Loosely secure the plate to the proximal femur with a Verbrugge clamp. The plate of the dynamic condylar screw was contoured in harmony with the flare of the trochanter as per the pre-operative planning. Dynamic condylar screw has been found to be less technically demanding and provided good to excellent results as compared to other implants in treating patients with supracondylar and simple intracondylar fractures of the femur.3 Traditionally the DCS has been used by the open technique by exposing the fracture site. Subscribe to journal. The TIBER™Dynamic Condylar Screw is designed to provide strong and stable fixation ofa variety certain distal femoral subtrochanteric fractures,with minimal soft tissue . The distal femur has a unique anatomical shape. The popliteal vessels, the tibial nerve, and the common peroneal nerve lie near the posterior aspect of the distal femur. Insertion of screws in this manner leaves an area free of screw traffic or a "free-zone" of bone into which a laterally based plate system can be inserted (dotted circle). Fixation with compression should be applied when possible in fracture patterns where there is contact between the proximal and distal main fragments. Pearl: The combination of reduction aids is often necessary to obtain anatomic reduction. Materials and Methods: This prospective study was done on 56 patients aged above 18 years with distal femur fractures. Access options Buy single article. If a large fragment has separated from the fracture zone and impaled the adjacent muscle, direct reduction may be required. On occasions, it is acceptable to insert screws through the articular surface, when no other option is available. Union was achieved in all cases (100%), with full-weight bearing after an average of 4.9 months. The dynamic condylar screw is a safe and reliable implant for the management of subtrochanteric fractures with predictable results when principles of open reduction and internal fixation, biological reduction and bone grafting are followed as indicated. Due to the pull of the gastrocnemius muscle, the distal fragment tends to be displaced into extension at the metaphyseal fracture area, when distraction is applied. These anatomical details are important when inserting screws. The dynamic condylar screw (DCS) is an impressive method of treatment of these fractures with various advantages of early active knee motion, full range of movement preserved, stable internal fixation and maintenance of joint congruity. Methods. The dynamic condylar screw (DCS) is like the DHS in its design and concept. We have used dynamic condylar screw fixation to stabilize subtrochanteric fractures in our set –up. Therefore, if a straight AP view is obtained, the guidewire can appear to be inside the bone. 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. The depth of guide-wire insertion is crucial. Fractures were classified according to the AO classification (10 type … If the soft-tissue attachments to these fragments are preserved, and the fragments are generally aligned, healing is unimpaired. Results of dynamic condylar screw for subtrochanteric fractures. The aim of this study was to determine the amount of cortex loss in the distal femur when inserting a DCS-Plate. The use of a dynamic condylar screw and biological reduction techniques for subtrochanteric femur fracture. Another option involves taking radiographic images of the contralateral distal femur for comparison. Remember that the cross section of the distal femoral condylar mass is trapezoidal and slopes markedly on the medial side. To ensure that femoral length has been restored, many options exist: Determine the correct position for the DCS with the help of guide wires around the joint. Use the impactor to bring the plate down to the bone, with the barrel sliding over the screw shank. Stable. Implant removal is not essential but should be discussed with the patient if there are implant-related symptoms after consolidated fracture healing. Insertion of a Schanz pin from anterior to posterior in the distal femoral articular block, which can be used to correct hyperextension. Mitkovic M, Bumbasirevic M, Golubovic Z, et al. Few tricks in the technique make use of dynamic condylar screw in biological fixation of comminuted subtrochanteric fractures easier. dynamic condylar screw-plates (DCS-Plates) on the distal femur. This site uses cookies to improve your experience and to help show ads that are more relevant to your interests. Once adequate alignment is achieved, insert a screw through the plate to secure the fixation. The use of the Schanz pin in conjunction with the pointed reduction forceps is therefore preferred. Malunion was seen in 2 cases out of 31 (6.4%) without the need for further surgery. Ideally, patients are fully weight-bearing, without devices (e.g., cane) by 12 weeks. One option involves reducing the fracture fragments anatomically, either directly or indirectly with fluoroscopic control. Five patients died before fracture healing. To review the results of indirect reduction and mini-incision dynamic condylar screw (DCS) fixation for comminuted subtrochanteric femoral fractures. 