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Cerclage Wire Systems
A number of configurations are available for cerclage wire systems. These include wrapped around twice patterns, eyelet bend back, crimped double barrel sleeve, and doubled symmetric twist. The article also outlines variations for tension band wiring, and provides an overview of their failure modes. This article describes and demonstrates several different techniques for using cerclage wires in orthopedic surgery. This article also discusses the proper technique for applying these wires.
Before inserting the cerclage wire, start it near the bone. Excess twisting weakens the wire, which decreases pressure generation. After attaching the wire, trim the excess with a razor blade, leaving a minimum of three full twists. The remaining muscle tissue will form a fibrotic capsule over the ends of the wire. Once secured, the surgical procedure will be completed without complications. This article is divided into two parts.
Long oblique and spiral fractures are the ideal candidates for cerclage wiring. If the wire is longer than the bone diameter, the effect will be inter-fragmentary compression and disrupt the fracture. Moreover, the length must be greater than the diameter of the bone, or else the cerclage wire will cause pain. Besides being effective for fracture repair, cerclage wire systems should never be used as a sole method of surgery.
A symmetrically twisted cerclage wire should have three full symmetric twists per centimeter. This type of wire will retain compression better than less-twisted versions. Additionally, the diameter and pattern of the wires affect the resistance to tension failure. The two-step twisting method maximizes the final retained compression. When using the double cerclage technique, it is important to maintain the orientation of the wire perpendicular to the bone axis.
A full cerclage wire is best suited for long oblique diaphyseal fractures. The full cerclage wire achieves inter-fragmentary compression and disrupts fractures with a length of 45 or more. This method requires a lot of patience and experience and is not suitable for all patients. In some cases, it may not even be possible to fix a femoral fracture with other means.
In many cases, the cerclage wire isn't a good choice for a small animal. The wires are often too thin and do not provide enough support. While the cable system is stronger than a cerclage wire, it's not the best option for small animals. It is more likely to fail, while a cable system can withstand a large amount of tension. When used properly, a cerclage wire is highly effective for treating fractures in dogs.
In long bones, a hemicerclage wire is inserted through the fracture line and holds other components to it. This method is particularly effective for fractures of the metaphysis, which is at the end of a long bone. The holes are drilled in the cortex. The wire crosses the fracture line on the outer cortex and may not cross in the medulla. Its shape allows for a variety of patterns.