Orthopedic (Cerclage) Wire Specification, Uses, Sizes and Surgical Techniques.

Orthopedic Cerclage Wire

Orthopedic (Cerclage) Wire used to hold body tissues together after an injury or surgery. Application generally involves using a needle with an attached length of thread to stitch the wound shut.

Orthopedic (Cerclage) Wire comes in different diameters and lengths. Orthopedic (Cerclage) Wire diameters are measured in SWG (Standard wire gauge) or Millimeter. Vast Ortho Orthopedic (Cerclage) Wires are made from SS 316L material.

Available Orthopedic (Cerclage) Wire sizes are

  • 16 SWG (1.60mm)
  • 18 SWG (1.25mm)
  • 20 SWG (0.90mm)
  • 22 SWG (0.70mm)
  • 24 SWG (0.55mm)
  • 26 SWG (0.45mm)
  • 28 SWG (0.35mm)
  • 30 SWG (0.30mm)

Orthopedic (Cerclage) Wire Uses

Orthopedic (Cerclage) Wire helps to achieve stable reduction of femoral fractures which can then be supplemented with a nail or a plate. The minimally invasive technique and instrumentation offer the advantage of minimal soft tissue dissection, and the procedure is associated with excellent outcomes without any major complications.

  • stabilization and fixation of proximal femur in cases of periprosthetic fractures of the femur, subtrochanteric fractures or as a prophylactic banding in total joint hip arthroplasty.
  • fractures of the patella
  • acetabular fractures
  • acromioclavicular joint dislocation

Orthopedic (Cerclage) Wire has been used in the past for osteosynthesis of femoral fractures. However, the technique went into disrepute as extensive soft tissue dissection, and periosteal stripping increased the risk of bone necrosis and delayed union. Advent of new instrumentation and minimally invasive technique has significantly reduced these complications. In spite of the limited indications for its application, reduction and stabilization with cerclage wiring can supplement osteosynthesis especially in spiral or oblique fracture morphology or those with a butterfly fragment instead of interfragmentary screw fixation.

Orthopedic (Cerclage) Wire techniques

There are many different Orthopedic (Cerclage) Wire techniques. Some of them are:

Continuous sutures

This technique involves a series of stitches that use a single strand of suture material. This type of suture can be placed rapidly and is also strong, since tension is distributed evenly throughout the continuous suture strand.

Interrupted sutures

This suture technique uses several strands of suture material to close the wound. After a stitch is made, the material is cut and tied off. This technique leads to a securely closed wound. If one of the stitches breaks, the remainder of the stitches will still hold the wound together.

Deep sutures

This type of suture is placed under the layers of tissue below (deep) to the skin. They may either be continuous or interrupted. This stitch is often used to close fascial layers.

Buried sutures

This type of suture is applied so that the suture knot is found inside (that is, under or within the area that is to be closed off). This type of suture is typically not removed and is useful when large sutures are used deeper in the body.

Purse-string sutures

This is a type of continuous suture that is placed around an area and tightened much like the drawstring on a bag. For example, this type of suture would be used in your intestines in order to secure an intestinal stapling device.

Subcutaneous sutures

These sutures are placed in your dermis, the layer of tissue that lies below the upper layer of your skin. Short stitches are placed in a line that is parallel to your wound. The stitches are then anchored at either end of the wound.

Orthopedic (Cerclage) Wire removal

When your Orthopedic (Cerclage) Wires are removed will depend on where they are on your body. Some general guidelines are as follows:

  • scalp: 7 to 10 days
  • face: 3 to 5 days
  • chest or trunk: 10 to 14 days
  • arms: 7 to 10 days
  • legs: 10 to 14 days
  • hands or feet: 10 to 14 days
  • palms of hands or soles of feet: 14 to 21 days

To remove your Orthopedic (Cerclage) Wires, your doctor will first sterilize the area. They’ll pick up one end of your suture and cut it, trying to stay as close to your skin as possible. Then, they’ll gently pull out the suture strand.

The broken Orthopedic (Cerclage) Wire

The body is a hostile environment for Orthopedic (Cerclage) Wire. Although the problems of electrochemical corrosion, direct chemical attack on the Orthopedic (Cerclage), and inflammation produced in reaction to the suture have been largley eliminated by the use of austenitic stainless steel wires, failure of the wires may still occur due to mechano-chemical cracking – the combined effect of insignificant stresses, usually from cold working, and insignificant chemical potentials produced by body fluids. Although stainless steel Orthopedic (Cerclage) Wire remains a satisfactory material for sternotomy closure or for reattaching costal cartilages, the two spectacular complications of a broken wire point out the need for care in using wire sutures. Bending, twisting, kinking and knotting must be avoided as much as possible.

