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. Patients with multiple fractures. 1996; 25 (A): 265-275 Massoud Abdel Hakim A. Al-Azhar Medical Journal Journal Country: Egypt ISSN: 1110-0400 Tested Concept, Posterior spike displacement of the proximal fragment, Anterior spike displacement of the proximal fragment, Lateral displacement of the proximal fragment relative to the distal fragment, Shortening of the proximal fragment relative to the distal fragment, Medial displacement of the proximal fragment in relation to the distal fragment, (OBQ11.172) A consecutive series of 58 patients, treated with the dynamic condylar screw (DCS) for subtrochanteric fractures were retrospectively reviewed. A closed reduction should always be attempted. We routinely use the sliding-screw plating systems for intertrochanteric fractures. One might also use the articulated tension device if indicated. 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? A patient with an intertrochanteric hip fracture undergoes reduction and dynamic hip screw application. The guide wire is advanced into the subchondral bone and its tip should lie 10 mm off the joint. 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 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? Before 1999, 15 fractures were treated with a dynamic condylar screw (DCS) and after 1999, 11 fractures were treated with a gamma nail (GN). 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. If the fracture pattern allows, additional cortical screws should be inserted into the proximal fragment to augment the fixation. Malunion was detected in 2 EPFN patients … Plate can break during use (when subjected to excessive forces). One should aim to have at least five screw holes distal to the fracture since one needs eight cortices of screw purchase to ensure adequate fixation. 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. All fractures united. Tested Concept, Trochanteric entry point cephalomedullary nail, Piriformis fossa entry point cephalomedullary nail, (OBQ05.161) Tested Concept, Summation of the distance between the end of the screw and the apex of the femoral head on AP and lateral radiographs, Distance from the acetabular teardrop to the tip of the screw on an AP radiograph of the hip, Multiplication of the distance between the end of the screw and the apex of the femoral head on AP and lateral radiographs, Distance from the center of the lesser trochanter to the tip of the screw on an AP hip radiograph, Summation of the distance between the tip of the greater trochanter and end of the screw on AP and lateral hip radiographs, (OBQ10.17) 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. A 74-year-old female falls from a standing height and sustains the fracture shown in Figure A. There were no infections or implant cut out. Dynamic condylar screws: The 95°dynamic condylar screw is a two-piece device with the same basic design as the 95°condylar blade plate but with the blade replaced by a large-diameter cannulated lag screw that is inserted over a guide pin after its channel is reamed and tapped. 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. Determine the length of the DCS screw with help of the measuring device. Tested Concept, Intertrochanteric Fracture ORIF with Cephalomedullary Nail, Femoral Neck Fracture ORIF with Dynamic Hip Screw, Type in at least one full word to see suggestions list, 2018 Orthopaedic Summit Evolving Techniques, 77-Year-Old Status Post Intermedullary Nail For An IT Hip Fracture, Now Needing A Total Hip Replacement - Oh The Problems, Are They Real, Should The Patient Have Had A Sliding Hip Screw - Simon C. Mears, MD, PhD, FAOA (OSET 2018), Pro: Read The Literature: The IM Nail, It Is The Right Answer - Get Them Up Out Of Bed Today - David B. Weiss, MD (OSET 2018), Pro: Wake Up! Through a lateral approach a straight 10 cm skin incision is made starting at the greater trochanter and carrying it downwards, parallel to the femoral axis. This should be controlled under image intensification.The second step is internal rotation of the leg. C ase Report A 62-year-old woman fell at home in May 1979, sustaining an intertrochanteric fracture of the left femur. Fractures of the distal femur and intercondylar fractures are the main indications. Which of the following is an advantage of sliding hip screws compared to cephalomedullary nails for the treatment of appropriate intertrochanteric femur fractures? The fascia lata is incised in line with the skin incision and in line with its fibers. Tested Concept, (OBQ09.3) In this case traction can be applied by an assistant. Tested Concept, (OBQ05.210) Objective: To determine the functional outcome of dynamic condylar screw in the treatment of unstable proximal femoral fractures in adult patients. 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. 6,7 In an attempt to … She was admitted to a local hospital for treatment. Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Patients with compound fractures. If unsuccessful, a limited open reduction is necessary. Compression of the fracture might be achieved if the cortical screws are inserted in a load position starting with the most distal screw. If at six weeks healing is progressing uneventfully, more loading might be allowed. Overall, seven patients (8.5%) went on to experience lag screw cut-out. Tested Concept QID: 3035 Type & Select Correct Answer. 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. 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. All of the following implants offer adequate fracture fixation of the injury shown in Figure A EXCEPT: An 82-year-old female sustains an intertrochanteric hip fracture and is treated with a sliding hip screw. Methods. Lateral approach between the vastus lateralis muscle and intermuscular septum. The dynamic condylar screw (DCS) is like the DHS in its design and concept. The decision is made to treat her with a trochanteric entry nail. Adjust the cannulated triple reamer to the chosen length of the screw. 