A new method for cerclage wire fixation to maximal pre-tension with minimal elongation to failure

Objective. To develop and test a new cerclage wire tightening technique, yielding reproducibly maximal pre-tension, load to failure and minimal elongation to failure of the wire junction. Design. Laboratory bench study. Background Cerclage wire fixation is difficult to perform by hand with reproducible quality and tightening tension, which are required for optimal performance. Methods. With the new technique, 1, 1.25 and 1.5 mm steel wires were passed through a 9 x 18 mm steel tube, grasped using a modified ASIF wire-tightener and tightened by twisting until spontaneous failure of the wires in the tube. These fixations were compared to wires pre-tightened by hand to controlled high or low pre-tension using the simple twist, the knot twist and twist secured against untwisting, loaded to failure on a testing machine. The tests assessed pre-tension, ultimate failure load and elongation to failure. Results. Wire twists performed with the new technique were always perfectly symmetrical and may be tightened to maximal pretension without weakening of the wire. The twist secured against untwisting combined high stiffness with high failure load. The knot twist elongates to an unacceptable degree, unlike the secured twist. The simple twist untwists under little tension. Conclusions. The new technique allows to obtain maximal pre-tension and thus minimal elongation to failure of simple wire twists, without having to worry about breaking the wire at the base of the twist due to over-tightening. Relevance Cerclage wire fixation is an effective and cheap method to perform osteosynthesis. For adequate performance, maximal pretension, symmetrical twisting and high load to failure are necessary. The here presented technique combines all of these pre-requisites in a simple fashion. (C) 2003 Elsevier Ltd. All rights reserved.