Effect of encerclage wiring with intermedullary nailing in subtrochanteric fractures of femur
Authors: Ravindra Patil,Sowen Modi*,Sreeharsha Rajoli,Ratish Kumar,Gunjan Ghelani
Number of views: 370
Introduction: Subtrochanteric typically defined as area from lesser trochanter to 5cm distal. Treating a subtrochanteric fractures is associated with difficulties due to anatomical and biomechanical factors comprising mainly due to poor reduction, varus deformity, non union, poor bone quality, comorbidities. Encerclage wire helps in reduction but its use remains controversial due to disturbance of blood supply to the underlying bone and soft tissue damage. This study was undertaken to study the use of encerclage wire for fracture reduction and associated complications.
Materials and Methods: Retrospective analysis of patients of age group 20 years and above having subtrochanteric femur fracture, admitted and treated with Long PFN between June 2016 and Sept 2018 were considered in this study. After exclusion 34 patients with an average follow up of 16.8 months were included in this study. Indications for encerclage were fracture patterns like long oblique, spiral, spiral wedge or comminuted fracture with butterfly fragment. Cerclage wire was employed in 15 patients and wire passed through cerclage wire passer. Assessment was done in terms of operation time, quality of reduction, neck shaft angle, union time, complications and final functional outcome by Harris Hip Score.
Result: Average operation time and blood loss was significantly higher in cerclage group as compared to without encerclage (p =0.042), anatomical reduction was achieved by in 93% in encerclage group as compared to 79% in non encerclage group. Postoperative Neck shaft angle was 132.80 versus 132.10. Mean Union rate was 14.3 weeks versus 15.6 weeks. 3 patient in non encerclage developed non-union of which 2 patients had nail breakage superficial wound infection was seen in 1 patient in encerclage group and was resolved with regular dressing. Mean range of hip flexion was 123.6o and extension was 14.8o.
Conclusion: Encerclage wire gives a better outcome for fracture reduction, decreases varus deformity, and overall there are no major complications. It is although associated with increased operation time and blood loss.