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. US$ 39.95. Material and Methods. 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. 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. Touch-down weight-bearing (10-15 kg) may be performed immediately with crutches, or a walker. 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 depth of guide-wire insertion is crucial. Screw available holes: 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 105, 110, 115, 120, 125, 130, 135, 140 and 145. 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. Ideally, patients are fully weight-bearing, without devices (e.g., cane) by 12 weeks. An image intensifier or intraoperative radiography was used for the procedure. 2. https://doi.org/10.1016/S0020-1383(02)00319-4. These screws may be fully threaded 2.7 or 3.5 mm lag screws (shown with gliding hole), 6.5mm partially threaded lag screws, or 4.0/4.5 mm cannulated, partially threaded lag screws. This site uses cookies to improve your experience and to help show ads that are more relevant to your interests. If the soft-tissue attachments to these fragments are preserved, and the fragments are generally aligned, healing is unimpaired. Safe positions would be anterolateral or anterior on the femur. Results of dynamic condylar screw for subtrochanteric fractures. To avoid this, the knee is brought into full extension, and the distal femoral fragment is stabilized in this position to the tibia. 11. In order to assess the exact length of the guidewire obtain an AP view with 30° internal rotation of the lower extremity. The radiological landmarks of the center of the femoral head, the center of the knee and the center of the ankle joint should all be in line if the mechanical axis of the femur is correct. Static cycling without load, as well as firm passive range of motion exercises of the knee, allow the patient to regain optimal range of motion. By continuing you agree to the use of cookies. The use of a dynamic condylar screw and biological reduction techniques for subtrochanteric femur fracture. Patients were assessed clinically and radiographically with regards to fracture classification, operating time, blood loss, time of union, malunion and other complications. screws.15 Dynamic condylar screws (DCS) simplify fixation and require less-exacting technique than CBPs.16 We aimed to review the results of indirect reduction and mini-incision DCS fixation for comminuted subtrochanteric femoral fractures. 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. subtrochanteric fractures and use of AO dynamic condylar screw (DCS), in their management. Next, slide the direct measuring device over the guide wire and determine guide-wire insertion depth and, thereby, the length of the DCS required. This latter orientation ensures that the plate comes to lie flush with the lateral cortex. This illustration shows the longitudinal axes of the lower limb. By using this site, you agree to the use of cookies by Flickr and our partners as … 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. A Schanz screw is inserted in the distal femoral articular block and used to counter the pull of the gastrocnemius. By Manzoor Ahmed Halwai, Shabir Ahmed Dhar, Mohammed Iqbal Wani, Mohammed Farooq Butt, Bashir Ahmed Mir, Murtaza Fazal Ali and Imtiyaz Hussain Dar. Insert the guide wire under image intensifier control all the way across the femur. Remember that the cross section of the distal femoral condylar mass is trapezoidal and slopes markedly on the medial side. The two holes closest to the barrel accept 6.5 mm Cancellous Bone Screws. This procedure may be performed with the patient in one of the following positions: For this procedure, the lateral/anterolateral approach is used. Stainless Steel (Grade SS 316L) 2. Materials and Methods: This prospective study was done on 56 patients aged above 18 years with distal femur fractures. Year: 2007. With stable fracture fixation, the surgeon and the physical therapy staff will design an individual program of progressive rehabilitation for each patient. Pitfall: It is important to remember that the distal femur tapers from the posterior to the anterior. Fixation with compression should be applied when possible in fracture patterns where there is contact between the proximal and distal main fragments. These screws must be countersunk and recessed beneath the articular surface. When the DCS is correctly inserted in the distal femur, the plate can be used to assist in the final reduction. The guide wire for the DCS is positioned at 2 cm proximal to the distal end of femur. Under image intensifier control, pass one guide wire lateral to medial along the tibio-femoral joint line (red). Mitkovic M, Bumbasirevic M, Golubovic Z, et al. The average operating time was 2 h and blood loss averaged 430 ml. 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. The distal femur has a unique anatomical shape. Secure the articulated tension device to the proximal femur with a bicortical screw. Copyright © 2021 Elsevier B.V. or its licensors or contributors. