XXXX treated with cerclage cables and long cephalomedullary nails: a review of 17 consecutive cases over 2 years.

@entity1 @entity173 @entity174
BACKGROUND: The conflict between the anatomist and biologist surgeons is exemplified by the debate about subtrochanteric @entity173 . Closed intramedullary nailing is biologically friendly but may result in prolonged procedures and malunion. By contrast, accurate anatomical open reduction may disturb the biological composition of the @entity174 environment. METHODS: There were 17 @entity1 at our institution over a 2-year period whose long oblique @entity173 would not reduce perfectly in an anatomical fashion using closed methods. All these @entity1 had their @entity174 treated identically using a new policy at our unit. This strategy involved reduction of the @entity174 through an open approach, and then employing cerclage cables to stabilise the @entity174 in an anatomical position before finally inserting a cephalomedullary nail. These @entity1 were retrospectively reviewed at an average of 18 months postoperatively, to assess their progressive functional and radiological outcome up to that point. RESULTS: One @entity1 had nonunion and required a secondary procedure. One @entity1 died 8 days postoperatively from a medical complication. The remaining 15 healed within 6 months and all returned to independent living. CONCLUSIONS: The results demonstrate that judicious use of cerclage cables to augment fixation of subtrochanteric femur @entity174 does not have a deleterious effect on healing. One should endeavour, however, to minimise the number of cables used. The basic science literature underpinning our approach to these unstable @entity174 is also discussed.
