Abstract

Introduction: Extra-articular proximal tibial fractures, particularly AO/OTA 41-A2 patterns, are associated with a high risk of malalignment when treated with intramedullary nailing. Deforming forces acting on the short proximal fragment, most notably from the quadriceps mechanism, frequently result in sagittal plane malalignment with procurvatum. Although suprapatellar intramedullary nailing and adjunctive reduction techniques such as Poller screws have improved outcomes, maintaining reduction in selected cases remains challenging. The role of circumferential cerclage cables as a reduction-maintaining adjunct in this setting is not well described in the literature.

Case Report: We present the case of a 29-year-old male who sustained an isolated AO/OTA 41-A2 extra-ar ticular proximal tibial fracture following a motor vehicle accident. Definitive fixation was performed using a suprapatellar intramedullary tibial nail. Intra-operatively, the proximal fragment repeatedly displaced into extension during guidewire passage and reaming despite appropriate entry point selection and standard re duction manoeuvres. To address persistent sagittal plane instability, a circumferential cerclage cable was applied around the proximal tibial metaphysis and tensioned under fluoroscopic guidance. This successfully neutralized deforming forces and maintained reduction throughout nail insertion. Final imaging confirmed satisfactory alignment in both sagittal and coronal planes.

Conclusion: Circumferential cerclage cable application may serve as a useful adjunct for maintaining reduc tion during suprapatellar intramedullary nailing of selected AO/OTA 41-A2 proximal tibial fractures with per sistent proximal fragment extension. When applied judiciously, this technique may help prevent malalignment.

DOI: doi.org/10.63721/26JCTC0126

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