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. A 5.0 mm or 6.0 mm Schanz pin in the medial and/or lateral femoral condyle to act as a joystick. This device has some technical advantages over the AO condylar blade plate. Courses, webinars, and online events, in your region or worldwide, Pediatric distal femur module is now online. Thirty-one consecutive patients with a mean age of 32.6 years, who sustained subtrochanteric femoral fractures, were treated with this method. Dynamic Condylar Screw used for fixation of: a, a subtrochanteric fracture, and b, a supracondylar fracture of the femur. At the posterior aspect of the knee lie the popliteal artery, nerve, and vein. In conclusion, use of biological (indirect) reduction techniques instead of anatomic, open reduction has proven to be successful, especially in comminuted subtrochanteric fractures. The patients were operated under spinal anaesthesia. Thrombo-prophylaxis should be given according to local treatment guidelines. A consecutive series of 58 patients, treated with the dynamic condylar screw (DCS) for subtrochanteric fractures were retrospectively reviewed. It is very important to restore the biomechanical axis of the lower limb. 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. Pass a second guide wire over the anterior surface of the knee to indicate the plane of the patello-femoral condyles (green). The aim of this study was to determine the amount of cortex loss in the distal femur when inserting a DCS-Plate. This study was conducted to evaluate the results of fixation of this device in our Scenario . A radiographic ruler can be used to measure the length of both femora. Because of this, vascular injuries occur in about 3% and nerve injuries in about 1% of fractures of the distal femur. This axis can be checked intraoperatively by using a piece of cable, such as the diathermy cord. 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. On the lateral view, the distal femur is divided into thirds and the DCS entry site is located at the junction of the anterior and middle thirds. Additionally, the compression screw will provide additional compression across any intraarticular split. Serial x-rays allow the surgeon to assess the healing of the fracture. Early range of motion helps restore movement in the early postoperative phase. Union was achieved in all cases (100%), with full-weight bearing after an average of 4.9 months. This implant is particularly useful for obtaining metaphyseal compression. Direct manipulation of intermediate fragments would risk disturbing their blood supply. Another method of assessing rotational reduction is to compare the cortical thickness above and below the fracture. The dynamic condylar screw (DCS) is like the DHS in its design and concept. Cite . This device has been studied and compared with cannulated screws and fixation with DHS showing inconclusive results. The preferred method depends on the fracture and soft-tissue injury pattern, the chosen stabilization device, and the experience and skills of the surgeon. It may not be used in situations of severe metaphyseal comminution and/or osteoporosis. If the mechanical axis is restored this should be adequate in most situations (fragmented patterns). 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]. Access options Buy single article. Lastly remove the articulated tension device and complete the fixation by inserting additional screws according to the preoperative plan. The early appearance of callus avoids the need for primary cancellous bone grafting, emphasising the importance of preserving biology of the fracture fragments. 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. Unless there are other injuries or complications, knee mobilization may be started immediately postoperatively. These anatomical details are important when inserting screws. Loosely secure the plate to the proximal femur with a Verbrugge clamp. 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. Injury 2003;34(2):123–128. Copyright © 2003 Elsevier Science Ltd. All rights reserved. If a shaft fracture is multifragmentary, the image intensifier cannot be used to compare cortical diameters on each side of the fracture. 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 … Use of Schanz pins inserted into the medial, or lateral, femoral articular block to correct varus or valgus angulation of the femoral block. 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. Strong. Subscribe to journal. Average follow-up was 3 years (range 14–65 months). The ideal entry point for the DCS is shown on the diagram. Complete the fixation of the plate to the femur with sufficient screws, using neutral insertion of the screws in the plate holes. Fixation of a C1 fracture with the dynamic condylar screw system. Touch-down weight-bearing progresses to full weight-bearing gradually, over a period of 2 to 3 weeks (beginning at 6–10 weeks postoperatively). Prior to plate fixation to the proximal fragment, final reduction of the metaphysis may be performed. 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. Pearl: In osteoporotic bone, tapping should be omitted. 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( 10-15 kg ) may be utilized to couple the screw shank soft tissue was used in situations of metaphyseal... The knee to indicate the plane of the distal femur when inserting a DCS-Plate worldwide, distal! And online events, in your region or worldwide, Pediatric distal femur, internal rotation of the femur. Is like the DHS plates and DCS plates are made of 316L steel... Used for the blade determines the alignment of the patella, and online events, your... For controlled collapse and compression Methods: this prospective study was to determine the amount cortex. Obtain an AP view with 30° internal rotation by 30° reveals that the plate comminuted proximal femur fractures II!
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