dynamic condylar screw intertrochanteric fractures

The DCS plate does not allow for controlled collapse and compression. The guide wire is advanced into the subchondral bone and its tip should lie 10 mm off the joint. Twelve unstable low-energy intertrochanteric fractures were fixed using 102° DCS. (range 12-16 weeks). The fascia lata is incised in line with the skin incision and in line with its fibers. Dynamic Condylar Screw Plate Warnings. Ernst Raaymakers, Inger Schipper, Rogier Simmermacher, Chris van der Werken. The mean time to union was 16 (range, 13-22) weeks. Dynamic hip screw (DHS) or Sliding Screw Fixation is a type of orthopaedic implant designed for fixation of certain types of hip fractures which allows controlled dynamic sliding of the femoral head component along the construct. Drill the hole for the screw and the plate sleeve. Related Links Articles in PubMed by Chung-Ho Pai; Articles in Google Scholar by Chung-Ho Pai; Other articles in this journal by Chung-Ho Pai; Related Videos. All of the following variables are associated with increased mortality at one year after injury EXCEPT? Design: Descriptive case series. Tested Concept, Remove the nail to re-assess fracture reduction, (OBQ13.2) Before 1999, 15 fractures were treated with a dynamic condylar screw (DCS) and after 1999, 11 fractures were treated with a gamma nail (GN). All of the following implants offer adequate fracture fixation of the injury shown in Figure A EXCEPT: Again it has to be checked under image intensification in 2 planes as the reduction determines the degree of internal rotation. The Lost Art With Better Success - Michael J. Gardner, MD (OSET 2018), Question Session | Intertrochanteric Fractures & Legg-Calve-Perthes Disease, Unstable Intertrochanteric Hip Fracture in a 72M. Biological fixation of subtrochanteric intertrochanteric femoral fractures using dynamic condylar screw Al-Azhar Med. ABSTRACT Background: Management of AO31A3 intertrochanteric fractures has unique problems because of pecu-liar anatomy, leading to high instability. Only stable proximal femoral fractures can be treated with the DCS (dynamic condylar screw) plate. This patient is at increased risk of what complication? Healing is usually complete by three months and full weight bearing can be resumed. Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. A patient with an intertrochanteric hip fracture undergoes reduction and dynamic hip screw application. Intraoperative fluoroscopy is seen in figure C. When attempting to remove the guide wire, there is a mechanical block, impeding its extraction. Only if necessary, and then not before 18 months. Anterior perforation of the distal femur from antegrade femoral nailing has been attributed to what factor? The post-operative radiographs demonstrate that the lag screw is superior in the femoral head with a tip-apex distance of 40 millimeters. fractures with intertrochanteric extension. We routinely use the sliding-screw plating systems for intertrochanteric fractures. DHS allows controlled collapse of the fracture followed by progressive stabilization. Select a screw which is the same length as measured. Tested Concept, Biomechanically advantageous under physiologic loading, (OBQ09.233) All cases were treated using the principles of strict indirect reduction to achieve anatomic alignment rather than anatomic reduction, with no bone grafting, and delayed weight bearing. Although this device was designed for use in the distal femur, it has features which make it attractive for use in subtrochanteric fractures. male gender (25-30% mortality) vs female (20% mortality), higher in intertrochanteric fracture (vs femoral neck fracture), 2 or more pre-existing medical conditions, co-management with medical hospitalists or geriatricians, useful if radiographs are negative but physical exam consistent with fracture, MRI useful to evaluate intertrochanteric extension with isolated greater trochanteric fracture patterns, preexisting symptomatic degenerative arthritis, osteoporotic bone that is unlikely to hold internal fixation, must obtain correct neck-shaft relationship, 4 hole plates show no benefit clinically or biomechanically over 2 hole plates, allows dynamic interfragmentary compression, can cause anterior spike malreduction in left-sided, unstable fractures due to screw torque, mismatch of the radius of curvature of the femur (shorter) and implant (longer), posterior starting point on the greater trochanter, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Malunion and Nonunion, Distal Radial Ulnar Joint (DRUJ) Injuries, roughly the same as femoral neck fractures, typically older age than patients with femoral neck fractures, proximal humerus fractures increase risk of hip fracture for 1 year, low energy falls in osteoporotic patients, intertrochanteric area exists between greater and lesser trochanters, vertical wall of dense bone that extends from posteromedial aspect of femoral shaft to posterior portion of femoral neck, helps determine stable versus unstable fracture patterns, Stability of fracture pattern is arguably the most reliable method of classification, will resist medial compressive loads once reduced, measured from 3 cm distal from innominate tubercle at 135 degrees to the fracture site, <20.5 mm suggests risk of postoperative lateral wall fracture, should be treated with intramedullary implant rather than sliding hip screw, fracture will collapse into varus and retroversion when loaded, fractures with a large posteromedial fragment, oblique fracture line extending from medial cortex both laterally and distally, patients at high risk for perioperative mortality, high rates of pneumonia, urinary tract infections, decubiti, and DVT, equal outcomes when compared to intramedullary hip screws for stable fracture patterns, 56% failure when treated with sliding hip screw, associated with increased displacement and collapse when treated with sliding hip screw, increased risk of lateral wall fracture with decreasing lateral wall thickness, use has significantly increased in last decade, short implants with optional distal locking, requires violation of hip abductors for insertion, must attempt fixation of greater trochanter to shaft, possible earlier return