Orthopedic (Cerclage) Wire General Techniques

Orthopedic (Cerclage) Wire refers to encircling fragments and tensioning the wire to hold fragments in alignment. Full cerclage wires encircle the entire circumference of the bone while hemi-cerclage wires are placed through holes in the bone to stabilize adjacent fragments. While hemi-cerclage techniques are described in many textbooks, this is a technique best avoided in most fracture repairs. It provides poor stability between fragments and can cause significant damage to fragments and blood supply when placed.

Orthopedic (Cerclage) Wires can be tightened in 1 of 2 ways. The wire ends may be twisted equally around each other producing a so-called “twist wire.” Alternatively, a wire may have a loop at one end allowing the free end to be passed through the loop and tightened around the bone. In both twist and looped Orthopedic (Cerclage) Wires, specially designed wire tighteners are available. Although it is possible to tighten Orthopedic (Cerclage) Wires without the benefit of these wire tighteners, the surgeon is strongly warned against this shortcut. Failure to purchase a wire tightener is false economy since these devices can apply much more tension than can be achieved by hand. The number one principle of successful Orthopedic (Cerclage) Wire application is that the wire must be tight. Which type of Orthopedic (Cerclage) Wire is preferred: twist or looped? To some degree this is based on personal preference and the differences do not have a major influence on surgical success. Research has shown that twist wires have better knot security but looped Orthopedic (Cerclage) Wires produce consistently more tension and fragment stability.

While Orthopedic (Cerclage) Wires can be valuable in fracture repair there is little doubt that they are the most often misused piece of orthopedic hardware and contribute to a high number of postoperative complications. A loose wire at a fracture site is virtual poison to the healing bone environment. As the loose wire moves back and forth it wipes out the vascular buds trying to revascularize and heal the fracture. The result is no blood supply, no healing, and a non-union. To successfully utilize Orthopedic (Cerclage) Wires the following rules must be strictly adhered to:

  • The wire must be tight!
  • The wire must be of sufficient diameter for the particular application. Err on the side of a wire that is too heavy rather than one that is too light.
  • Orthopedic (Cerclage) Wires are never used as the sole means of fracture stabilization.
  • Wires must be placed perpendicular to the long axis of the bone.
  • Never use only 1 wire. Always use at least 2, preferably more.
  • Care must be taken in proper spacing of wires. They must be placed at least a 1/2 cm from the fracture ends and spaced approximately 1 cm apart. If it is not possible to satisfy rules #5 and #6 at the same time, then the fracture is not amenable to wire fixation.
  • If wires are used to stabilize a fracture then fragments must be anatomically reduced and the over-all fracture repair must be fashioned to eliminate the possibility of fracture collapse. For example, a comminuted fracture may not be suitable for wire fixation if there is a chance one fragment will shift and cause collapse of the other adjacent fragments. Such an occurrence will leave a mass of avascular bone fragments encircled by loose wires; a disaster waiting to happen!

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Orthopedic (Cerclage) Wire Contraindications

Contraindications may be qualified or total, and need to be taken into consideration when evaluating the prognosis in each case. The physician’s education, training and professional judgement must be relied upon to choose the most appropriate device and treatment. Conditions presenting an increased risk of failure include:

  • Any active or suspected latent infection or marked local inflammation in or about the affected area.
  • Compromised vascularity that would inhibit adequate blood supply to the fracture or the operative site.
  • Bone stock compromised by disease, infection or prior implantation that can not provide adequate support and/or fixation of the devices.
  • Material sensitivity, documented or suspected.
  • Obesity. An overweight or obese patient can produce loads on the implant that can lead to failure of the fixation of the device or to
    failure of the device itself.
  • Patients having inadequate tissue coverage over the operative site.
  • Implant utilization that would interfere with anatomical structures or physiological performance.
  • Any mental or neuromuscular disorder which would create an unacceptable risk of fixation failure or complications in postoperative care.
  • Other medical or surgical conditions which would preclude the potential benefit of surgery.
  • All associated diseases which could endanger the function and success of the Orthopedic (Cerclage) Wire.

Warnings and Precautionary for Orthopedic (Cerclage) Wire

Before using Orthopedic (Cerclage) Wire, the surgeon and ancillary staff should study the safety information in these instructions, as well as any product-specific information in the product description, surgical procedures and/or brochures.

