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

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


Hypothesis: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Cerclage; periprosthetic humeral fracture; total shoulder arthroplasty.

Publication types

  • Comparative Study

MeSH terms

  • Animals
  • Arthroplasty, Replacement / adverse effects*
  • Biocompatible Materials
  • Biomechanical Phenomena
  • Bone Wires*
  • Cattle
  • Humans
  • Humerus / injuries
  • Humerus / surgery*
  • Models, Animal
  • Periprosthetic Fractures / etiology
  • Periprosthetic Fractures / surgery*
  • Stainless Steel
  • Suture Techniques
  • Sutures


  • Biocompatible Materials
  • Stainless Steel