Monofilament Cerclage Wiring Fixation with Locking Plates for Distal Femoral Fracture: Is it Appropriate?

Abstract

Purpose: We aimed to determine the efficacy of cerclage wiring by comparing the clinical and radiological results between internal fixation with locking plates after distal femoral fracture reduction with or without cerclage wiring.

Materials and methods: One hundred and one patients who received open reduction internal fixation for distal femoral fractures of oblique, spiral, and spiral wedge type between 2007 and 2014 were reviewed retrospectively. Only locking plate fixation was performed in 46 patients, and locking plate fixation with additional cerclage wiring was performed in 55 patients (Group CW). Demographic, clinical, and radiologic factors were evaluated in both the groups. Age, gender, bone mineral density, bone graft, and the presence of concomitant fractures were measured as demographic factors. The range of motion of knee joint, Lysholm knee score, visual analog scale score, procedure time, and C-arm time were measured as clinical factors preoperatively and at the final followup. We also evaluated the duration of bone union and knee joint alignment radiologically.

Results: There were no demographic differences between the two groups. Furthermore, there were no statistically significant differences between the two groups in terms of clinical and radiological parameters. However, the procedure time used was significantly longer in Group LP than in Group CW (108.4 vs. 95.2 min; P = 0.027). The C-arm time was longer in Group LP (2.8 vs. 1.2 s; P = 0.017).

Conclusions: Open reduction and locking plate fixation with additional cerclage wiring is a useful method for the reduction of complicated distal femoral fractures, without increased complications such as nonunion.

Level of evidence: Level III, retrospective cohort design, treatment study.

Keywords: Cerclage wiring fixation; distal femoral fracture; locking plate; open reduction.

Figure 1

Images of a Dall–Miles passor and a monofilament 19-gauge (1.0 mm) wire

Figure 2

Schematic demonstration of reduction of distal femoral fracture using monofilament cerclage wiring fixation. (a) Anteroposterior and lateral illustration of complicated distal femoral fracture, (b) variable size and shape of wire passer, (c) cerclage wiring was done using wire passer which had appropriate size and shape to distal femur, and (d) anteroposterior and lateral illustration of reduction using cerclage wires

Figure 3

(a) Pre- and postoperative X-rays of a case treated with locking plate fixation and additional cerclage wiring. (b) Pre- and postoperative X-rays of a case treated with only locking plate fixation

Figure 4

One-year postoperative X-ray of a case treated with locking plate fixation and additional cerclage wiring; bone union is observed