{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T17:09:37Z","timestamp":1788455377409,"version":"build-2803163510"},"reference-count":39,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,9,19]],"date-time":"2024-09-19T00:00:00Z","timestamp":1726704000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The reduction of two-part oblique or spiral fractures of the distal femur using steel wire cerclage prior to plate osteosynthesis is a proven procedure. In addition to being useful in fracture reduction, wire cerclage was also shown to increase the stability of osteosynthesis. Nevertheless, metal corrosion and the allergenic potency of steel remain problematic disadvantages of this method. A biomechanical study was carried out to evaluate titanium cable cerclage as an alternative supplement for plate osteosynthesis of a distal femoral two-part fracture. Materials and Methods: An unstable AO\/OTA 32-A2.3 fracture was created in eleven pairs of nonosteoporotic human cadaver femora. All the samples were treated with polyaxial angular stable plate osteosynthesis. One femur from each pair was randomly selected for an additional fracture fixation with multifilament titanium cable cerclage. Stepwise cyclic axial loading was applied in a load-to-failure mode using a servohydraulic testing machine. Results: All specimens (mean age: 80 years; range: 57\u201391 years) withstood a cycling force of at least 1800 N. With a mean load of 2982 N (95% CI: 2629\u20133335 N), the pressure forces resulting in osteosynthesis failure were significantly higher in specimens with an additional titanium cerclage (Group 1) than in samples that were solely treated with plate osteosynthesis (Group 2) at 2545 N (95% CI: 2257\u20132834 N) (p = 0.024). In both groups, cutting out the distal screws at the condyle region, resulting in shearing of the distal fragment proximal to the fracture line, was the most frequent cause of construct failure. Among the specimens assigned to Group 1, 36% exhibited a specific fracture pattern, namely, a fracture of the dorsal buttress above the cerclage. Analysis of axial stiffness (p = 0.286) and irreversible deformity of the specimens revealed no differences between the groups (p = 0.374). Conclusion: Titanium cable cerclage application, as a supplement to an angular stable plate, resulted in an increased load to failure. In terms of stability, the use of this adjunct for fracture fixation of supracondylar two-part oblique femoral fractures might, therefore, be an option, especially in patients who are sensitive to nickel.<\/jats:p>","DOI":"10.3390\/medicina60091524","type":"journal-article","created":{"date-parts":[[2024,9,19]],"date-time":"2024-09-19T03:34:20Z","timestamp":1726716860000},"page":"1524","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Titanium Cable Cerclage Increases the Load to Failure in Plate Osteosynthesis for Distal Femoral Fractures"],"prefix":"10.3390","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4666-3187","authenticated-orcid":false,"given":"Christopher","family":"Bliemel","sequence":"first","affiliation":[{"name":"Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043 Marburg, Germany"},{"name":"Philipps-University Marburg, 35037 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakob","family":"Cornelius","sequence":"additional","affiliation":[{"name":"Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043 Marburg, Germany"},{"name":"Philipps-University Marburg, 35037 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie","family":"Lehmann","sequence":"additional","affiliation":[{"name":"Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043 Marburg, Germany"},{"name":"Philipps-University Marburg, 35037 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9239-5182","authenticated-orcid":false,"given":"Ludwig","family":"Oberkircher","sequence":"additional","affiliation":[{"name":"Philipps-University Marburg, 35037 Marburg, Germany"},{"name":"Clinic for Trauma and Orthopaedic Surgery and Joint Replacement, Medical Campus Bodensee, 88048 Friedrichshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"Visser","sequence":"additional","affiliation":[{"name":"Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043 Marburg, Germany"},{"name":"Philipps-University Marburg, 35037 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bastian","family":"Pass","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital Essen, 45131 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Ruchholtz","sequence":"additional","affiliation":[{"name":"Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043 Marburg, Germany"},{"name":"Philipps-University Marburg, 35037 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3010-5156","authenticated-orcid":false,"given":"Martin","family":"B\u00e4umlein","sequence":"additional","affiliation":[{"name":"Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043 Marburg, Germany"},{"name":"Philipps-University Marburg, 35037 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/S0020-1383(00)80034-0","article-title":"The epidemiology of fractures of the distal femur","volume":"31","author":"Martinet","year":"2000","journal-title":"Injury"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2688","DOI":"10.1016\/j.injury.2016.10.013","article-title":"Impact of cement-augmented condylar screws in locking plate osteosynthesis for distal femoral fractures\u2014A biomechanical analysis","volume":"47","author":"Bliemel","year":"2016","journal-title":"Injury"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1016\/j.injury.2018.04.025","article-title":"One year after proximal or distal periprosthetic fracture of the femur -two conditions with divergent outcomes?","volume":"49","author":"Eschbach","year":"2018","journal-title":"Injury"},{"key":"ref_4","first-page":"1","article-title":"Computer-assisted navigation for intramedullary nailing of intertrochanteric femur fractures: A preliminary result","volume":"20","author":"Coviello","year":"2023","journal-title":"Med. 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