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Cerclage performance analysis – a biomechanical comparison of different techniques and materials

BACKGROUND: Wire cerclages play a fundamental role in fracture fixation. With an increasing variety of designs being commercially available the question arises which cerclage should be used. This study investigates the biomechanical properties of metallic and non-metallic cerclages and their differe...

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Autores principales: Hägerich, L. M., Dyrna, F. G. E., Katthagen, J. C., Michel, P. A., Heilmann, L. F., Frank, A., Raschke, M. J., Schliemann, B., Riesenbeck, O.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9714204/
https://www.ncbi.nlm.nih.gov/pubmed/36451236
http://dx.doi.org/10.1186/s12891-022-05983-6
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author Hägerich, L. M.
Dyrna, F. G. E.
Katthagen, J. C.
Michel, P. A.
Heilmann, L. F.
Frank, A.
Raschke, M. J.
Schliemann, B.
Riesenbeck, O.
author_facet Hägerich, L. M.
Dyrna, F. G. E.
Katthagen, J. C.
Michel, P. A.
Heilmann, L. F.
Frank, A.
Raschke, M. J.
Schliemann, B.
Riesenbeck, O.
author_sort Hägerich, L. M.
collection PubMed
description BACKGROUND: Wire cerclages play a fundamental role in fracture fixation. With an increasing variety of designs being commercially available the question arises which cerclage should be used. This study investigates the biomechanical properties of metallic and non-metallic cerclages and their different application-types. Furthermore, potential influence of muscular interposition between bone and cerclage constructs was tested. METHODS: Samples of the following four different cerclage types were tested on 3D printed models of human humeri as well as on human cadaveric humeri with and without muscular interposition: Titanium Cable Cerclage (CC), Steel Wire Cerclage (SWC), Suture Tape (ST), Suture Tape Cerclage (STC) with both single- (sSTC) and double-loop application (dSTC). A preinstalled self-locking mechanism secured by the provided tensioner in the STCs being the main difference to the STs. Cyclic loading was performed to 1 kN and then linearly to a maximum load of 3 kN. Statistical analysis was performed using either one-way ANOVA and post-hoc Tukey or Kruskal–Wallis and post-hoc Dunn test depending on normalization of data (p < 0.05). RESULTS: Whilst all cerclage options could withstand high loads during failure testing, only within the CC and dSTC group, all samples reached the maximal testing load of 3000 N without any failure. The SWC reached 2977.5 ± 63.6 N, the ST 1970.8 ± 145.9 N, and the sSTC 1617.0 ± 341.6 N on average. Neither muscular interposition nor bone quality showed to have a negative influence on the biomechanical properties of the cerclage constructs, presenting no significant differences. CONCLUSION: All tested cerclage constructs produce reliable stability but differ in their resulting compression forces, in a simplified fracture model. Therefore, non-metallic cerclage alternatives can provide similar stability with less compression and stiffness to metallic cable constructs, but they may offer several advantages and could possibly provide future benefits. Especially, by offering more elasticity without losing overall stability, may offer a biologic benefit. Installing any cerclage constructs should be performed carefully, especially if poor bone quality is present, as the tightening process leads to high forces on the construct. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12891-022-05983-6.
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spelling pubmed-97142042022-12-02 Cerclage performance analysis – a biomechanical comparison of different techniques and materials Hägerich, L. M. Dyrna, F. G. E. Katthagen, J. C. Michel, P. A. Heilmann, L. F. Frank, A. Raschke, M. J. Schliemann, B. Riesenbeck, O. BMC Musculoskelet Disord Research BACKGROUND: Wire cerclages play a fundamental role in fracture fixation. With an increasing variety of designs being commercially available the question arises which cerclage should be used. This study investigates the biomechanical properties of metallic and non-metallic cerclages and their different application-types. Furthermore, potential influence of muscular interposition between bone and cerclage constructs was tested. METHODS: Samples of the following four different cerclage types were tested on 3D printed models of human humeri as well as on human cadaveric humeri with and without muscular interposition: Titanium Cable Cerclage (CC), Steel Wire Cerclage (SWC), Suture Tape (ST), Suture Tape Cerclage (STC) with both single- (sSTC) and double-loop application (dSTC). A preinstalled self-locking mechanism secured by the provided tensioner in the STCs being the main difference to the STs. Cyclic loading was performed to 1 kN and then linearly to a maximum load of 3 kN. Statistical analysis was performed using either one-way ANOVA and post-hoc Tukey or Kruskal–Wallis and post-hoc Dunn test depending on normalization of data (p < 0.05). RESULTS: Whilst all cerclage options could withstand high loads during failure testing, only within the CC and dSTC group, all samples reached the maximal testing load of 3000 N without any failure. The SWC reached 2977.5 ± 63.6 N, the ST 1970.8 ± 145.9 N, and the sSTC 1617.0 ± 341.6 N on average. Neither muscular interposition nor bone quality showed to have a negative influence on the biomechanical properties of the cerclage constructs, presenting no significant differences. CONCLUSION: All tested cerclage constructs produce reliable stability but differ in their resulting compression forces, in a simplified fracture model. Therefore, non-metallic cerclage alternatives can provide similar stability with less compression and stiffness to metallic cable constructs, but they may offer several advantages and could possibly provide future benefits. Especially, by offering more elasticity without losing overall stability, may offer a biologic benefit. Installing any cerclage constructs should be performed carefully, especially if poor bone quality is present, as the tightening process leads to high forces on the construct. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12891-022-05983-6. BioMed Central 2022-12-01 /pmc/articles/PMC9714204/ /pubmed/36451236 http://dx.doi.org/10.1186/s12891-022-05983-6 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Hägerich, L. M.
Dyrna, F. G. E.
Katthagen, J. C.
Michel, P. A.
Heilmann, L. F.
Frank, A.
Raschke, M. J.
Schliemann, B.
Riesenbeck, O.
Cerclage performance analysis – a biomechanical comparison of different techniques and materials
title Cerclage performance analysis – a biomechanical comparison of different techniques and materials
title_full Cerclage performance analysis – a biomechanical comparison of different techniques and materials
title_fullStr Cerclage performance analysis – a biomechanical comparison of different techniques and materials
title_full_unstemmed Cerclage performance analysis – a biomechanical comparison of different techniques and materials
title_short Cerclage performance analysis – a biomechanical comparison of different techniques and materials
title_sort cerclage performance analysis – a biomechanical comparison of different techniques and materials
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9714204/
https://www.ncbi.nlm.nih.gov/pubmed/36451236
http://dx.doi.org/10.1186/s12891-022-05983-6
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