Evaluation of cerclage wiring in the treatment of subtrochanteric fractures.

Treatment of subtrochanteric fractures is challenging because of their typical displacement pattern. Use of circumferential cerclage wires can be added to intramedullary nailing to facilitate better anatomical reduction. Concerns exist regarding additional soft tissue damage and ischemia of the periosteum. The aim of this study was to assess the effect of cerclage on union and infection rates. The postoperative results of 115 patients over 11 years were retrospectively viewed. Twenty-three patients were treated with cerclage. The primary outcome measure was 'return to theatre for fixation failure'. There was no difference in reoperation rate or in infection rate. Average displacement of the lateral wall was larger (9mm vs 1,3mm) in the no-cerclage group (p=0,003). The mean duration of surgery in the cerclage group was 28 minutes longer (p=0.003). Cerclage wiring does not lead to higher re-operation, nor higher infection rates. The use of cerclage wire in open reduction is advocated when closed reduction is not satisfactory.