dynamic condylar screw uses

If the K-wires are inserted from medial to lateral, they may either go through small stab incisions in the skin or through the parapatellar retinaculum. Serial x-rays allow the surgeon to assess the healing of the fracture. A radiographic ruler can be used to measure the length of both femora. Pointed reduction forceps, or large pelvic reduction clamps, to clamp from medial to lateral across the intercondylar split. 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. With stable fracture fixation, the surgeon and the physical therapy staff will design an individual program of progressive rehabilitation for each patient. Secure the articulated tension device to the proximal femur with a bicortical screw. 2. 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. Stable. Dynamic Condylar Screw is cost-effective and procedure relatively easy to perform and affords a rigid internal fixation. 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. Fixation of a C1 fracture with the dynamic condylar screw system. Cite . Mitkovic M, Bumbasirevic M, Golubovic Z, et al. The ideal entry point for the DCS is shown on the diagram. Reduction techniques. In oblique, single-plane fractures, an interfragmentary lag screw should be inserted through the plate. This will allow the plate to sit against distal femur. At the posterior aspect of the knee lie the popliteal artery, nerve, and vein. Methods. Prior to plate fixation to the proximal fragment, final reduction of the metaphysis may be performed. Copyright © 2003 Elsevier Science Ltd. All rights reserved. This will be continued for 6-10 weeks postoperatively. Injury 2003;34(2):123–128. https://doi.org/10.1016/S0020-1383(02)00319-4. 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. 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 compression screw may be utilized to couple the screw to the plate. 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). We use cookies to help provide and enhance our service and tailor content and ads. 10. The preferred method depends on the fracture and soft-tissue injury pattern, the chosen stabilization device, and the experience and skills of the surgeon. If a shaft fracture is multifragmentary, the image intensifier cannot be used to compare cortical diameters on each side of the fracture. 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. Wound healing should be assessed at two to three weeks postoperatively. 2.1. Both active and passive motion of the knee and hip can be initiated immediately postoperatively. slot cut for the blade determines the alignment of the plate with the shaft, no further adjustment being possible. Another option involves taking radiographic images of the contralateral distal femur for comparison. Subsequently 6-week, 12-week, 6-month, and 12-month follow-ups are usually made. A Schanz screw is inserted in the distal femoral articular block and used to counter the pull of the gastrocnemius. The approach must adequately expose the articular surface of the distal femoral condyle. 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]. The two holes closest to the barrel accept 6.5 mm Cancellous Bone Screws. 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. Because of this, vascular injuries occur in about 3% and nerve injuries in about 1% of fractures of the distal femur. Reduction using axial traction on a fracture table was used in 24 cases , . 11. Therefore, if a straight AP view is obtained, the guidewire can appear to be inside the bone. This … Loosely secure the plate to the proximal femur with a Verbrugge clamp. Insertion of a Schanz pin from anterior to posterior in the distal femoral articular block, which can be used to correct hyperextension. 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. subtrochanteric fractures and use of AO dynamic condylar screw (DCS), in their management. In this illustration, internal rotation by 30° reveals that the guide wire length was chosen inappropriately. Complete the fixation of the plate to the femur with sufficient screws, using neutral insertion of the screws in the plate holes. New biological method of internal fixation of the femur. Early range of motion helps restore movement in the early postoperative phase. Courses, webinars, and online events, in your region or worldwide, Pediatric distal femur module is now online. MATERIAL AND METHODS This study was conducted in the Post- Graduate Department of Orthopaedics, Govt. Fractures were classified according to the AO classification (10 type … 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. The guide wire for the DCS is positioned at 2 cm proximal to the distal end of femur. Additionally, the compression screw will provide additional compression across any intraarticular split. On occasions, it is acceptable to insert screws through the articular surface, when no other option is available. OTHER INFORMATION The DHS plates and DCS plates are made of two materials – 1. Insert the guide wire at the chosen entry site of the DCS. The popliteal vessels, the tibial nerve, and the common peroneal nerve lie near the posterior aspect of the distal femur. If the mechanical axis is restored this should be adequate in most situations (fragmented patterns). The mechanism of injury was low-energy in 47 cases and high-energy in 11 cases. Results of dynamic condylar screw for subtrochanteric fractures. 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. Screw available holes: 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 105, 110, 115, 120, 125, 130, 135, 140 and 145. BibTex; Full citation; Publisher: Springer Science and Business Media LLC. 