Cerclage wiring in internal fixation of acetabular fractures

In the last 100 fractures of the acetabulum surgically treated in our institution, cerclage wires have been used as a reduction tool in 14 patients. In each case the fracture pattern affected both columns, and nine of them were approached through a single ilioinguinal exposure. To evaluate our initial experience with the method, these patients were reviewed using medical records, operative notes, and radiological assessment to determine its indications and effectiveness. In each patient, using a limited further dissection, at least one cerclage wire was passed through the greater sciatic notch, embracing the proximal extent of a posterior column fragment. It was then tightened above the anterior-inferior iliac spine, achieving reduction. In 11 cases reduction was obtained to within 1 mm, and joint congruence with < 3 mm of residual displacement was obtained in 13 hips. This reduction was maintained until union, except in one case, where it was lost postsurgery. Cerclage wires may be used to successfully effect an indirect reduction of the posterior column from an anterior approach in fractures affecting both columns, where the posterior column fracture line is proximal. The technique may contribute to fracture stabilization, but supplementary fixation was added in 12 of our patients.