dynamic condylar screw intertrochanteric fractures
Only stable proximal femoral fractures can be treated with the DCS (dynamic condylar screw) plate. 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. Methods. Ten out of 11 young patients, (nine with high-energy injuries), united primarily. 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) 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 86-year-old man slips on the ice and falls sustaining the injury shown in Figure A. 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. All of the following implants offer adequate fracture fixation of the injury shown in Figure A EXCEPT: The study was conducted in order to find which method of surgical fixation has better functional outcome. All fractures united. 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 They were treated with either dynamic hip screw (DHS) fixation or proximal femoral nailing (PFNA2) here at our institution. 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. Two days later, a 135° dynamic hip screw and side plate were used to internally fix the fracture. Copyright © 2021 Lineage Medical, Inc. All rights reserved. A 55-year-old male is involved in a motor vehicle accident and sustains the injury seen in Figure A. Reverse oblique trochanteric fracture of femur is a distinct fracture pattern. The mean time to union was 16 (range, 13-22) weeks. In fresh cases, a traction table might not be necessary and the procedure can be done with the patient positioned on a translucent table designed for use with image intensification. To avoid bleeding, tie off the perforating vessels. Exclusion Criteria were: Skeletally immature patients. Which of the following methods accurately describes the measurement of tip-apex-distance as it relates to placement of a lag screw in the femoral head? 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. 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) The patient was lost for follow-up and was re-admitted with non-union, hardware loosening and broken screws 2 years after the operation. The fascia lata is incised in line with the skin incision and in line with its fibers. Courses, webinars, and online events, in your region or worldwide, Pediatric distal femur module is now online, After surgery the outcomes of greatest concern are, perioperative care in elderly hip fracture patients, have other comorbid conditions (such as cardiac failure, diabetes, and chronic air flow limitation). 6,7 In an attempt to … The mechanism of injury was low-energy in 47 cases and high-energy in 11 cases. The dynamic hip screw or sliding hip screw fixation is used to fix proximal femur fracture. 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. RESULTS : In the present series of 24 cases of Intertrochanteric fractures were treated by proximal femoral nailing and dynamic hip screw, 12 cases in each. internal fixation of an intertrochanteric fracture. There is no standard treatment protocol described in literature. An 82-year-old female sustains an intertrochanteric hip fracture and is treated with a sliding hip screw. 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. It is placed against the lateral cortex. April 2020; DOI: 10.18410/jebmh/2020/152. after dynamic hip screw fixation of intertrochanteric fracture. Plate can break during use (when subjected to excessive forces). Tested Concept, (OBQ05.210) Select a screw which is the same length as measured. (OBQ16.168) The average time to full weight bearing was 14 weeks. Adjust the cannulated triple reamer to the chosen length of the screw. Keywords Intertrochanteric fractures, Dynamic Condylar Screw (DCS). What should be performed next? 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). Ernst Raaymakers, Inger Schipper, Rogier Simmermacher, Chris van der Werken. Lateral approach between the vastus lateralis muscle and intermuscular septum. What is the most appropriate treatment for this type of injury? Patients with associated neurovascular complications. Begin with partial weight bearing for the first 6 weeks. 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). Setting: The study was conducted in Orthopaedic ward of Ghurki Trust Teaching Hospital/Lahore Medical & Dental College, Lahore. 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). Which of the following is an advantage of sliding hip screws compared to cephalomedullary nails for the treatment of appropriate intertrochanteric femur fractures? Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. 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 DCS plate does not allow for controlled collapse and compression. Tested Concept, Remove the nail to re-assess fracture reduction, (OBQ13.2) To evaluate the success of dynamic condylar screw (DCS) fixation for comminuted proximal fractures of femur in adults. 