Study of the Effectiveness of a Polymer Cerclage System Compared to Cerclages Used in Standard Care (CERCPMCF) )

Official title

Outcomes of Adjuvant "Polymer Cerclage System "OrthoLoop" to Manage Prosthetic Rehabilitation, Per Prosthetic or Primary Femoral and Humeral Fractures. A Prospective , Multicentric, Simple Blind , Comparative, Non-inferiority Study, Compared to Cerclage Systems Used in Standard Care.

Overview

The use of cerclage wiring in the management of long bone fractures is common. With the increase in the placement of total hip ans shoulder prostheses, the occurrence of peri-prosthetic hip an shoulder fractures is also increasing, notably due to an older population. Whether it is for a fracture on a native femur or humerus, or on a periprosthetic hip or shoulder fracture, the use of cerclage wiring is an adjuvant additional but not the main means to ensure stable osteosynthesis, allowing re-loading and early rehabilitation of patients. This method has demonstrated its ability to improve the fixation of this fracture type, associated with osteosynthesis or hip/shoulder prosthesis revision surgery. However, metal cerclage expose to a risk of metallosis which can compromise bone fusion, injury to neighboring soft parts causing pain and also injury to the surgical team when handling them. More recently, non-metallic cerclage have been developed and could overcome certain risks associated with metallic cerclage, while ensuring their bone fixing capacity and therefore bone consolidation. Indeed, non-metallic cerclage could withstand similar or even greater stresses than metallic cables, in particular concerning their resistance to rupture. The "Sterile Self Locking Polymer Cerclage System" named OrthoLoop is a polymer cerclage which has been developed and could be used in these indications. Thus, this study (SERRE) aims to investigate the clinical results and sequelae of adjuvant cerclage wires OrthoLoop Cerclage in the management of rehabilitation, per prosthetic or primary femoral or humeral fractures compared with cerclages system used in standard care. SERRE is a 36 months follow up study in two arms : * Experimental group: "OrthoLoop cercalge" * Control group: "cerclages used in standard care" After each surgery, the patient follow-up period is 36 months. with 4 planned consultation visits after surgery at 6-8 weeks, 3, 6 and 36 months, with collection and measurement of the endpoints. The main objective of this study is to assess the role of "OrthoLoop cerclage" of COUSIN Biotech in comparison with cerclages (metallic for the majority) used in standard care ; in the optimization of the consolidation of primary and periprosthetic femoral or humeral fractures, 6 months after surgery.

Interventions

• Device Implantation of Ortholoop cerclage
  implantation of Sterile Self Locking Polymer Cerclage System named OrthoLoop to the patient and follow up for 36 months post-intervention
• Device Implantation of Cerclage used in current practice
  implantation of Cerclage used in current practice to patients and follow up for 36 months post-intervention

Primary outcome measures

• Assess role of Polymer Cerclage System OrthoLoop of COUSIN Biotech in comparison with cerclages (metallic for the majority) used in standard care; in the optimization of the consolidation of primary and periprosthetic fractures of long bones [Time frame: 6 months post-surgery]

Secondary outcome measures (7)

• Assess consolidation rate during 6 months post surgery [Time frame: 6 months post-surgery]
• Asses union time [Time frame: 3, 6 and 36 months post-surgery]
• Assess rupture and migration rate of the cerclage after surgery throughout the follow-up [Time frame: 3, 6 and 36 months post-surgery]
• Assess pain [Time frame: 6-8 weeks,3, 6 and 36 months post-surgery]
• To report the incidence of complications and their treatment, particularly with respect to the need of further surgery [Time frame: During the whole study (up to 36 months)]]
• Assess surgery characteristics [Time frame: During surgery (at D0)]
• Assess physicians satisfaction regarding the use of "Sterile Self Locking Polymer Cerclage System [Time frame: During surgery (at D0)]

