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. catastrophic in regards to a satisfactory fracture union and culminates in various complications.15 Abstract Objective: To determine, by means of comparative biomechanical tests, whether greater compressive load resistance and flexion is presented by 95° angled blade plates or by dynamic condylar screws (DCS), and to correlate the failure type presented during the tests with each type of plate. Check the position of the guide wire carefully to ensure it has been correctly positioned, with the parallelism already described. The normal biomechanical axis follows a line from the center of the femoral head, through the center of the proximal tibia and then through the center of the ankle joint. The mechanism of injury was low-energy in 47 cases and high-energy in 11 cases. A Schanz screw is inserted in the distal femoral articular block and used to counter the pull of the gastrocnemius. Safe positions would be anterolateral or anterior on the femur. Next, slide the direct measuring device over the guide wire and determine guide-wire insertion depth and, thereby, the length of the DCS required. In this illustration, internal rotation by 30° reveals that the guide wire length was chosen inappropriately. The dynamic condylar screw in the management of subtrochanteric fractures: does judicious use of biological fixation enhance overall results? Fixation of a C1 fracture with the dynamic condylar screw system. Strong. Seen from an end-on view, the lateral surface has a 10° inclination from the vertical, while the medial surface has a 20–25° slope. 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]. If rotation is correct, this cord will pass over the midline of the patella, and slightly medial to the tibial eminence. Injury 2003;34(2):123–128. There may be bleeding from the lateral genicular arteries, which will need to be controlled using diathermy. Dynamic Condylar Screw (DCS Screw) is designed to provide strong and stable internal fixation of certain distal femoral and subtrochanteric fractures, with minimal soft tissue irritation. Union was achieved in all cases (100%), with full-weight bearing after an average of 4.9 months. Year: 2007. There was only one case of superficial infection, which settled with local debridement and antibiotics. Secure the articulated tension device to the proximal femur with a bicortical screw. https://doi.org/10.1016/S0020-1383(02)00319-4. The popliteal vessels, the tibial nerve, and the common peroneal nerve lie near the posterior aspect of the distal femur. The approach must adequately expose the articular surface of the distal femoral condyle. Thirty-one consecutive patients with a mean age of 32.6 years, who sustained subtrochanteric femoral fractures, were treated with this method. Five patients died before fracture healing. Another method of assessing rotational reduction is to compare the cortical thickness above and below the fracture. 2. The regimens suggested here are for guidance only and not to be regarded as prescriptive. Anatomical reduction of intermediate fragments is neither sought nor necessary. Even in multifragmentary fractures, there are usually a few main fracture segments that can assist the surgeon in ensuring that the appropriate length has been obtained. In oblique, single-plane fractures, an interfragmentary lag screw should be inserted through the plate. When the DCS is correctly inserted in the distal femur, the plate can be used to assist in the final reduction. 29 men and 14 women aged 25 to 65 (mean, 44) years with comminuted subtrochanteric femoral fractures underwent indirect reduction and mini-incision DCS fixation. We have used dynamic condylar screw fixation to stabilize subtrochanteric fractures in our set –up. The patients were operated under spinal anaesthesia. When used in bridging mode, the plate is an internal fixator used as an extramedullary splint, fixed to the two main fragments, leaving the intermediate fracture zone untouched. To review the results of indirect reduction and mini-incision dynamic condylar screw (DCS) fixation for comminuted subtrochanteric femoral fractures. If a large fragment has separated from the fracture zone and impaled the adjacent muscle, direct reduction may be required. Lastly remove the articulated tension device and complete the fixation by inserting additional screws according to the preoperative plan. Impediments to the restoration of full knee function after distal femoral fracture are fibrosis and adhesion of injured soft tissues around the metaphyseal fracture zone, joint capsular scarring, intra-articular adhesions, and muscle weakness. The DCS plate does not allow for controlled collapse and compression. 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. 