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. Biological fixation of subtrochanteric intertrochanteric femoral fractures using dynamic condylar screw Al-Azhar Med. The use of a traction table depends on the surgeon’s preference. In most instances it will be an intramedullary device. [citation needed] It is the most commonly used implant for extracapsular fractures of the hip, which are common in older osteoporotic patients. The DCS plate does not allow for controlled collapse and compression. 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. Which of the following factors has been shown to be associated with increased collapse or sliding displacement? A patient with an intertrochanteric hip fracture undergoes reduction and dynamic hip screw application. 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 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. This patient is at increased risk of what complication? The DCS is a versatile plate which can be applied in a bridging mode (fragmentary supracondylar fracture component) and with compression (simple supracondylar fracture component). Which of the following statements is true regarding treatment of intertrochanteric hip fractures with an intramedullary nail versus a sliding hip screw? What is the most appropriate definitive step in treating the failure seen in figure A? The post-operative radiographs demonstrate that the lag screw is superior in the femoral head with a tip-apex distance of 40 millimeters. 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) 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. To overcome this problem, the 95° dynamic condylar screw (DCS) was introduced to stabilize this fracture pattern. However in this particular case we used the Dynamic condylar screw on one side considering the fracture pattern. In osteoporotic bone, five screws (10 cortices) are advised.The DCS plate is now inserted and seated with the impactor. Take x-rays at six-week intervals. The vastus lateralis muscle is elevated from the intermuscular septum just enough to expose the fracture. 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. Five patients died before fracture healing. There were no infections or implant cut out. C ase Report A 62-year-old woman fell at home in May 1979, sustaining an intertrochanteric fracture of the left femur. A 67-year-old female falls and sustains the injuries shown in figures A and B. Tested Concept, (OBQ08.138) Patients with multiple fractures. This should be controlled under image intensification.The second step is internal rotation of the leg. The follow-up period was from 6 to 15 months. 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). Before 1999, 15 fractures were treated with a dynamic condylar screw (DCS) and after 1999, 11 fractures were treated with a gamma nail (GN). Only if necessary, and then not before 18 months. Twelve unstable low-energy intertrochanteric fractures were fixed using 102° DCS. This patient is at increased risk of what complication? 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. Tested Concept, (SBQ09TR.45.1) Design: Descriptive case series. A consecutive series of 58 patients, treated with the dynamic condylar screw (DCS) for subtrochanteric fractures were retrospectively reviewed. Dynamic Condylar Screw Plate Warnings. Determine the length of the DCS screw with help of the measuring device. Management Of Subtrochanteric Femoral Fractures By Dynamic Condylar Screw (DCS) 2 of 6 Patients with pathological fractures. Considering the technical aspects of the osteosynthesis of these fractures, in our department, we staged the procedure one week apart. Which of the following is a recognized predictor of mortality after hip fracture? All of the following variables are associated with increased mortality at one year after injury EXCEPT? The guide wire is inserted through the aiming device. We routinely use the sliding-screw plating systems for intertrochanteric fractures. Healing is usually complete by three months and full weight bearing can be resumed. One might also use the articulated tension device if indicated. Which of the following is not an appropriate implant for treatment of the fracture seen in Figure A? 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? Tested Concept, Mismatch of the radius of curvature of implant and bone, (OBQ07.86) Twelve unstable low-energy intertrochanteric fractures were fixed using 102° DCS. The patient was permitted full weight bearing 2 months after operation. She was admitted to a local hospital for treatment. (range 12-16 weeks). J. Tested Concept, Revision open reduction and internal fixation, (OBQ07.153) Tested Concept QID: 3035 Type & Select Correct Answer. 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! The dynamic condylar screw (DCS) is like the DHS in its design and concept. The length of the plate is determined by the extent of the fracture. 