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

Ki Chul Park; Hyun Joong Cho; Hun Chul Kim; Kyung-Sik Min; Hae Won Jeong

doi:10.4055/jkoa.2016.51.6.486

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

Original Article

Journal of the Korean Orthopaedic Association 2016; 51(6): 486-492.

Published online: 30 December 2016

DOI: https://doi.org/10.4055/jkoa.2016.51.6.486

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

Ki Chul Park, M.D., Hyun Joong Cho, M.D., Hun Chul Kim, Kyung-Sik Min, Hae Won Jeong

Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Guri, Korea.

Correspondence to: Ki Chul Park, M.D. Department of Orthopaedic Surgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 11923, Korea. TEL: +82-31-560-2318, FAX: +82-31-557-8781, kcpark@hanyang.ac.kr

Received 8 April 2016 Revised 18 May 2016 Accepted 23 June 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: acetabular fracture, both column fracture, cerclage wire, quadrilateral

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.

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.

Table 1

Patient Demographic Data

^*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.

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