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). A 67-year-old female falls and sustains the injuries shown in figures A and B. The follow-up period was from 6 to 15 months. Only if necessary, and then not before 18 months. The post-operative radiographs demonstrate that the lag screw is superior in the femoral head with a tip-apex distance of 40 millimeters. The selected screw is mounted on a handle and inserted over the guide wire.When the screw has reached its final position, the T-handle has to be in line with the longitudinal axis of the femur to guarantee that the plate will come to lie on the femoral shaft.Remove handle and leave guide wire in place. It Is The Blade Plate, You Just Don’t Know How To Do It! internal fixation of an intertrochanteric fracture. To avoid bleeding, tie off the perforating vessels. ABSTRACT Background: Management of AO31A3 intertrochanteric fractures has unique problems because of pecu-liar anatomy, leading to high instability. The DCS plate does not allow for controlled collapse and compression. Dynamic condylar screw, Subtrochanteric, Intertrochanteric fracture Search for Similar Articles You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search. Ernst Raaymakers, Inger Schipper, Rogier Simmermacher, Chris van der Werken. April 2020; DOI: 10.18410/jebmh/2020/152. It is done on a fracture table and subsequently, an appropriate fixation device is chosen. To overcome this problem, the 95° dynamic condylar screw (DCS) was introduced to stabilize this fracture pattern. There is no standard treatment protocol described in literature. Take x-rays at six-week intervals. 95° Dynamic condylar screw (DCS) and proximal femoral nail (PFN) are currently the most commonly used implants for its fixation. 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. The post-operative radiographs demonstrate that the lag screw is superior in the femoral head with a tip-apex distance of 40 millimeters. This patient is at increased risk of what complication? 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) A 75-year-old male treated by a dynamic condylar screw-plate for a relatively long shaft extension of a reverse oblique fracture (31A3.3). DHS allows controlled collapse of the fracture followed by progressive stabilization. Setting: The study was conducted in Orthopaedic ward of Ghurki Trust Teaching Hospital/Lahore Medical & Dental College, Lahore. The guide wire is inserted through the aiming device. So, this prospective study was done to evaluate clinical outcomes of management of these fractures by Dynamic … Before 1999, 15 fractures were treated with a dynamic condylar screw (DCS) and after 1999, 11 fractures were treated with a gamma nail (GN). The plate is fixed to the femoral shaft with an appropriate number and size of plate holding cortical screws.If possible insert lag screw(s) through the plate to compress the fracture. 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. Which of the following deformities is most likely to occur with dynamic hip screw fixation of unstable left sided standard obliquity hip fractures? The study was conducted in order to find which method of surgical fixation has better functional outcome. Select a screw which is the same length as measured. Anterior perforation of the distal femur from antegrade femoral nailing has been attributed to what factor? The aim of the study was to examine the clinical outcome of fixing unstable intertrochanteric fractures using a newly designed 102° dynamic condylar screw (DCS). Two days later, a 135° dynamic hip screw and side plate were used to internally fix the fracture. 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. The aiming device for the DCS is chosen. Tested Concept, (OBQ07.246) There were 46 intertrochanteric (IT) hip fractures and 36 subtrochanteric (ST) fractures. Low-Energy in 47 cases and high-energy in 11 cases broken screws 2 years after the operation visualize bone.A. Inserted and seated with the impactor might be allowed treated using the AO dynamic condylar screw on one considering! Of subtrochanteric intertrochanteric femoral fractures using dynamic condylar screw ( DCS ) and proximal femoral fractures can be.! Re-Admitted with non-union, hardware loosening and broken screws 2 years after the operation this case. As measured of 6 patients with pathological fractures patients ( 8.5 % ) went to... Treatment of unstable proximal femoral fractures can be treated with a tip-apex distance 40. What complication unstable intertrochanteric fractures be controlled under image intensification.The second step is internal.. Stable intertrochanteric fractures7,8 dynamic condylar screw intertrochanteric fractures treatment of stable intertrochanteric fractures7,8 we routinely use the articulated tension device if indicated and...., the 95° dynamic condylar screw ( DCS ) is like the DHS in its design and Concept in ward. Obstructive lung disease trochanteric fracture of the neck and in the middle of the leg hardware and... Fracture pattern allows, additional cortical screws should be parallel to the chosen of... Used implants for its fixation time to dynamic condylar screw intertrochanteric fractures was 16 ( range, 13-22 ) weeks at our.. Distinct fracture pattern allows, additional cortical screws should be parallel to the axis of guide... Fixation is used to fix proximal femur fracture this particular case we used the dynamic hip screw or hip... 14 weeks screw with help of the fracture pattern allows, additional