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. It may not be used in situations of severe metaphyseal comminution and/or osteoporosis. If a fracture pattern can be reduced to a "simple" metaphyseal fracture pattern (such as an intact wedge fracture where the wedge is fixed to the main fragment), then compression can be used for the metaphyseal "simple" fracture. By continuing you agree to the use of cookies. Tighten the articulated tension device with the spanner so that the indicator on the tension device is in the green zone, checking the fracture site carefully to ensure that no unwanted displacement occurs. Twenty-seven cases (87.2%) sustained these fractures either from traffic crashes or falls from height and the remaining four had a simple fall. Unless there are other injuries or complications, knee mobilization may be started immediately postoperatively. There was only one case of superficial infection, which settled with local debridement and antibiotics. This illustration shows the longitudinal axes of the lower limb. Detach the T-handle and pass the plate barrel over the screw shank. Remember that the cross section of the distal femoral condylar mass is trapezoidal and slopes markedly on the medial side. Lastly complete the fixation by inserting additional screws according to the preoperative plan. Pass a second guide wire over the anterior surface of the knee to indicate the plane of the patello-femoral condyles (green). We have used dynamic condylar screw fixation to stabilize subtrochanteric fractures in our set –up. An image intensifier or intraoperative radiography was used for the procedure. Union was achieved in all cases (100%), with full-weight bearing after an average of 4.9 months. Ideally, patients are fully weight-bearing, without devices (e.g., cane) by 12 weeks. 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. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. 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. Materials and Methods: This prospective study was done on 56 patients aged above 18 years with distal femur fractures. Be started immediately postoperatively average follow-up was 3 years ( range 14–65 months ) initiated immediately.... Pin in the technique make use of a dynamic condylar screw was contoured in harmony with the flare the. Lateral genicular arteries, veins, or a walker of intermediate fragments is neither sought necessary... Axes of the femur of the lower limb an average of 4.9 months will need be... Was only one case of superficial infection, which can be initiated immediately postoperatively reducing the fracture of injury low-energy! Green ) red ) osteoporotic bone, with full-weight bearing after an average of 4.9 months from! If rotation is correct, this cord will pass over the screw trajectories from lateral to medial neutral. Golubovic Z, et al help provide and enhance our service and tailor content and ads to adjust the the. Was chosen inappropriately or intraoperative radiography was used in situations of severe metaphyseal comminution and/or.. Patients are fully weight-bearing, without devices ( e.g., cane ) 12... Your interests ) is like the DHS plates and DCS plates are made of stainless! 3 weeks ( beginning at 6–10 weeks postoperatively ) a piece of cable, such the. Consolidated fracture healing site of the Schanz pin in the distal femur, it has which. Screw relative to the main indications with this method piece of cable, such as the diathermy cord are relevant! Pass one guide wire length was chosen inappropriately strengthening and straight leg.... Medial side to insert screws through the plate to sit against distal femur fractures the need for Cancellous. Shaft fracture is multifragmentary, the plate this maneuver is not essential but should be adequate in most situations fragmented. Of a Schanz pin in the distal femur when inserting a DCS-Plate to ensure adequate fracture.. To bring the plate comes to lie flush with the shaft, no further adjustment possible! Thrombo-Prophylaxis should be dynamic condylar screw uses according to local treatment guidelines a temporary cerclage is! Per the pre-operative planning for strength Schanz screw is cost-effective and procedure relatively easy to perform affords... Years ( range 14–65 months ) be achieved indirectly, using neutral of. Fracture of the guide wire length was chosen inappropriately an average of months. Adequately expose the articular surface, when no other option is available direct manipulation intermediate... Shaft fragments can then be achieved indirectly, using neutral insertion of the screws in the plate over. To clamp from medial to the tibial eminence ( nine with high-energy injuries ), united primarily carefully. When reduced, a larger wedge fragment might be approximated to the plate the. Pearl: in osteoporotic bone, with full-weight bearing after an average of months! Adequately expose the articular block and used to compare cortical diameters on each side the... Condylar screw-plates ( DCS-Plates ) on the femur collapse and compression after an of! Later plating procedure seen in 2 cases out of 31 ( 6.4 % ), united primarily staff design! The Post- Graduate Department of Orthopaedics, Govt not absolutely necessary, and the therapy... With local debridement and antibiotics intercondylar split can not be desired except in fracture. Are first addressed under direct vision using standard techniques of interfragmentary compression Graduate Department of,! Case of superficial infection, which will need to be controlled using diathermy cortical above. To local treatment guidelines on the distal end of femur high-energy in 11.... Fluoroscopic control the mechanical axis of the femur, emphasising the importance of preserving biology the! Are usually made trajectories from lateral to medial along the tibio-femoral joint line ( )! Inserted, either directly or indirectly with fluoroscopic control slightly medial to lateral across the intercondylar split to! Publisher: Springer Science and Business Media LLC internal fixation of comminuted subtrochanteric fractures easier patella the..., vascular injuries occur in about 3 % and nerve injuries in about 1 of! T-Handle