Additionally, the compression screw will provide additional compression across any intraarticular split. Anatomical reduction of intermediate fragments is neither sought nor necessary. The ideal entry point for the DCS is shown on the diagram. If the plate does not fit nicely against the side of the distal femur, then a chisel can be used to prepare a small channel for the DCS to recess into. subtrochanteric fractures and use of AO dynamic condylar screw (DCS), in their management. The ideal position of the DCS is shown by the yellow wire. A study was designed to examine the outcomes of patients with closed comminuted subtrochanteric femoral fractures fixed with a dynamic condylar screw (DCS) and using biological (indirect) reduction techniques at a tertiary referral centre. Alternative: Some surgeons reconnect T-handle to the screw to help to adjust the position the plate. The mechanism of injury was low-energy in 47 cases and high-energy in 11 cases. Loosely secure the plate to the proximal femur with a Verbrugge clamp. Because of this, vascular injuries occur in about 3% and nerve injuries in about 1% of fractures of the distal femur. Ideally, patients are fully weight-bearing, without devices (e.g., cane) by 12 weeks. Alignment of the main shaft fragments can be achieved indirectly with the use of: Mechanical stability, provided by the bridging plate, is adequate for gentle functional rehabilitation and results in satisfactory indirect healing (callus formation). Wound healing should be assessed at two to three weeks postoperatively. The popliteal vessels, the tibial nerve, and the common peroneal nerve lie near the posterior aspect of the distal femur. Reduction techniques. The regimens suggested here are for guidance only and not to be regarded as prescriptive. This device has some technical advantages over the AO condylar blade plate. The Dynamic condylar screw is an impressive mode of treatment with advantages of early and good range of motion, stable internal fixation and maintenance of anatomical reduction but the main disadvantage is that it can only be used when atleast 4 cms of … Five patients died before fracture healing. Another option involves taking radiographic images of the contralateral distal femur for comparison. A 5.0 mm or 6.0 mm Schanz pin in the medial and/or lateral femoral condyle to act as a joystick. The use of a dynamic condylar screw and biological reduction techniques for subtrochanteric femur fracture. Secure the articulated tension device to the proximal femur with a bicortical screw. Use the impactor to bring the plate down to the bone, with the barrel sliding over the screw shank. After tapping, insert the DCS over the guide wire, so that its outer end is still visible 2-3 mm outside the lateral cortex of the distal femur. At the posterior aspect of the knee lie the popliteal artery, nerve, and vein. This will be continued for 6-10 weeks postoperatively. Not only must the biomechanical axis be restored, but care should be taken to ensure that there is no malrotation of the distal femur on the proximal femur. Thrombo-prophylaxis should be given according to local treatment guidelines. Stainless Steel (Grade SS 316L) 2. This procedure may be performed with the patient in one of the following positions: For this procedure, the lateral/anterolateral approach is used. A Schanz screw is inserted in the distal femoral articular block and used to counter the pull of the gastrocnemius. Thirty-one consecutive patients with a mean age of 32.6 years, who sustained subtrochanteric femoral fractures, were treated with this method. Serial x-rays allow the surgeon to assess the healing of the fracture. If rotation is correct, this cord will pass over the midline of the patella, and slightly medial to the tibial eminence. Insertion of a Schanz pin from anterior to posterior in the distal femoral articular block, which can be used to correct hyperextension. If a shaft fracture is multifragmentary, the image intensifier cannot be used to compare cortical diameters on each side of the fracture. Shortening is due to the pull of the quadriceps and hamstring muscles, while the varus and extension deformity is caused by the unopposed pull of the adductors and gastrocnemius, respectively. Fixation with compression should be applied when possible in fracture patterns where there is contact between the proximal and distal main fragments. The Dynamic Condylar Screw (DCS; Synthes, Bettlach, Switzerland) has been designed for the internal fixation of fractures of the distal and subtrochan- teric regions of the femur and has superior biomechanical properties compared to the blade plate [23–25]. The patients were operated under spinal anaesthesia. Direct manipulation of intermediate fragments would risk disturbing their blood supply. Florian Gebhard, Phil Kregor, Chris Oliver, Markku T Nousiainen. A cancellous screw can then be inserted into the most distal screw hole of the plate to prevent rotation of the distal femoral articular block around the axis of the DCS. The Dynamic Condylar Screw (DCS; Synthes, Bettlach, Switzerland) has been designed for the internal fixation of fractures of the distal and subtrochanteric regions of the femur and has superior biomechanical properties compared to the blade plate [23,24,25]. Attempts at a reduction of the intercondylar split with the pointed reduction forceps alone are often unsuccessful, as rotational control of the femoral condyle is also needed. This study was conducted to evaluate the results of fixation of this device in our Scenario .
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