Journal List > J Korean Orthop Assoc > v.51(6) > 1013486

Park, Cho, Kim, Min, and Jeong: Cerclage Clamping Using Cerclage Passer for Reduction of Anterior and Posterior Column Fracture

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.

Figures and Tables

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.

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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.

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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.

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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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Table 1

Patient Demographic Data

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*Classification according to the standard of Matta.1,9) Rt, right; MRF, multiple rib fracture; Lt, left.

Notes

CONFLICTS OF INTEREST The authors have nothing to disclose.

References

1. Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am. 1996; 78:1632–1645.
2. Rowe CR, Lowell JD. Prognosis of fractures of the acetabulum. J Bone Joint Surg Am. 1961; 43:30–92.
crossref
3. Judet R, Judet J, Letournel E. Fractures of the acetabulum: classification and surgical approaches for open reduction. Preliminary report. J Bone Joint Surg Am. 1964; 46:1615–1646.
4. Gänsslen A, Krettek C. Internal fixation of acetabular both-column fractures via the ilioinguinal approach. Oper Orthop Traumatol. 2009; 21:270–282.
5. Kang CH, Lee KJ, Min BW, Jung JH. Indirect reduction of posterior column through ilioinguinal approach in case of both column fractures. J Korean Hip Soc. 2009; 21:334–338.
crossref
6. Kang CS, Min BW. Cable fixation in displaced fractures of the acetabulum: 21 patients followed for 2-8 years. Acta Orthop Scand. 2002; 73:619–624.
crossref
7. Kang CS, Min BW, Song KS, Kang CH, Park JW. Cable fixation method for displaced acetabular fracture. J Korean Soc Fract. 1996; 9:574–582.
crossref
8. Lin HH, Hung SH, Su YP, Chiu FY, Liu CL. Cerclage wiring in displaced associated anterior column and posterior hemi-transverse acetabular fractures. Injury. 2012; 43:917–920.
crossref
9. Matta JM. Operative treatment of acetabular fractures through the ilioinguinal approach. A 10-year perspective. Clin Orthop Relat Res. 1994; (305):10–19.
crossref
10. Kim JA, Kim M, Kang SM, Lim KT, Kim TS, Kang JY. Magnetic bead droplet immunoassay of oligomer amyloid β for the diagnosis of Alzheimer's disease using micro-pillars to enhance the stability of the oil-water interface. Biosens Bioelectron. 2015; 67:724–732.
crossref
11. Letournel E. Acetabulum fractures: classification and management. Clin Orthop Relat Res. 1980; (151):81–106.
crossref
12. Mayo KA. Open reduction and internal fixation of fractures of the acetabulum. Results in 163 fractures. Clin Orthop Relat Res. 1994; (305):31–37.
crossref
13. Yoon TR, Jung SN, Park SJ, Song EK. Internal fixation with pelvic plate for displaced acetabular fracture. J Korean Soc Fract. 2000; 13:733–740.
crossref
14. Kang CS, Kim SY. The analysis of clinical results of acetabular fractures after open reduction and internal fixation with wire. J Korean Hip Soc. 1989; 1:1–11.
15. Kim CK, Jin JW, Yoon JH, Jung SW, Peang JW. Cerclage wiring in internal fixation of displaced acetabular fractures. J Korean Fract Soc. 2008; 21:95–102.
crossref
16. Kim HY, Yang DS, Park CK, Choy WS. Modified Stoppa approach for surgical treatment of acetabular fracture. Clin Orthop Surg. 2015; 7:29–38.
crossref
17. Kim JW, Kim YC. Modified Stoppa approach in acetabular fractures. J Korean Fract Soc. 2014; 27:274–280.
crossref
18. Matta JM, Merritt PO. Displaced acetabular fractures. Clin Orthop Relat Res. 1988; (230):83–97.
crossref
19. Tile M, Helfet DL, Kellam JF. Fractures of the pelvis and acetabulum. 3rd ed. Philadelphia: Williams & Wilkins;2003. p. 419–495.
20. Rim YT, Lee KB, Rowe SM, Chung JY, Song EK. Wire fixation for acetabular fracture: indication, advantage and technique. J Korean Orthop Assoc. 1999; 34:373–381.
crossref
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