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Fracture fixation: wire

icanis
Contributor(s):

Synonym(s): Cerclage, tension band, Kirschner, 'K' wire


Introduction

  • To stabilize a fracture using stainless steel wire until healing is complete.
  • Three main methods are used:
    • Cerclage, hemicerclage.
    • Kirschner ('K' wire).
    • Tension band.

Uses



Cerclage, hemicerclage
  • Few practical applications:
    • → In conjunction with other methods of fixation, eg i/m pin.
    • → Longitudinal, oblique or spiral fractures of diaphysis.
    • Alone for mandibular symphyseal separations.


  • Kirschner
  • → Physeal fractures - young animals, eg cross pins.
  • → In conjunction with other methods of fixation to resist rotational forces, eg skewer pins, sheering, etc.
  • → As part of tension band method.
  • → During fracture reduction as temporary fixation for fragments.

    Tension band
  • → Fractures where compression can be achieved by providing resistance to muscle/tendon/ligament distractive forces, eg avulsion fractures: olecranon fracture, malleolar hock fracture.

Advantages

  • Same as: Fracture - internal fixation Fracture: internal fixation.
  • Relatively inexpensive.
  • Relatively quick procedure.
  • Minimal soft tissue dissection.

Disadvantages

Cerclage, hemicerclage
  • Single wires.
Cerclage, hemicerclage
  • Single wires may → stress concentration.
  • Alone are rarely strong enough to resist forces acting on fracture site - generally >2 cerclage wires per fracture line advisable on a long bone in conjuction with another form of fixation, eg intramedullary pin ESF.
  • Hemicerclage are attached through hole in cortex.
'K' wire
  • Bend easily.
  • Often migrate - may need removing after fracture healing.
Tension band
  • Overlying soft tissues may interfere with the application of this technique.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Good when correctly applied.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Roe S C (1997) Mechanical characteristics and comparisons of cerclage wires: introduction of the double-wrap and loop/twist tying methodsVet Surg 26 (4), 310-316 PubMed.
  • Prieur W D (1992) Tension band wiring in small animals. Waltham Inter Focus (1), 10-17 VetMedResource.

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