Effect of cerclage wiring on humeral shaft fracture associated with the third fragment.

INTRODUCTION

In humeral shaft fractures, the presence of a free bone fragment, called the third fragment or butterfly fragment, is thought to induce non-union. We hypothesised that non-union and subsequent reoperations could be reduced by performing cerclage wiring for fragments, in addition to intramedullary nailing for fractures with the third fragment. This study aimed to examine the effectiveness of cerclage wiring for the third fragments associated with humeral shaft fractures.

MATERIALS AND

METHODS

This study included patients with humeral shaft fractures involving the third fragment, who underwent osteosynthesis with intramedullary nailing at our institution between April 2013 and June 2024. The patients were divided into two groups: those who underwent osteosynthesis using an intramedullary nail alone (Group1) and those who underwent osteosynthesis using an intramedullary nail with cerclage wiring (Group2). Patient and injury characteristics, surgical time, intraoperative blood loss, postoperative complications, fracture healing, time to bone union, and reoperation were investigated and compared between the two groups.

RESULTS

Sixteen patients were included in Group1 and 27 patients were included in Group2. There were no significant differences in patient characteristics or injuries. Surgical time was significantly longer (p = 0.01) and intraoperative blood loss was significantly greater (p = 0.01) in Group2. There were no significant differences in the rates of infection and postoperative nerve paralysis (p = 1, 0.522). The rates in non-union was significantly higher in Group1 (p = 0.05). There were no significant differences in reoperation rate (p = 0.137). In cases where fracture healing was achieved, the time to bone union was significantly longer in Group1 (p < 0.001).

CONCLUSION

Cerclage wiring, in addition to intramedullary nailing for fractures with a third fragment, may prevent non-union. Although the addition of cerclage wiring significantly increased the surgical time and intraoperative blood loss, there was no increase in postoperative complications.