Does cerclage wiring with intramedullary nailing in subtrochanteric fractures improve the final outcome?

Treatment of subtrochanteric fractures is challenging due to anatomical and biomechanical factors. Many methods have been suggested to achieve and maintain fracture reduction during operative fixation for subtrochanteric fractures. Open reduction and intramedullary fixation, clamp assisted reduction without cerclage wires and fracture reduction cables are suggested methods. We conducted a retrospective study to look for the results of subtrochanteric fractures managed by intramedullary fixation with or without cerclage wires. We reviewed all cases of subtrochanteric fractures operated with intramedullary fixation with long proximal femoral nail with or without cerclage wire fixation. All available data from patient’s records available in medical records department were retrieved and evaluated. Statistical analysis were performed using SPSS software (v16). There were 86 cases of subtrochanteric fractures operated with intramedullary fixation at our Hospitals over a period of 5 years. Quality of fracture reduction of fractures are assessed good reduction was seen more often in cerclage group 64%. Cerclage wiring was done in 14 cases. Nonunion was seen in 8 cases overall, 3 in cerclage group and 5 in non Cerclage group. Implant failure was seen in 3 cases in no cerclage group and 2 cases of cerclage group. We conclude that anatomical reduction is the key factor for successful outcomes. Closed reduction with good to acceptable reduction had better results. Cerclage wiring should be considered in selected cases where reduction is poor after open reduction.