Abstract
INTRODUCTION: The use of a cerclage for osteosynthesis is a controversially discussed topic. They are said to damage the periosteal blood circulation and therefore impair bony healing. This article examines the available evidence on whether cerclages actually lead to a relevant reduction in periosteal perfusion. METHODS: A systematic review of the literature was performed in the PubMed library, searching for experimental studies concerning the influence of cerclages on periosteal blood supply. RESULTS: No experimental study exists which used a fracture model to investigate the influence of cerclages on the periosteal blood supply of fractured bones. A total of seven experimental studies could be identified. Of these studies two used human cadaver femora, which showed no relevant impairment of the blood supply. The other five investigations were animal experiments carried out on live animals. In rabbit femora the blood perfusion was shown by scintigraphy to be postoperatively decreased by 45-56% . In contrast, three other studies using dog femora and one using equine radii showed no relevant impairment of the periosteal blood supply. One study used an osteotomy model, the others used intact bones. CONCLUSION: Only one study using a rabbit model could demonstrate a relevant reduction of the periosteal blood supply by cerclages. In four other investigations on animal models over longer postoperative time periods the blood perfusion of the bones showed no impairment. In two series of experiments on human cadaveric femora no negative effects were also found. At least in the mid-term and long-term run the fear that cerclages could impair the blood supply of intact bone or postosteotomy cannot be confirmed by experimental studies. There is no experimental study using a fractured bone model.