Cerclage wiring: Innovations and applications

Immediate full weight-bearing of osteosynthesis constructs is gaining increasing importance in modern trauma surgery. Many geriatric patients cannot reliably adhere to partial weight-bearing instructions, and younger patients may benefit from accelerated rehabilitation enabled by early full weight-bearing. In this context, an older technique of minimally invasive cerclage fixation of the tibia is receiving renewed attention. The surgical technique has been adapted to contemporary cerclage systems and biomechanically evaluated for the first time. Several studies using synthetic and cadaveric bone models have demonstrated that modern cable cerclages, particularly in spiral fractures, are capable of significantly increasing the stiffness of both locking plate and intramedullary nail osteosyntheses, provided that anatomical reduction is achieved through the cerclage. From a biomechanical standpoint, the additive cerclage thus enables immediate postoperative full weight-bearing. Early clinical studies suggest, that minimally invasive tibial cerclage can be applied without an increased complication rate and is associated with faster rehabilitation and higher patient satisfaction in the early postoperative phase. Although evidence is limited, the principle of additive cerclage appears to be transferable to humeral shaft spiral fractures.