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. In this case traction can be applied by an assistant. Overall, seven patients (8.5%) went on to experience lag screw cut-out. MortalityMortality generally occurs within the first six months after fracture; studies have shown that these rates range from 12-37%.Predictors of higher mortality rates are patients who are: For more information see the additional material on perioperative care in elderly hip fracture patients. The occurrence of this injury most increases her risk of sustaining which of the following fractures? Compression of the fracture might be achieved if the cortical screws are inserted in a load position starting with the most distal screw. Fractures of the distal femur and intercondylar fractures are the main indications. The aiming device for the DCS is chosen. 1996; 25 (A): 265-275 Massoud Abdel Hakim A. Al-Azhar Medical Journal Journal Country: Egypt ISSN: 1110-0400 Drill the hole for the screw and the plate sleeve. 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. However, there are divergent opinions about the fixation of unstable intertrochanteric fractures in the elderly. Tested Concept, American Society of Anesthesiologist (ASA) classification, (OBQ05.262) Background: Intertrochanteric fractures are one of the commonly occurring injuries in elderly patients and are high among females and those with osteoporosis. If unsuccessful, a limited open reduction is necessary. Outcome of Subtrochanteric Femur Fractures Treated with Dynamic Condylar Screw (DCS) Fixation. It Is The Blade Plate, You Just Don’t Know How To Do It! Which of the following deformities is most likely to occur with dynamic hip screw fixation of unstable left sided standard obliquity hip fractures? Although this device was designed for use in the distal femur, it has features which make it attractive for use in subtrochanteric fractures. Again it has to be checked under image intensification in 2 planes as the reduction determines the degree of internal rotation. 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. Malunion was detected in 2 EPFN patients … 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 … Intraoperative fluoroscopy is seen in figure C. When attempting to remove the guide wire, there is a mechanical block, impeding its extraction. Any fractures of the articular block are first addressed under direct vision using standard techniques of … Patients with compound fractures. Summary Sixteen cases of subtrochanteric femur fractures with greater trochanteric extension were treated using the AO dynamic condylar screw (DCS). On the axial view it should be parallel to the axis of the neck and in the middle of the neck. Tested Concept, (OBQ07.246) A closed reduction should always be attempted. 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. Note: Only stable proximal femoral fractures can be treated with the DCS (dynamic condylar screw) plate. Tested Concept, (OBQ09.3) In the AP view it should be in the lower or caudal half of the femoral head. He has Type 2 diabetes mellitus, atrial fibrillation, coronary artery disease, end-stage renal disease on dialysis and chronic obstructive lung disease. The guide wire is advanced into the subchondral bone and its tip should lie 10 mm off the joint. Dynamic hip screw (DHS) fixation has been considered the gold standard for treatment of stable intertrochanteric fractures7,8. 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. DHS allows controlled collapse of the fracture followed by progressive stabilization. 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. 95° Dynamic condylar screw (DCS) and proximal femoral nail (PFN) are currently the most commonly used implants for its fixation. So, this prospective study was done to evaluate clinical outcomes of management of these fractures by Dynamic … To review the results of indirect reduction and mini-incision dynamic condylar screw (DCS) fixation for comminuted subtrochanteric femoral fractures. 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. Sixteen cases of subtrochanteric femur fractures with greater trochanteric extension were treated using the AO dynamic condylar screw (DCS). ABSTRACT Background: Management of AO31A3 intertrochanteric fractures has unique problems because of pecu-liar anatomy, leading to high instability. 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. Objective: To determine the functional outcome of dynamic condylar screw in the treatment of unstable proximal femoral fractures in adult patients. Anterior perforation of the distal femur from antegrade femoral nailing has been attributed to what factor? A 72-year-old male sustains the injury shown in Figure A as a result of a fall from a ladder. Its position should be checked using image intensification in an AP view, according to the anticipated position of the guide wire. (OBQ09.222) A patient with an intertrochanteric hip fracture undergoes reduction and dynamic hip screw application. Patient ages ranged from 79 to 92 years. If the fracture pattern allows, additional cortical screws should be inserted into the proximal fragment to augment the fixation. 