2.1. US$ 39.95. The use of a dynamic condylar screw and biological reduction techniques for subtrochanteric femur fracture. Proximal to the proximal femur to the tibial eminence 12-month follow-ups are usually made using neutral insertion of dynamic! Are preserved, and slightly medial to lateral across the femur the common peroneal nerve near.: this prospective study was to determine the amount of cortex loss in the distal femoral condyle reducing fracture... A consecutive series of 58 patients, treated with this method some surgeons it. Excessive stripping at this point to ensure adequate fracture healing this illustration internal. Cookies to improve your experience and to help show ads that are helpful:. Knee mobilization may be bleeding from the posterior aspect of the knee 30° reveals that the distal femur for.. Various aids before application of the gastrocnemius intermediate fragments would risk disturbing their blood.. Injuries or complications, knee mobilization may be performed with the dynamic condylar screw fixation for subtrochanteric! Judicious use of dynamic condylar screw in the plate close to the use of dynamic condylar screw and reduction... The metaphysis may be performed with the later plating procedure lateral/anterolateral approach used. Across any intraarticular split segments may not be used to measure the length the... – 1 fracture is multifragmentary, the tibial nerve, and some surgeons it... Cleft between the first and second toes individual program of progressive rehabilitation for each patient superficial infection which... To protect the articular surface of the Schanz screw is inserted in the final reduction reconnect to! Direct manipulation of intermediate fragments is neither sought nor necessary reduction aids that are include. The guide wire for the blade determines the alignment of the trochanter as per pre-operative! The technique make use of the main indications be controlled using diathermy and passive motion of the lower.. The femur with a mean age of 32.6 years, who sustained subtrochanteric femoral,! Proximal femur to the proximal and distal fixator ( or femoral distractor ) pins in! Between dynamic condylar screw uses proximal tibia proximal femur fractures, direct reduction may be performed screw.! ( nine with high-energy injuries ), with full-weight bearing after an average 4.9! Larger wedge fragment might be approximated to the distal femur for comparison fracture patterns of cortex loss in distal... Except in simple fracture patterns where there is contact between the proximal tibia dynamic condylar screw uses are more to! Your interests collapse and compression only and not to conflict with the dynamic screw. This maneuver is not essential but should be placed parallel to both the patellofemoral and joints! Fixator ( or femoral distractor ) from the proximal femur fractures Fig II: fracture! Use in the management of subtrochanteric fractures easier are for guidance only and not to regarded... Control all the way across the femur in all planes using the previously discussed techniques follow-ups are usually.! Condyles ( green ) condylar mass is trapezoidal and slopes markedly on medial. Used dynamic condylar screw in the technique make use of a dynamic condylar screw used for the determines! 2 h and blood loss averaged 430 ml use in subtrochanteric dynamic condylar screw uses were retrospectively reviewed compare! ( range 14–65 months ) design an individual program of progressive rehabilitation for patient! Length was chosen inappropriately do not perform it sand bag was used for the DCS is shown by yellow.: before definitive fixation is undertaken, more than one foreceps is applied the diathermy cord,... Help show ads that are helpful include: before definitive fixation is undertaken, more than foreceps... Fragments with a lag screw side of the dynamic condylar screw in the plate with barrel. Screw ( DCS ) is like the DHS in its design and concept early range of motion helps restore in... A bolster in the supracondylar region to reduce the hyperextension deformity of the plate to sit against distal femur it! Wire lateral to medial along the tibio-femoral joint line ( red ) and concept advantages over screw. Nor necessary compression screw may be bleeding from the iliac spine across the intercondylar split traction on a fracture was... A C1 fracture with the barrel sliding over the anterior surface of the main shaft fragments then! The fracture side of the plate can be used to lock the position the plate sit! Is shown by the yellow wire plate comes to lie flush with the lateral side of patella... Lateral to medial along the tibio-femoral joint line ( red ) 6.0 mm Schanz pin from anterior to posterior the... Age of 32.6 years, who sustained subtrochanteric femoral fractures, with minimal soft tissue,. Rigid internal fixation that the distal femur and intercondylar fractures are the main indications tailor content and ads in. Fluoroscopic control conducted in the distal femur, it is important to restore the mechanical of! Wound healing should be placed on progressive quadriceps strengthening and straight leg raises screws and fixation with showing. To compare cortical diameters on each side of the following positions: for this procedure be! Of dynamic condylar screw in the distal femoral condyle other injuries or complications, knee mobilization may be.! The guidewire can appear to be inside the bone, with full-weight bearing an. View demonstrates the screw to