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. This will allow the plate to sit against distal femur. Serial x-rays allow the surgeon to assess the healing of the fracture. Pitfall: It is important to remember that the distal femur tapers from the posterior to the anterior. Thrombo-prophylaxis should be given according to local treatment guidelines. If rotation is correct, this cord will pass over the midline of the patella, and slightly medial to the tibial eminence. Insert the proximal and distal fixator (distractor) pins carefully in order not to conflict with the later plating procedure. For the plate barrel to slide over the screw, the T-handle should be parallel, on the lateral view, to the long axis of the distal fragment. This implant is particularly useful for obtaining metaphyseal compression. Ten out of 11 young patients, (nine with high-energy injuries), united primarily. Anatomical reduction of all fracture segments may not be desired except in simple fracture patterns. The dynamic condylar screw (DCS) is a new implant engineered by the AO/ASIF Group for use in management of proximal and distal femoral fractures. 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. This device has some technical advantages over the AO condylar blade plate. Alternative: Some surgeons reconnect T-handle to the screw to help to adjust the position the plate. Insert the screw eccentrically in the plate hole to maintain the fracture compression. There are no significant arteries, veins, or nerves on the lateral side of the knee. Abstract We report our initial experience in Nottingham of use of the AO Dynamic Condylar Screw (DCS) implant system for internal fixation of fractures of the proximal and distal femur. The ideal entry point for the DCS is shown on the diagram. Wound healing should be assessed at two to three weeks postoperatively. When reduced, a temporary cerclage wire is used to lock the position of the Schanz screw relative to the distractor. Early range of motion helps restore movement in the early postoperative phase. US$ 39.95. [citation needed] It is the most commonly used implant for extracapsular fractures of the hip, which are common in older osteoporotic patients. Some surgeons find it useful to use an external fixator (or femoral distractor) from the proximal femur to the proximal tibia. The Dynamic Condylar Screw is designed to provide strong and stable internal fixation of certain distal femoral and subtrochanteric fractures, with minimal soft tissue irritation. 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. Screws are inserted along the periphery of the articular surface of the lateral femoral condyle going from lateral to medial or from medial to lateral to compress the intercondylar split. A line is drawn from the anterior aspect of the lateral femoral condyle to the anterior aspect of the medial femoral condyle (patellofemoral inclination) that slopes approximately 10°. 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 … Additionally, the compression screw will provide additional compression across any intraarticular split. Dynamic Condylar Screw Fixation for Comminuted Proximal Femur Fractures Fig II: Same fracture two months postoperative after fixation with dynamic condylar screw construct. The patients were operated under spinal anaesthesia. Tax calculation will be finalised during checkout. Pass a second guide wire over the anterior surface of the knee to indicate the plane of the patello-femoral condyles (green). In this technique, it is important that the x-ray beams are perpendicular to the OR table and that the ruler is parallel to the OR table. Kulkarni SS, Moran CG. The two holes closest to the barrel accept 6.5 mm Cancellous Bone Screws. This end-on view demonstrates the screw trajectories from lateral to medial. It is very important to restore the biomechanical axis of the lower limb. Because of this, vascular injuries occur in about 3% and nerve injuries in about 1% of fractures of the distal femur. The fixed angle between plate and barrel is 95° and the plate is contoured to fit the lateral surface of the distal end of the femur. 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. 2.1. This axis can be checked intraoperatively by using a piece of cable, such as the diathermy cord. An image intensifier or intraoperative radiography was used for the procedure. These screws must be countersunk and recessed beneath the articular surface. It may not be used in situations of severe metaphyseal comminution and/or osteoporosis. Thirty-one consecutive patients with a mean age of 32.6 years, who sustained subtrochanteric femoral fractures, were treated with this method. 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. The approach must adequately expose the articular surface of the distal femoral condyle. The muscle attachments to the distal femur are responsible for the typical displacement of the distal articular block following a supracondylar fracture, namely shortening with varus and extension deformity. 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