JOT - 2026-09-23 - Journal Article
Cerclage for Fracture Reduction is Not Associated with Nonunion in Vancouver B or C Periprosthetic Femur Fractures with Stable Implants: A Multicenter Retrospective Study.
Leland CR, Wong AW, Lehle CH, Wagner RK, Grisdela PT, Borgida JS, Aneja A, Ly TV, Suneja N, Wixted JJ, Appleton PT, Rodriguez EK, Harris MB, Weaver MJ, von Keudell AG, Stenquist DS
Topics
Key Takeaway
Cerclage use during lateral locked plating of Vancouver B1/C periprosthetic femur fractures was not associated with nonunion (aOR 0.3, 95% CI 0.1–1.8), with nonunion rates of 4% vs. 10% in cerclage vs. no-cerclage groups.
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Summary
This multicenter retrospective study asked whether circumferential cerclage wiring for fracture reduction during single lateral locked plating of Vancouver B1 and C periprosthetic femur fractures increases nonunion risk. 102 patients received cerclage and 39 did not, with significant baseline differences including higher proportion of B1 fractures, longer plates, stainless steel constructs, and neutralization-mode fixation in the cerclage group. Multivariable logistic regression controlling for age, sex, ASA, and Vancouver classification showed no association between cerclage and nonunion (aOR 0.3; 95% CI 0.1–1.8; P=0.19), and no significant differences in deep infection (6% vs. 0%) or implant revision (8% vs. 15%).
Key Limitation
The no-cerclage group had a disproportionately higher rate of Vancouver C fractures and shorter, titanium plates used in bridging mode, creating substantial construct heterogeneity that limits direct comparison even after multivariable adjustment.
Original Abstract
OBJECTIVES
To determine whether circumferential cerclage wiring for fracture reduction during lateral locked plating (LLP) of Vancouver B1 and C periprosthetic femur fractures is associated with nonunion.
METHODS
Design: Retrospective cohort study.
SETTING
Three academic Level I trauma centers.
PATIENT SELECTION CRITERIA
Patients aged >50 years with a Vancouver B1 or C periprosthetic femur fracture (OTA/AO IV.3B1 and IV.3C) who underwent open reduction and internal fixation with a single LLP with or without circumferential cerclage for fracture reduction from 2010-2023 were included.
OUTCOME MEASURES AND COMPARISONS
The primary outcome was nonunion. The association between cerclage use and nonunion was assessed using multivariable logistic regression controlling for age, sex, ASA classification, and Vancouver classification. Secondary outcomes included deep infection and implant revision.
RESULTS
141 patients were included: 102 patients (72%; median age 78 years [IQR, 70-87]; 67% female) were treated with cerclage for fracture reduction and 39 patients (28%; median age 82 years [IQR, 70-89]; 85% female) were not. More patients treated with cerclage sustained a Vancouver B1 than Vancouver C fracture (n=78/102 [76%] vs. n=24/39 [24%]; P<0.001). Plates were longer (16 holes [IQR, 13-18] vs. 14 holes [IQR, 13-16]; P=0.02), stainless steel (n=91/102 [89%] vs. n=27/39 [69%]; P<0.01), and used in neutralization mode (n=96/102 [94%] vs. n=28/39 [72%]; P=0.001) in patients treated with cerclage. Nonunion occurred in 4 patients (4%) treated with cerclage and 4 patients (10%) without (P=0.30). Cerclage use was not associated with developing nonunion in multivariable regression (adjusted odds ratio, 0.3; 95% CI, 0.1-1.8; P=0.19). Infection occurred in 6 patients (6%) treated with cerclage and 0 patients (0%) without (P=0.28). Implant revision occurred in 8 patients (8%) treated with cerclage and 6 patients (15%) without (P=0.31).
CONCLUSIONS
While baseline between-group differences were noted in Vancouver classification, the judicious use of circumferential cerclage wiring for fracture reduction and stabilization in Vancouver B and C periprosthetic femur fractures with stable implants was not associated with nonunion. No differences were noted in incidence of deep infection or implant revision following cerclage use in this population.
LEVEL OF EVIDENCE
Therapeutic Level III.