Abstract
Dall-Miles cables were introduced in 1985 by Stryker Orthopedics for reattachment after greater trochanteric osteotomy. Prior fixation for greater trochanteric osteotomies was obtained with stainless steel monofilament wire, routinely used by Sir John Charnley. The cables were clearly much stronger. This system consisted of a rectangular four clawed grip and two cables. Two cables were passed thru the claw and around the medial aspect of the upper femur, as well as around the neck or under the collar of a femoral component. A tensioner was devised which would distract opposite ends of one cable, and a powerful squeezing device is used to fix rigidly the cable so that it remained securely held in the claw. In addition, “sleeves” were developed—small rectangular solids made of cobalt-chrome with two parallel holes going from end to end. Two ends of cable are passed thru the holes, pulled tight and locked by using the squeezing tool, the “crimp”, which holds the cables very securely in the desired position.
All of this worked much better than the wiring technique. However, it needed some additional features. The vertical pull of the abductor musculature was not optimally opposed by the cerclage aspects going thru the cross pieces in a largely lateral to medial direction. The vertical pull could relatively easily displace the trochanteric fragment.
I solved this problem by incorporating a secure distal cerclage cable whose tails were taken to and passed thru the lower bar (cross piece) of the grip. The ends of this cable coming thru the lower cross piece are pulled, distracted away very tightly and the lower cross piece is crimped, holding the cable securely. That cable is then passed around the shaft of the femur and cerclaged tightly, using a simple sleeve, tightly crimped.
This technique was published in this citation. Krackow, KA. A Technique for Improved Dall Miles Trochanteric Re-attachment.
