Outcomes of cerclage wiring for intraoperative calcar fractures in cementless hemiarthroplasty in older patients with femoral neck fractures.

Abstract

Background: Cementless hip hemiarthroplasty is one of the options for the treatment of osteoporotic femoral neck fractures. Intraoperative periprosthetic femoral calcar fractures sometimes occur during the surgery, and the use of cerclage wiring to maintain the position and stability of the femoral stem and prevent the progression of the fracture. This study examines the outcomes of cerclage wiring to treat intraoperative periprosthetic calcar fractures in cementless hip hemiarthroplasty in osteoporotic femoral neck fractures.

Materials and methods: A retrospective review of femoral neck fractures treated with cementless hemiarthroplasty was conducted. Twenty-one calcar fractures that underwent cerclage wiring were compared with a demographically similar control group of 21 patients without intraoperative fractures. Radiological parameters, including proximal femoral morphology and stem subsidence, and Harris Hip score were evaluated for clinical outcomes.

Results: A tapered wedge-shaped type cementless stem was used in all of the cases. The most common femur types were Dorr B in both groups. The average stem subsidence of wires applied below a lesser trochanter was less than above (p = 0.905). The fracture group had a mean HHS of 83.85 ± 6.62, and the control group had a mean HHS of 88.00 ± 5.76 (p = 0.067).

Conclusions: Using cerclage wiring in treating intraoperative periprosthetic femoral calcar fractures provides adequate fixation for the stability of the femoral stem either above or below the lesser trochanter.