Efficacy of Minimally Invasive Reduction With Cerclage Fixation in Spiral or Oblique Subtrochanteric Femoral Fractures: A Retrospective Cohort Study Comparing Cables and Wires

OBJECTIVES: To compare the outcomes of a minimally invasive reduction (MIR) technique using a cable and wire in spiral or oblique subtrochanteric femoral fractures (SFFs). Design: Retrospective cohort study. Setting: Two University Hospitals. Patient Selection Criteria: Skeletally mature patients with spiral or oblique SFFs (OTA/AO 32A1 and 32A2) treated with intramedullary nailing and MIR with a cerclage wire passer using either a single-loop cable or cerclage wire or MIR without cable or wire between May 2016 and November 2021 were included. Outcome Measures and Comparisons: Coronal and sagittal interfragmentary gap, neck-shaft angle, coronal and sagittal angulation, fracture union, time to union, and Radiographic Union Score for Hip (RUSH) at 6 months post operation were compared. RESULTS:A total of 46 patients were included, with 16 each in the cable and wire groups and 14 in the non-wiring group. There were no differences in demographics (P > 0.05), fracture classification (P = 0.710), or operative data (P > 0.05) between the three groups. The cable group showed significantly better coronal (P = 0.003) and sagittal (P = 0.003) interfragmentary gap, shorter union time (P < 0.001), and higher 6-month RUSH score (P < 0.001) among the three groups. There were no significant differences in outcome measures between the wire and non-wiring groups (all P > 0.05). No mechanical complications or reoperations were observed in all three groups. CONCLUSIONS: Minimally invasive reduction using a cable is more effective than wire or non-wiring reduction to improve reduction quality and promote bone union in the SFFs.