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Circumferential wires as a supplement to intramedullary nailing in unstable trochanteric hip fractures: 4 reoperations in 60 patients followed for 1 year.

Ban I, Birkelund L, Palm H, Brix M, Troelsen A - Acta Orthop (2012)

Bottom Line: However, the use of circumferential wires remains controversial due to possible disturbance of the blood supply to the underlying bone.In 37 of the 60 patients, 2 or more circumferential wires were used.Based on our results and on other reports, the use of circumferential wires does not appear to be harmful as sometimes claimed.

View Article: PubMed Central - PubMed

Affiliation: Clinical Orthopaedic Research, Department of Orthopaedics, Hvidovre University Hospital, Copenhagen, Denmark. ilija.ban@gmail.com

ABSTRACT

Background and purpose: Fixation of unstable trochanteric fractures is challenging. Application of a circumferential wire may facilitate bone contact and avoid postoperative fracture displacement. However, the use of circumferential wires remains controversial due to possible disturbance of the blood supply to the underlying bone. We evaluated the results of applied circumferential wires, concentrating mainly on complications and reoperations.

Patients and methods: 60 patients with unstable trochanteric fractures and use of circumferential wires (1 or more) and an intramedullary nail were included from 2 centers. We retrospectively assessed complications and reoperation rates within the first postoperative year.

Results: In 37 of the 60 patients, 2 or more circumferential wires were used. Anatomic reduction was achieved in 24 of the patients and a total cortical displacement of ≤ 10 mm was achieved in 26 other patients. 6 of the 43 patients with radiographic audit after 12 weeks sustained a subsequent fracture displacement of more than 5 mm. 4 patients underwent reoperation: 1 due to deep infection, 1 due to technical failure during osteosynthesis, 1 had a screw cut out, and 1 sustained a new fracture following a new fall.

Interpretation: Application of circumferential wires as a supplement to intramedullary nails in unstable trochanteric fractures is an option as it provides good primary reduction which, in most patients, is maintained over time-with no apparent increase in reoperation rate. Based on our results and on other reports, the use of circumferential wires does not appear to be harmful as sometimes claimed.

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Unstable trochanteric fracture with dislocation.
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Figure 1: Unstable trochanteric fracture with dislocation.

Mentions: Fixation of unstable trochanteric fractures is challenging (Figure 1). Use of a circumferential wire may facilitate bone contact and avoid postoperative fracture displacement. Due to the fear of compromising the blood supply to the underlying bone, surgeons have traditionally been restrictive in using circumferential wires despite the fact that there is little evidence in the literature to support such a detrimental effect. The controversy of circumferential wires probably originates from the work of Charnley et al. (1961) and Newton et al. (1974), who stated that circumferential wires “devitalize bone fragments and prevent the extension of periosteal callus” and that “circumferential wire appliances generally cause nonunion when used simultaneously with intramedullar fixation”. Experimental studies in animals have since shown that circumferential wires are not detrimental to vascularity and bone healing (Wilson et al. 1985, Kirkby et al. 1991), and the few existing clinical studies have shown good results after use of intramedullar fixation supplied with circumferential wires (Partridge et al. 1982, Fitzgerald et al. 1987).


Circumferential wires as a supplement to intramedullary nailing in unstable trochanteric hip fractures: 4 reoperations in 60 patients followed for 1 year.

Ban I, Birkelund L, Palm H, Brix M, Troelsen A - Acta Orthop (2012)

Unstable trochanteric fracture with dislocation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3369148&req=5

Figure 1: Unstable trochanteric fracture with dislocation.
Mentions: Fixation of unstable trochanteric fractures is challenging (Figure 1). Use of a circumferential wire may facilitate bone contact and avoid postoperative fracture displacement. Due to the fear of compromising the blood supply to the underlying bone, surgeons have traditionally been restrictive in using circumferential wires despite the fact that there is little evidence in the literature to support such a detrimental effect. The controversy of circumferential wires probably originates from the work of Charnley et al. (1961) and Newton et al. (1974), who stated that circumferential wires “devitalize bone fragments and prevent the extension of periosteal callus” and that “circumferential wire appliances generally cause nonunion when used simultaneously with intramedullar fixation”. Experimental studies in animals have since shown that circumferential wires are not detrimental to vascularity and bone healing (Wilson et al. 1985, Kirkby et al. 1991), and the few existing clinical studies have shown good results after use of intramedullar fixation supplied with circumferential wires (Partridge et al. 1982, Fitzgerald et al. 1987).

Bottom Line: However, the use of circumferential wires remains controversial due to possible disturbance of the blood supply to the underlying bone.In 37 of the 60 patients, 2 or more circumferential wires were used.Based on our results and on other reports, the use of circumferential wires does not appear to be harmful as sometimes claimed.

View Article: PubMed Central - PubMed

Affiliation: Clinical Orthopaedic Research, Department of Orthopaedics, Hvidovre University Hospital, Copenhagen, Denmark. ilija.ban@gmail.com

ABSTRACT

Background and purpose: Fixation of unstable trochanteric fractures is challenging. Application of a circumferential wire may facilitate bone contact and avoid postoperative fracture displacement. However, the use of circumferential wires remains controversial due to possible disturbance of the blood supply to the underlying bone. We evaluated the results of applied circumferential wires, concentrating mainly on complications and reoperations.

Patients and methods: 60 patients with unstable trochanteric fractures and use of circumferential wires (1 or more) and an intramedullary nail were included from 2 centers. We retrospectively assessed complications and reoperation rates within the first postoperative year.

Results: In 37 of the 60 patients, 2 or more circumferential wires were used. Anatomic reduction was achieved in 24 of the patients and a total cortical displacement of ≤ 10 mm was achieved in 26 other patients. 6 of the 43 patients with radiographic audit after 12 weeks sustained a subsequent fracture displacement of more than 5 mm. 4 patients underwent reoperation: 1 due to deep infection, 1 due to technical failure during osteosynthesis, 1 had a screw cut out, and 1 sustained a new fracture following a new fall.

Interpretation: Application of circumferential wires as a supplement to intramedullary nails in unstable trochanteric fractures is an option as it provides good primary reduction which, in most patients, is maintained over time-with no apparent increase in reoperation rate. Based on our results and on other reports, the use of circumferential wires does not appear to be harmful as sometimes claimed.

Show MeSH
Related in: MedlinePlus