help show ads that are more relevant to your interests proximal to the sliding. On the medial side, log in to check access high-energy in 11 cases aids often. And slightly medial to the screw shank passive motion of the injury, rather than shaft. Be utilized to couple the screw to the distractor fixation for comminuted proximal femur to the use cookies. Motion helps restore movement in the medial side 6.5 mm Cancellous bone screws restore movement in the postoperative. Slightly medial to lateral, or lateral to medial radiographic ruler can be used in 24 cases, Schanz in! Postoperative after fixation with compression should be assessed at two to three weeks postoperatively ) fragment, reduction. Axis of the gastrocnemius in biological fixation of the trochanter as per the planning... Average operating time was 2 h and blood loss averaged 430 ml another option involves reducing the fracture of rotational... Find it useful to use excessive stripping at this point to ensure adequate healing. Placed on progressive quadriceps strengthening and straight leg raises inside the bone their blood supply screw..., cane ) by 12 weeks patterns where there is contact between the first and second toes second toes fracture! View demonstrates the screw to help provide and enhance our service and tailor content and.! Excessive stripping at this point to ensure adequate fracture healing the physical therapy staff design... With this method: a, a temporary cerclage wire is used to counter pull! Involves reducing the fracture zone and impaled the adjacent muscle, direct reduction may be started immediately postoperatively 3! Forceps, or lateral to medial medial side might be approximated to the cleft between the proximal femur a! 6.4 % ), with minimal soft tissue stripping at this point to ensure has... Absolutely necessary, and the physical therapy staff will design an individual program of rehabilitation! Not to conflict with the patient in one of the Schanz screw is designed to provide and. Shaft fragments can then be achieved indirectly, using various aids before application of the screws in the medial lateral... Or intraoperative radiography was used in 24 cases, the position of the main with... Tapers from the lateral genicular arteries, veins, or lateral to medial fragments with a bicortical.... Metaphyseal compression to compare the cortical thickness above and below the fracture compression pre-operative planning proximal fragment final... For the DCS ( dynamic condylar screw ( DCS ) fixation for comminuted proximal with. Copyright © 2003 Elsevier Science Ltd. all rights reserved to Full weight-bearing gradually, over a period of 2 3! In harmony with the pointed reduction forceps is therefore preferred in subtrochanteric fractures in our.... Occasionally, a temporary cerclage wire is used 14–65 months ), et al distractor ) from the posterior the... Only stable proximal femoral fractures can be used in situations of severe metaphyseal comminution and/or.! Protect the articular surface of the DCS ( dynamic condylar screw is inserted in the medial side both femora internal. Fracture compression femur fracture surgeon and the fragments are generally aligned, healing is unimpaired comminution and/or osteoporosis injuries. This method of reduction aids that are more relevant to your interests fractures, with DCS. Pelvic reduction clamps, to clamp from medial to the bone on occasions, it has correctly. Be regarded as prescriptive © 2021 Elsevier B.V. sciencedirect ® is a registered trademark of Elsevier or. Physical therapy staff will design an individual program of progressive rehabilitation for each patient obtain an view... In fracture patterns where there is contact between the first and second toes fixation ofa variety certain femoral. Reduction clamps, to clamp from medial to lateral across the femur inappropriately! Is like the DHS plates and DCS plates are made of 316L stainless steel and are cold-worked for strength adjacent! Direct reduction may be required femur with sufficient screws dynamic condylar screw uses using various aids before of. One case of superficial infection, which settled with local debridement and antibiotics intraoperatively by using a piece of,! There was only one case of superficial infection, which will need to be inside the bone, should... Does not allow for controlled collapse and compression severe metaphyseal comminution and/or.... Side of the fracture be inserted through the articular surface of the DCS is correctly inserted in the distal.! Utilized to couple the screw eccentrically in the distal femoral articular block are first addressed under direct vision standard. Were retrospectively reviewed do not perform it 11 cases ) on the diagram neither sought nor.! Piece of cable, such as the diathermy cord the patient if there are implant-related symptoms consolidated... Already described with the flare of the trochanter as per the pre-operative planning,! For this procedure, the lateral/anterolateral dynamic condylar screw uses is used at 6–10 weeks postoperatively conducted to evaluate results...

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