J Korean Orthop Assoc.  2016 Dec;51(6):486-492. 10.4055/jkoa.2016.51.6.486.

Cerclage Clamping Using Cerclage Passer for Reduction of Anterior and Posterior Column Fracture

Affiliations
  • 1Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Guri, Korea. kcpark@hanyang.ac.kr

Abstract

PURPOSE
Both column and T-shaped acetabular fractures are frequently presented with difficulty in reduction. Incomplete reduction may cause traumatic arthritis in the hip joint, resulting in inferior clinical outcomes. The purpose of this study is to introduce our wiring technique and to report the clinical and radiological outcomes of such technique.
MATERIALS AND METHODS
Eight patients who underwent our proposed technique for having acetabular fracture with displaced quadrilateral plate between March 2013 and December 2014 were enrolled. All patients were followed-up more than 1 year. The wire passer was set up from an anterolateral aspect of the iliac crest to the greater sciatic notch, between the abductor muscle and the periosteum. The quadrilateral plate of acetabular fracture was reduced with wiring. Internal fixation was added to the pelvic brim. An analysis of the clinical and radiological outcomes was performed.
RESULTS
Reduction was performed within the 3 mm intra-articular step-off in all patients. The mean duration of union was 11.8 weeks (9-15 weeks). Five patients (62.5%) showed excellent results, and radiologically, three patients (37.5%) showed good results, and seven patients (87.5%) showed better than good results.
CONCLUSION
The cerclage wiring fixation technique using a large cerclage passer instrument can be a useful and safe reduction method in some cases of acetabular fractures.

Keyword

acetabular fracture; both column fracture; cerclage wire; quadrilateral

MeSH Terms

Acetabulum
Arthritis
Constriction*
Hip Joint
Humans
Methods
Periosteum

Figure

  • Figure 1 The percutaneous cerclage passer consists of 2 dividable forceps that are connected in the middle flat part. When closing the forceps, the tube tips will meet together.

  • Figure 2 (A) Initial radiograph of a 45-year-old male showing both column fractures with a quadralateral plate fracture. (B, C) 3-Dimensional computed tomography scan shows comminuted fracture at both column with medially displaced quadrilateral plate. (D) Supine position with mild knee flexion for iliopsoas muscle relaxation. (E) A large cerclage passer delivers the wire from the iliac crest to the greater sciatic notch with ease and safety. (F) Intraoperative fluoroscopy shows that reduction was performed by pelvic reduction clamp, and cerclage wiring: then reconstruction plate and screws are added for fixation.

  • Figure 3 (A) Immediate postoperative radiograph shows anatomical reduction with cerclage wiring and plate fixation. (B) Radiograph after 12 months after the operation shows union of the fracture site and good joint congruency.

  • Figure 4 A large cerclage passer (Depuy Synthes, Paoli, PA, USA) was carefully advanced into the true pelvis, along the bony surface of the outer ilium, and the wire was set through the greater sciatic notch.


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