Eligibility criteria

Inclusion criteria

• patient with femoral or humeral fracture requiring the installation of one or more cerclage(s) and respecting at least one of the criteria below:
• Primary femoral or humeral fractures (diaphyseal, metaphyseal, epiphyseal proximal or distal) with osteosynthesis by plate and screw or osteosynthesis by Intramedullary nailing associated with the installation of one or more cerclage(s)
• Patients with traumatic fracture of femur or humerus that required prosthetic rehabilitation associated with the installation of one or more cerclage(s)
• Peri-prosthetic fracture of the femur or humerus
• Resumption of prosthesis (hip, knee, shoulder, elbow) requiring the installation of one or more cerclages
• who underwent fixation with cerclage wiring (Sterile Self Locking Polymer Cerclage System or other cerclage systems used in standard care)
• age ≥18 years
• Who have given free, informed and written consent to participate in the study
• Patient able to communicate in French
• Patient affiliated to a social security system or entitled to a social security system

Exclusion criteria

• high-energy injury,
• associated damage to other long bones,
• fracture extension to the articular surface with displacement
• Severe disease that could interfere with the study results or be life threatening
• Patients with an infection
• Allergy to any component of the medical products
• Pregnant or breastfeeding women
• Anticipated unavailability during the study
• Participation in a clinical trial within 3 months prior to the inclusion visit.
• Patient with linguistic or psychological incapacity to understand and sign the informed consent.
• Patient deprived of liberty by administrative or judicial decision, or being under guardianship.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

France · 15 centers

• Clinique ESQUIROL SAINT HILAIRE — Agen
• Hôpital Privé Francheville — Périgueux
• CH Tourcoing — Tourcoing
• CHU Lille — Lille
• CH Agen — Agen
• CH Arcachon — Arcachon
• Clinique de Saint Omer — Blendecques
• CH Le Mans — Le Mans
• … and 7 more centers

Publications

• Lindahl H. Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury. 2007 Jun;38(6):651-4. doi: 10.1016/j.injury.2007.02.048. Epub 2007 May 2. PMID 17477925
• Rayan F, Haddad F. Periprosthetic femoral fractures in total hip arthroplasty - a review. Hip Int. 2010 Oct-Dec;20(4):418-26. doi: 10.1177/112070001002000402. PMID 21157744
• Tsiridis E, Pavlou G, Venkatesh R, Bobak P, Gie G. Periprosthetic femoral fractures around hip arthroplasty: current concepts in their management. Hip Int. 2009 Apr-Jun;19(2):75-86. doi: 10.1177/112070000901900201. PMID 19462362
• Ferbert T, Jaber A, Gress N, Schmidmaier G, Gotterbarm T, Merle C. Impact of intraoperative femoral fractures in primary hip arthroplasty: a comparative study with a mid-term follow-up. Hip Int. 2020 Sep;30(5):544-551. doi: 10.1177/1120700019849911. Epub 2019 May 17. PMID 31096789
• Ebraheim NA, Sochacki KR, Liu X, Hirschfeld AG, Liu J. Locking plate fixation of periprosthetic femur fractures with and without cerclage wires. Orthop Surg. 2013 Aug;5(3):183-7. doi: 10.1111/os.12052. PMID 24002835
• Angelini A, Battiato C. Combination of low-contact cerclage wiring and osteosynthesis in the treatment of femoral fractures. Eur J Orthop Surg Traumatol. 2016 May;26(4):397-406. doi: 10.1007/s00590-016-1761-3. Epub 2016 Mar 17. PMID 26983607
• Gordon K, Winkler M, Hofstadter T, Dorn U, Augat P. Managing Vancouver B1 fractures by cerclage system compared to locking plate fixation - a biomechanical study. Injury. 2016 Jun;47 Suppl 2:S51-7. doi: 10.1016/S0020-1383(16)47009-9. PMID 27338228
• Angelini A, Battiato C. Past and present of the use of cerclage wires in orthopedics. Eur J Orthop Surg Traumatol. 2015 May;25(4):623-35. doi: 10.1007/s00590-014-1520-2. Epub 2014 Sep 4. PMID 25186972

Identifiers

NCT: NCT05087667 · 3069_CERCPMCF

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