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J Shoulder Elbow Surg. 2014 Oct;23(10):1568-74. doi: 10.1016/j.jse.2014.02.012. Epub 2014 May 6.

Stainless steel wire versus FiberWire suture cerclage fixation to stabilize the humerus in total shoulder arthroplasty.

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Department of Orthopaedics, University of Zürich, Balgrist University Hospital, Zürich, Switzerland. Electronic address:
Department of Orthopaedics, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
Department of Ortrhopaedics, Private Hospital Maria Hilf, Klagenfurt, Austria.



No. 5 FiberWire (Arthrex, Naples, FL, USA) cerclage (FWC) and 1.25-mm stainless steel wire cerclage (SSWC) are biomechanically similar in resistance to prosthetic subsidence in shoulder arthroplasty.


In this laboratory bench study, 3 different surgical knot configurations (4-throw knot, cow hitch, and simple hitch) using a No. 5 FWC were evaluated and compared with a 1.25-mm SSWC. First, distraction tests were performed using bovine femoral cortical half shells mounted on a testing jig. Cerclage tightening, load to a 3-mm gap opening, and load to total failure were measured. Second, uncemented humeral prosthetic stems were inserted into an experimentally split humeral medullary canal, secured by the cerclage. After 100 N of preloading, the prosthesis was advanced into the humerus at a speed of 0.2 mm/s, and resistance during subsidence up to a penetration depth of 10 mm, as well as gap opening, was measured.


Tightening force showed higher values for SSWC (618 N) than FWC (131-137 N) (P < .001). Load to total failure was comparable among the 3 different FWC knots (2,642-2,804 N), which were significantly stronger than SSWC (1,775 N, P < .001). At 3 mm of distraction, SSWC (1,820 N), cow hitch (1,803 N), and single-throw hitch (1,709 N) performed significantly better than a 4-throw knot (1,289 N) (P < .01). Subsidence testing showed no difference in force restraint or gap opening between the best FWC and SSWC.


FWCs appear, in vitro, equally suitable to steel wires to stabilize nondisplaced periprosthetic humeral fractures. To actively reduce a displaced fracture, steel wires may still be the first choice.


Cerclage; periprosthetic humeral fracture; total shoulder arthroplasty

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