The effect of the cerclage wire in the treatment of subtrochanteric femur fracture with the long proximal femoral nail: A review of 52 cases

Introduction: To present the effect of the cerclage fixation, which was performed for the purpose of preserving the alignment obtained by open reduction, on the long-term clinical and radiological results of subtrochanteric fractures. Materials and methods: The inclusion criterias were at least 2 years of follow-up, no severe cognitive impairment, and to be able to walk independently prior to fracture. Patients with transverse or short oblique subtrochanteric hip fractures (AO/OTA class 32-A3.1), patients underwent previous femoral or hip operation for the same side and those with segmental fractures, bilateral fractures and pathological fractures were not included in the study. The clinical and radiological results of the patients were evaluated. The clinical evaluations were performed with Palmer and Parker Mobility Score (PPM), Lower Extremity Functional Score (LEFS), visual analogue score (VAS) and return to pre-injury activity status. The elapsed time between the trauma and the surgery date, the duration of surgery the estimated amount of bleeding, and the length of hospital stay of patients were assessed. Results: Thirty-two of the 52 patients were female and 20 were male. The mean age of females was 77.80 ± 9.75 years and the mean age of the males was 79.18 ± 6.50 years. The mean follow-up period of the patients was 62.25 ± 34.68 months. The mean time until the patients' surgery was 6.18 ± 3.32 days. The mean duration of surgery was 52.6 ± 13.8 min. The mean amount of bleeding was 176 ± 90 ml. The mean length of patients' hospital stay was 6.2 ± 3.2 days. The postoperative mean duration of union was found to be 3.8 ± 1.6 months. The mean value of varus/valgus angulation in coronal plane measurements was 0.52°. No complication was observed in any patient during the cerclage application. The mean number of wire was 1.3. LEFS difference was statistically significant. PPM decline was not statistically significant. Conclusion: Open reduction and the use of cerclage did not produce a negative effect in terms of fracture union. The generation of medial support by anatomical reduction of the fracture prevents the implant failure and provide a basis for union.