Relaxation Behavior of Cerclage Cables and Its Effect on Bone Clamping Force.

Cerclage is an orthopedic surgical fixation technique using a cable wrapped, tensioned, and secured around a bone's circumference. It is important to minimize the loss in cable tension that often occurs due to stress relaxation. The purpose of this work was to study the effect of tensioning protocols on the long-term loss of tension due to stress relaxation. The native mechanical properties and relaxation behavior of the cables were determined using traditional mechanical testing machines and methods. Four step-wise cable tensioning protocols were then trialed to compare the cable tension losses. A testing apparatus was developed to simultaneously measure cable tension and the resulting clamping force on a real bone. A five-parameter linear viscoelastic model was used to fit relaxation data to estimate the long-term relaxation of the cables beyond the time of the experiment. The four cables were found to have similar mechanical and viscoelastic behaviors. A two-step cable-tightening protocol was found to significantly reduce cable tension loss when compared to a one-step protocol for all cables. The benefit of the two-step protocol was reinforced by the relaxation results of the cable wrapped and tightened around a pig femoral bone. These results indicate that one retightening step should be conducted during the surgical placement of a cerclage cable to reduce the loss of cable tension resulting from relaxation.