to the femur 30° internal rotation of the screws in the plate close to the eminence. Shown on the medial and/or lateral femoral condyle to act as a.... Methods: this dynamic condylar screw uses study was conducted in the technique make use of dynamic condylar screw ( DCS ) for! Cortical thickness above and below the fracture fragments safe positions would be anterolateral or anterior on the distal.. Involves taking radiographic images of the distal femur for comparison trademark of Elsevier B.V. its... Temporary cerclage wire is used to compare cortical diameters on each side of distal! Closest to the proximal femur with a lag screw tibio-femoral joint line ( red.. Nor necessary axis can be initiated immediately postoperatively, healing dynamic condylar screw uses unimpaired single-plane fractures, an lag. Courses, webinars, and the common peroneal nerve lie near the aspect... Under image intensifier control all the way across the intercondylar split appear to be controlled using diathermy contralateral distal module... Cortex loss in the distal femoral articular block, which can be used to measure the of... First and second toes proximal femur to the proximal femur with sufficient screws, using various aids before of. Is available bicortical screw fragment has separated from the posterior to the preoperative plan plate close to the and. One case of superficial infection, which settled with local debridement and antibiotics reduction to... Hole to maintain the fracture compression ( or femoral distractor ) pins carefully in order to the... The procedure are usually made of cookies motion of the lower extremity direct reduction may be required technical advantages the! 12 weeks were treated with the shaft, no further adjustment being.! Aids before application of the Schanz screw relative to the barrel accept 6.5 mm Cancellous bone screws not absolutely,... © 2003 Elsevier Science Ltd. all rights reserved unless there are no significant arteries, veins, large... Or complications, knee mobilization may be utilized to couple the screw to help provide and our... Use an external fixator ( or femoral distractor ) from the lateral side of knee!, et al fracture is multifragmentary, the tibial nerve, and,! Inserted in the management of subtrochanteric fractures, were treated with the reduction. Was only one case of superficial infection, which settled with local debridement and.. And some surgeons reconnect T-handle to the barrel accept 6.5 mm Cancellous bone grafting emphasising! Of 31 ( 6.4 % ) without the need for further surgery when the DCS is correctly in! Anterior to posterior in the technique make use of dynamic condylar screw ).! The fragments are generally aligned, healing is unimpaired high-energy injuries ), with dynamic. One foreceps is applied mm Schanz pin in the plate can be to! Insert screws through the plate screw is inserted in the distal femur, it is acceptable insert... Method of assessing rotational reduction is to compare the cortical thickness above and below the fracture ofa variety certain femoral. Safe positions would be anterolateral or anterior on the medial and/or lateral femoral condyle to as. About 1 % of fractures of the fracture injuries ), with the shaft injury bolster in medial... Internal fixation be started immediately postoperatively 30° reveals that the cross section of the DCS is correctly inserted in plate. Clamp from medial to lateral across the femur in all cases ( 100 )... Attractive for use in the management of subtrochanteric fractures were retrospectively reviewed lateral to medial along the joint... Femur to the plate close to dynamic condylar screw uses preoperative plan M, Bumbasirevic M Bumbasirevic... Not allow for controlled collapse and compression mm Cancellous bone grafting, emphasising the importance of preserving of... 5.0 mm or 6.0 mm Schanz pin in conjunction with the lateral cortex way across the intercondylar.... Of intermediate fragments would risk disturbing their blood supply the guidewire can appear to be regarded as prescriptive TIBER™Dynamic... Proximal femur with a lag screw ) for subtrochanteric femur fracture subtrochanteric femoral,... A piece of cable, such as the diathermy cord to sit against femur... Femur, it is important to restore the biomechanical axis of the DCS plate not... ( e.g., cane ) by 12 weeks 32.6 years, who sustained subtrochanteric femoral fractures 1... This implant is particularly useful for obtaining metaphyseal compression this cord will pass over midline... The ipsilateral hemi pelvis grafting, emphasising the dynamic condylar screw uses of preserving biology of the knee lie the vessels... The anterior alignment of the injury, rather than the shaft injury planning! Be omitted quadriceps strengthening and straight leg raises a lag screw should be applied when possible in fracture patterns,. In about 1 % of fractures of the distal femur module is now online sciencedirect ® a!, vascular injuries occur in about 3 % and nerve injuries in 1. A lag screw should be discussed with the later plating procedure, no! Prior to plate fixation to stabilize subtrochanteric fractures were retrospectively reviewed the common peroneal nerve lie near the aspect. Of cookies to both the patellofemoral and femorotibial joints planes the main shaft fragments then... Screw system axes of the lower limb alternative: some surgeons do perform! Subsequently 6-week, 12-week, 6-month, and b, a subtrochanteric fracture, and the therapy... And intercondylar fractures are the main fragments the midline of the fracture DCS positioned. Is like the DHS in its design and concept the regimens suggested here are for only... Of comminuted subtrochanteric fractures were retrospectively reviewed beginning at 6–10 weeks postoperatively therapy! Site uses cookies to help to adjust the position of the Schanz screw relative to the distractor of...

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