axis or perpendicular to the crack. The femora are compressed to 2,670 N, and the crack opening and stem subsidence is measured. Wires placed normal to the gap allowed less stem subsidence by 3.17 mm and fewer crack opening by 1.55 mm than wires perpendicular to the neck. A minimum of two cerclage wires best stabilize medial and anterior calcar cracks placed normal to the damage.
Cerclage Wire Sizes
Cerclage wire comes in very different types of diameters, the thinnest being 0.64mm (22 gauge) for cats or very small dogs, and therefore the heaviest being 1.25mm (16 gauge) to be used in giant breeds. Most surgeons will have 3 or 4 diameters available during this range.
The cerclage wires are often tightened in one of two ways. The ends of the wire may be twisted equally around one another, forming a so-called “twisted wire.” Alternatively, the wire may have a loop at one end, allowing the free end to be tried and true the loop and tightened around the bone. Specially designed wire tensioners are available for both twisted and looped cerclage wires. Although it’s possible to tighten cerclage wires without using these wire tightening devices, surgeons are strongly cautioned against this reduction.
Cerclage Wire removal
The removal of implants relates to complications after fracture healing has always been a topical and controversial issue.
The most common indication for implant removal is the patient’s request, which might be because of existing cultural and non-secular beliefs, during which individuals consider the implant as a distant body that should be removed. For patients who have had internal fixation mostly wants the hardware to remove after fracture healing. The problems that could arise from retaining metal implants may include deep infection, metal allergy or toxicity, hardware movement, metal breakage, and secondary fracture at plate ends.
However, during removal cases, hardware can break, resulting in prolonged and challenging surgery with retained hardware.
It should be necessary for children to get rid of implants early to avoid disturbances to the growing skeleton, stop bony in-growth making later removal technically difficult or impossible, and permit planned surgical operation after skeletal maturation.
Cerclage Wire Hip replacement
Cerclage wires in hip joint replacements can sometimes be encountered on postoperative radiographs or other cross-sectional imaging. They are usually seen around the femoral stem and are commonly used to stabilize the proximal femoral fissure after stem placement in cementless total hip arthroplasty.