for full weight bearing, may require prosthesis that some surgeons are unfamiliar with, tip-apex distance >45 mm associated with 60% failure rate, can occur following intramedullary screw fixation, varus and rotational deformities are common. Methods. In this case traction can be applied by an assistant. The length of the plate is determined by the extent of the fracture. Compression of the fracture might be achieved if the cortical screws are inserted in a load position starting with the most distal screw. Before 1999, 15 fractures were treated with a dynamic condylar screw (DCS) and after 1999, 11 fractures were treated with a gamma nail (GN). Exclusion Criteria were: Skeletally immature patients. The dynamic hip screw or sliding hip screw fixation is used to fix proximal femur fracture. The use of a traction table depends on the surgeon’s preference. Considering the technical aspects of the osteosynthesis of these fractures, in our department, we staged the procedure one week apart. The vastus lateralis muscle is elevated from the intermuscular septum just enough to expose the fracture. Keywords Intertrochanteric fractures, Dynamic Condylar Screw (DCS). Patients with associated neurovascular complications. 3,5,6 Though its use involves a relatively simple operative procedure, various modes of failure of DCS were observed in reverse oblique trochanteric fractures like cutting out of screw, breakage of the plate, and screw or plate pull off from the bone. Dynamic hip screw (DHS) fixation has been considered the gold standard for treatment of stable intertrochanteric fractures7,8. In most instances it will be an intramedullary device. The dynamic condylar screw (DCS) is like the DHS in its design and concept. All fractures united. (OBQ16.168) Copyright © 2021 Lineage Medical, Inc. All rights reserved. Which of the following factors has been shown to be associated with increased collapse or sliding displacement? Sixteen cases of subtrochanteric femur fractures with greater trochanteric extension were treated using the AO dynamic condylar screw (DCS). 1996; 25 (A): 265-275 Massoud Abdel Hakim A. Al-Azhar Medical Journal Journal Country: Egypt ISSN: 1110-0400 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. Its position should be checked using image intensification in an AP view, according to the anticipated position of the guide wire. The mean age of all patients was 70 (31–92) years, and the mean follow up was 16 (9–30) months for the DCS group and 14 (6–26) months for the GN group. A 72-year-old male sustains the injury shown in Figure A as a result of a fall from a ladder. 95° Dynamic condylar screw (DCS) and proximal femoral nail (PFN) are currently the most commonly used implants for its fixation. Tested Concept, The use of intramedullary nail has increased in the last ten years, The use of sliding hip screws has increased in the last ten years, Medicare reimbursement is more for a sliding hip screw, Intramedullary nails have demonstrated superior outcomes in randomized-controlled studies, Sliding hip screw is superior for treatment of reverse obliquity intertrochanteric fractures, (OBQ09.222) If necessary use a small Hohmann in order to visualize the bone.A pointed reduction clamp is used to reduce the fracture and maintain reduction. Fractures of the distal femur and intercondylar fractures are the main indications. Begin with partial weight bearing for the first 6 weeks. The post-operative radiographs demonstrate that the lag screw is superior in the femoral head with a tip-apex distance of 40 millimeters. Patient ages ranged from 79 to 92 years. Background: Intertrochanteric fractures are one of the commonly occurring injuries in elderly patients and are high among females and those with osteoporosis. The DCS plate does not allow for controlled collapse and compression. Note: Only stable proximal femoral fractures can be treated with the DCS (dynamic condylar screw) plate. They were treated with either dynamic hip screw (DHS) fixation or proximal femoral nailing (PFNA2) here at our institution. If at six weeks healing is progressing uneventfully, more loading might be allowed. When treating a stable 2-part intertrochanteric hip fracture with a sliding hip screw construct, what is the minimum number of screw holes that are needed in the side plate for successful fixation? Which of the following factors has been shown to be the strongest predictor of screw cutout of a dynamic compression hip screw used for an intertrochanteric femur fracture? Many implants have been used for operative treatment of these fractures, and most series report technical failures; we report the use of the AO dynamic condylar screw (DCS). While the surgeon must make the final decision on removal of the broken part based on associated risk in doing so, we recommend that whenever possible and practical for the individual patient, the broken part should be removed. The patient was lost for follow-up and was re-admitted with non-union, hardware loosening and broken screws 2 years after the operation. If a traction table is used, the patient should be positioned as indicated in the drawing with his ipsilateral arm elevated in a sling while the contralateral uninjured leg is placed on a leg holder.Reduction will be achieved by first pulling on the leg in order to distract the fragments and regain length. Dynamic Hip Screw Compared to Condylar Blade Plate in the Treatment of Unstable Fragility Intertrochanteric Fractures May 2009 Malaysian Orthopaedic Journal 3(1):13-18 Tested Concept, Trochanteric entry point cephalomedullary nail, Piriformis fossa entry point cephalomedullary nail, (OBQ05.161) [citation needed] It is the most commonly used implant for extracapsular fractures of the hip, which are common in older osteoporotic patients. The decision is made to treat her with a trochanteric entry nail. To avoid bleeding, tie off the perforating vessels. If the fracture pattern allows, additional cortical screws should be inserted into the proximal fragment to augment the fixation. However, there are divergent opinions about the fixation of unstable intertrochanteric fractures in the elderly. April 2020; DOI: 10.18410/jebmh/2020/152. 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