Volume 7, Issue 4 (12-2025)
Tabari Biomed Stu Res J 2025, 7(4): 26-36 |
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Shirdel S S, Taheri S, Ghadiry A, Daryaee M. Adjunctive Cerclage in Subtrochanteric Femur Fractures Treated With Long Cephalomedullary Nailing: A Narrative Review. Tabari Biomed Stu Res J 2025; 7 (4) :26-36
URL: http://tbsrj.mazums.ac.ir/article-1-3908-en.html
URL: http://tbsrj.mazums.ac.ir/article-1-3908-en.html
1- Assistant Professor of Orthopedic Surgery, Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran
2- Assistant Professor, Department of Orthopedics, Golestan University of Medical Sciences, Gorgan, Iran
2- Assistant Professor, Department of Orthopedics, Golestan University of Medical Sciences, Gorgan, Iran
Abstract:
Subtrochanteric femur fractures are challenging injuries because of the high mechanical stresses across the subtrochanteric region and the deforming forces exerted by the surrounding muscles. Long cephalomedullary nailing is commonly used for operative fixation; Adjunctive cerclage wiring or cable fixation has therefore been used to facilitate reduction and restore cortical contact before nail insertion. Nevertheless, concerns remain regarding additional soft-tissue dissection, periosteal blood supply, operative time, and blood loss. This narrative review evaluates the available evidence regarding the use of adjunctive cerclage during intramedullary fixation of subtrochanteric femur fractures. Clinical comparative studies, case series, biomechanical investigations, and previous systematic reviews were considered, with particular attention to reduction quality, fracture :union:, non:union:, implant-related complications, reoperation, operative parameters, and functional outcomes. Current evidence most consistently suggests that cerclage-assisted fixation improves fracture reduction and may reduce residual displacement and varus malalignment. Several studies have also reported shorter healing times or favorable :union: outcomes; however, evidence that cerclage reduces non:union:, implant failure, or reoperation remains less consistent. Cerclage may increase operative time and blood loss in some series, while available comparative evidence has not demonstrated a consistent increase in infection or non:union:. The potential benefit appears to be greatest in unstable fracture patterns in which satisfactory alignment and medial cortical contact cannot be achieved by closed or percutaneous reduction alone. Therefore, adjunctive cerclage should be considered a selective reduction tool rather than a routine component of every subtrochanteric fracture fixation.
Keywords: : Subtrochanteric Femur Fracture, Cerclage, Intramedullary Nailing, Cephalomedullary Nail, Fracture Reduction
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