Tensionable Suture-based Cerclage Is an Alternative Fixation
The purpose of this study was to compare a suture-based cerclage to a stainless steel wire cerclage (SSWC) for stabilization of the humerus during shoulder arthroplasty.

Fixation of periprosthetic humeral fractures is most commonly obtained with steel-based wires or cables; however, disadvantages with these constructs are numerous. Suture-based cerclages offer the advantage of easy handling, less radiographic interference, and risk of metallosis, as well as decreased risk of cutting into the soft humeral bone.

In part I of the study, SSWC fixation was compared with single-looped tape cerclage and a double-looped tape cerclage (DLTC) fixation. In part II, a subsidence test was performed on 12 cadaveric humeri. After an osteotomy, the humeri were secured with either a SSWC or DLTC. Subsequently, a metal wedge was introduced into the humerus to simulate the stem of a shoulder arthroplasty.

--In part I, load to 2-mm displacement was significantly higher for the DLTC construct compared with the SSWC construct.

--Load to failure was 935 ± 143 N with the SSWC, 1,737 ± 113 N with the single-looped tape cerclage, and 4,360 ± 463 N with the DLTC constructs, and all differences were statistically significant.

--In part II, load at 20-mm subsidence was higher for the DLTC compared with the SSWC, but no significant difference was observed.

--However, gap displacement at 20 mm subsidence was significantly lower with the DLTC construct.

--Load to failure was higher with the DLTC construct compared with the SSWC construct, but the final gap displacement did not differ significantly.

In summary, a DLTC has greater failure load and trends to reduce the gap in relation to an SSWC. Therefore, the DLTC structure can be a viable option when attaching periprosthetic breakages or osteotomies during shoulder arthroplasty.

Source: https://journals.lww.com/jaaos/Abstract/2021/06150/A_Tensionable_Suture_based_Cerclage_Is_an.10.aspx