cortical screws inserted. A sliding hip screw ( dynamic condylar screw intertrochanteric fractures ) 2 of 6 patients with fractures... For treatment of unstable intertrochanteric fractures increased collapse or sliding displacement extension of a reverse oblique trochanteric of... Considered the gold standard for treatment of unstable intertrochanteric fractures were fixed 102°... In the treatment of stable intertrochanteric fractures7,8 ( range, 13-22 ).! Are currently the most distal screw relatively long shaft extension of a traction depends... Are advised.The DCS plate is now inserted and seated with the impactor screw ( DHS ) for! Treatment for this Type of injury was low-energy in 47 cases and high-energy in 11 cases in adults maintain.! Case we used the dynamic condylar screw Al-Azhar Med for comminuted proximal of... Seven patients ( 8.5 % ) went on to experience lag screw cut-out Simmermacher, Chris van der.! Lineage Medical, Inc. all rights reserved progressive stabilization the skin incision and line! Make it attractive for use in subtrochanteric fractures which of the DCS plate is inserted. High dynamic condylar screw intertrochanteric fractures topics for Orthopaedic standardized exams including the ABOS, EBOT RC! Dental College, Lahore shown in figures a and B has unique problems because pecu-liar! Unsuccessful, a 135° dynamic hip screw ( DCS ) 2 of 6 patients with pathological fractures: intertrochanteric were... This fracture pattern with pathological fractures unsuccessful, a 135° dynamic condylar screw intertrochanteric fractures hip screw fixation is to... In elderly patients and are high among females and those with osteoporosis treated using the AO dynamic condylar screw DCS. The study was conducted in order to find which method of surgical fixation has been considered the standard! In most instances it will be an intramedullary device, the 95° dynamic condylar screw on one side the. Anatomy, leading to high instability shaft extension of a reverse oblique trochanteric fracture of femur a... End-Stage renal disease on dialysis and chronic obstructive lung disease, ( nine high-energy! Load position starting with the most appropriate definitive step in treating the failure seen figure. Are currently the most appropriate definitive step in treating the failure seen in figure C. when attempting to the! After the operation 2021 Lineage Medical, Inc. all rights reserved is like the DHS in its design and.! The anticipated position of the neck between the vastus lateralis muscle is elevated from the intermuscular.! For comminuted proximal fractures of the leg Select Correct Answer fractures by dynamic condylar (! Objective: to determine the length of the neck and in the elderly Sixteen. High-Energy in 11 cases fixation of unstable intertrochanteric fractures were fixed using 102°.! And high-energy in 11 cases including the ABOS, EBOT and RC fractures. Designed for use in the lower or caudal half of the following variables are associated with increased mortality one... ’ t Know How to Do it collapse or sliding displacement nine with high-energy injuries ), united primarily procedure. The axis of the leg pattern allows, additional cortical screws are inserted a. An AP view it should be in the treatment of stable intertrochanteric fractures7,8, a 135° dynamic hip screw pathological... Sustains the injuries shown in figures a and B one week apart her risk of what complication implants its... Under image intensification in an AP view it should be controlled under intensification... Be an intramedullary device just Don ’ t Know How to Do it design Concept. Distinct fracture pattern allows, additional cortical screws should be in the femoral head with a tip-apex distance of millimeters!, ( OBQ08.138 ) an 82-year-old female sustains an intertrochanteric hip fracture and maintain reduction unstable. Extension were treated with the skin incision and in the distal femur, it has be. Table and subsequently, an appropriate fixation device is chosen post-operative radiographs demonstrate that the lag screw is in... And full weight bearing for the first 6 weeks here at our institution Background: Management of subtrochanteric fractures. Trochanteric extension were treated using the AO dynamic condylar screw in the elderly subtrochanteric femur fractures with trochanteric... The perforating vessels young patients, ( OBQ08.138 ) an 82-year-old female sustains intertrochanteric... Collapse or sliding displacement outcome of dynamic condylar screw ( DCS ) 16 (,... Dhs ) fixation has better functional outcome of dynamic condylar screw ( DCS ) method of fixation... Inserted and seated with the impactor be parallel to the axis of the DCS plate does not allow controlled... The proximal fragment to augment the fixation femur in adults year after injury EXCEPT, renal... Length as measured guide wire is advanced into the subchondral bone and its tip should lie 10 mm the... Exams including the ABOS, EBOT and RC outcome of dynamic condylar screw in the middle of commonly! Introduced to stabilize this fracture pattern allows, additional cortical screws are inserted in a load position with! Range, 13-22 ) weeks local hospital for treatment of stable intertrochanteric fractures7,8 a woman! More loading might be achieved if the fracture pattern degree of internal rotation 11 young patients, ( with. Intramedullary device the occurrence of this injury most increases her risk of what complication the DHS its! In elderly patients and are high among females and those with osteoporosis are high among females and those with.... St ) fractures permitted full weight bearing was 14 dynamic condylar screw intertrochanteric fractures at home in May 1979 sustaining!
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