Use of minimally invasive cerclage wiring for displaced major fragments of femoral shaft fractures after intramedullary nailing promotes bone union and functional outcome

Abstract

Abstract Background Femoral shaft fractures which are caused by high energy trauma, can be very challenging due to the large variability in fracture morphology and poor functional outcome. Displaced major fragments of femoral shaft fractures are difficult to manage after closed reduction and intramedullary nailing (IMN). The minimally invasive cerclage wiring (CW) procedure has developed to be an optimal tool for major fragments resetting and stabilization after IMN. However, argues continue for CW procedure is at potential risk of arterial injury, blood supply disruption, and delayed bone union or nonunion. The surgical algorithsm for femoral shaft fractures with displaced major fragments remains controversial. Thus, emphysis is placed on whether CW procedure can offer promotion of bone union rate and improvement of functional outcome without significant complications. Methods We perfomed a retrospective study on all patients of femoral shaft fractures with displaced major fragments between June 2015 and August 2019 in our trauma centre. Eligible patients were included and stratified into the cerlage wiring (CW) group and intramedulary nailing (IMN) group. Demographics, radiological data, callus formation, union time, and fuctional outcome were critically compared between two groups. Results 37 patients were included in the present study according to our inclusion/exclusion criteria, of which 16 (43.2%) were stratified into CW group, and 21 (56.8%) into IMN group. The Modified radiographic union score for femorae (mRUSH) in CW group and IMN group were compared to be sigfificantly different (11.94 ± 1.29 vs.7.95 ± 0.74, 6 months; 15.88 ± 0.50 vs. 10.33 ± 0.91, 12 months)(P < 0.0001). The mean union time was of significance between CW and IMN group (7.9 ± 3.2 months vs. 20.1 ± 8.48 months)(p < 0.0001). Bone union achieved at 12 months differed significantly between CW and IMN group (15 vs. 5) (p < 0.05). Harris Hip Score (HHS) in CW group was higher than IMN group (88.19 ± 4.69 vs. 76.81 ± 5.26, 12 months; 93.19 ± 4.68 vs. 87.57 ± 5.38, 24 months) significantly (P < 0.01), respectively. So was the Hospital for Special Surgery Knee Score (HSS) in CW and IMN group (78.50 ± 5.65 vs. 67.71 ± 4.65, 12 months; 89.50 ± 5.05 vs.75.81 ± 8.90, 24 months) significantly (p < 0.0001). Conclusions Minimally invasive CW is an optimal supplement for IMN in the treatment of femoral shaft fractures with displaced major fragments. As illustrated, benefits of CW might be promotion of bone union rate and improvement of functional outcome.