Cerclage Wire is made from medical grade materials and are designed, constructed and produced with utmost care. These quality Orthopedic Wire assure best working results provided they are used in the proper manner. Therefore, the following instructions for use and safety recommendations must be observed.

Improper use of  Orthopedic (Cerclage) Wirecan lead to damage to the tissue, premature wear, destruction of the instruments and injury to the operator, patients or other persons.

It is vital for the operating surgeon to take an active role in the medical management of their patients. The surgeon should thoroughly understand all aspects of the surgical procedure and instruments including their limitations. Care in appropriate selection and proper use of surgical instruments is the responsibility of the surgeon and the surgical team. Adequate surgical training should be completed before use of implants.

Factors which could impair the success of the operation:

  • Allergies to implanted materials.
  • Localized bone tumours.
  • Osteoporosis or osteomalacia.
  • System disease and metabolic disturbances.
  • Alcohol and drug abuse.
  • Physical activities involving excessive shocks, whereby the implant is exposed to blows and/or excessive loading.
  • Patients who are mentally unable to understand and comply with the doctor’s instructions.
  • Poor general health.

Possible Adverse Effects

The following adverse effects are the most common resulting from implantation:

  • Loosening of the Cerclage Wire, which may result from cyclic loading of the fixation site and/or tissue reaction of the implant.
  • Early and late infection.
  • Further bone fracture resulting from unusual stress or weakened bone substance.
  • Temporary or chronic neural damage resulting from pressure or hematomata.
  • Wound hematomas and delayed wound healing.
  • Vascular disease including venal thrombosis, pulmonary embolism and cardiac arrest.
  • Heterotopic ossification.
  • Pain and discomfort due to presence of the Orthopedic (Cerclage) Wire.
  • Mechanical failure of the implant, including bending, loosening or breakage.
  • Migration of implant resulting in injury.

Preoperative Planning for Orthopedic (Cerclage) Wire

The operating planning is carried out following a thorough clinical evaluation of the patient, Also, x-rays must be taken to allow a clear indication of the bony anatomy and associated deformities. At the time of the operation, the corresponding implantation instruments in addition to a complete size of Orthopedic (Cerclage) Wire must be available.

The clinician should discuss with the patient the possible risks and complications associated with the use of implants. It is important to determine pre-operatively whether the patient is allergic to any of the implant materials. Also, the patient needs to be informed that the performance of the device cannot be guaranteed as complications can affect the life expectancy of the device.

Orthopedic (Cerclage) Wire Precautions

  • Confirm functionality of instruments and check for wear during reprocessing. Replace worn or damaged instruments prior to use.
  • It is recommended to use the instruments identified for this Orthopedic Wire.
  • Handle devices with care and dispose worn bone cutting instruments in a sharps container.
  • Always irrigate and apply suction for removal of debris potentially generated during implantation or removal.

Orthopedic (Cerclage) Wire Warnings

  • Orthopedic (Cerclage) Wire can break during use (when subjected to excessive forces). While the surgeon must make the final decision on removal of the broken part based on associated risk in doing so, we recommend that whenever possible and practical for the individual patient, the broken part should be removed. Be aware that implants are not as strong as native bone. Implants subjected to substantial loads may fail.
  • Instruments, screws and cut plates may have sharp edges or moving joints that may pinch or tear user’s glove or skin.
  • Take care to remove all fragments that are not fixated during the surgery.
  • While the surgeon must make the final decision on implant removal, we recommend that whenever possible and practical for the individual patient, fixation devices should be removed once their service as an aid to healing is accomplished. Cerclage Wire removal should be followed by adequate post-operative management to avoid refracture.

Orthopedic (Cerclage) Wire General Adverse Events

As with all major surgical procedures, risks, side effects and adverse events can occur. While many possible reactions may occur, some of the most common include: Problems resulting from anesthesia and patient positioning (e.g. nausea, vomiting, dental injuries, neurological impairments, etc.), thrombosis, embolism, infection, nerve and/or tooth root damage or injury of other critical structures including blood vessels, excessive bleeding, damage to soft tissues incl. swelling, abnormal scar formation, functional impairment of the musculoskeletal system, pain, discomfort or abnormal sensation due to the presence of the device, allergy or hypersensitivity reactions, side effects associated with hardware prominence, loosening, bending, or breakage of the device, mal-union, non-union or delayed union which may lead to breakage of the Orthopedic (Cerclage) Wire, reoperation.