Cerclage wires technique

Indications for using cerclage wires are long oblique or spiral fractures, to which at least two wires can be applied.

They are usually used as an additional fixation method for fractures primarily repaired with an intramedullary pin or neutralization plate. Cerclage wires can protect bone fissures and be used as a temporary fragment stabilization but never as the sole means of fracture repair.

$Cerclage of a long oblique fracture$

The distance between the cerclage wires must be at least ½ bone diameter away from the tip of the fragment and ½–1 bone diameter away from each other. In general, this means 0.5 cm from the tip of a fragment and 1 cm between each wire.

$Cerclage of a long oblique fracture$

The distance between the cerclage wires must be at least 0.5 bone diameter away from the tip of the fragment

Pitfall: Placing cerclage wires on a short oblique fracture will generate larger shear forces, causing loss of reduction, the fracture to shear, and collapse.

$Cerclage wiring of a short oblique fracture impossible$

$Placing cerclage wires on a short oblique fracture will generate larger shear forces, causing loss of reduction, the fracture to shear, and collapse$

The cerclage wire is placed around the bone using a wire passer. Avoid any soft-tissue entrapment between the bone and the wire.

Twist knot, single loop, or double loop cerclage wire can be used. Double-loop knots have the greatest knot tightness, followed by a single loop and twist knot.

Note: If used in combination with a bone plate, place the knot on the bone in a position that avoids interference with the plate.