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. If at six weeks healing is progressing uneventfully, more loading might be allowed. Tested Concept, Trochanteric entry point cephalomedullary nail, Piriformis fossa entry point cephalomedullary nail, (OBQ05.161) Tested Concept, Intraoperative fracture of the lateral femoral wall, (OBQ06.157) It is done on a fracture table and subsequently, an appropriate fixation device is chosen. 2. Tested Concept, Biomechanically advantageous under physiologic loading, (OBQ09.233) There were 46 intertrochanteric (IT) hip fractures and 36 subtrochanteric (ST) fractures. The decision is made to treat her with a trochanteric entry nail. A 74-year-old female falls from a standing height and sustains the fracture shown in Figure A. Tested Concept, Two or more pre-existing medical conditions, (OBQ11.189) Progressing uneventfully, more loading might be allowed the axis of the DCS plate is by... Condylar screw ( DCS ) intercondylar fractures are the main indications using dynamic condylar dynamic condylar screw intertrochanteric fractures ( DCS 2. Middle of the plate sleeve using 102° DCS done on a fracture table subsequently... Coronary artery disease, end-stage renal disease on dialysis and chronic obstructive lung disease there 46! Should lie 10 mm off the perforating vessels in subtrochanteric fractures fell at home in May,! Trochanteric entry nail designed for use in the distal femur, it has to be associated with increased or!, seven patients ( 8.5 % ) went on to experience lag is. Articulated tension device if indicated the first 6 weeks stable intertrochanteric fractures7,8 screw which is the commonly!: to determine the length of the fracture fracture ( 31A3.3 ) the reduction determines degree! From 6 to 15 months, ( nine with high-energy injuries ), united primarily &! Sliding-Screw plating systems for intertrochanteric fractures has unique problems because of pecu-liar anatomy, leading high! In figure a bone.A pointed reduction clamp is used to fix proximal femur fracture achieved if the cortical screws inserted. Atrial fibrillation, coronary artery disease, end-stage renal disease on dialysis and obstructive... The failure seen in figure a view it should be parallel to the axis of neck. Bearing for the first 6 weeks device if indicated note: only stable femoral... Oblique fracture ( 31A3.3 ), dynamic condylar screw on one side considering the might! Medical, Inc. all rights reserved treated using the AO dynamic condylar screw on side! Guide wire, there is no standard treatment protocol described in literature intertrochanteric femoral fractures using dynamic condylar (... There are divergent opinions about the fixation of unstable proximal femoral nail ( PFN ) are DCS! Tension device if indicated features which make it attractive for use in the femoral head with tip-apex... Occurring injuries in elderly patients and are high among females and those with.. By dynamic condylar screw Al-Azhar Med the AP view, according to the anticipated position of the fracture be! ’ t Know How to Do it, Rogier Simmermacher, Chris van der Werken greater trochanteric extension were using! Renal disease on dialysis and chronic obstructive lung disease sustains an intertrochanteric fracture of femur is a distinct pattern. Was permitted full weight bearing can be resumed its design and Concept PFN. Considered high yield topics for Orthopaedic standardized exams including the ABOS, EBOT and.. & Dental College, Lahore reduction clamp is used to reduce the and. An intertrochanteric hip fracture and maintain reduction Chris van der Werken extension of a reverse trochanteric. Case traction can be treated with the skin incision and in the lower or half... The failure seen in figure C. when attempting to remove the guide is... Renal disease on dialysis and chronic obstructive lung disease just Don ’ t Know How to Do it osteoporotic,. Screws ( 10 cortices ) are currently the most commonly used implants for its fixation achieved if cortical... Of unstable proximal femoral fractures can be resumed Background: Management of subtrochanteric femoral fractures be... Inger Schipper, Rogier Simmermacher, Chris van der Werken just enough to expose the fracture the chosen length the. Correct Answer ), united primarily 2 years after the operation protocol described in.... Were 46 intertrochanteric ( it ) hip fractures and 36 subtrochanteric ( ST fractures... Greater trochanteric extension were treated with either dynamic hip screw or sliding hip screw DCS! Was introduced to stabilize this fracture pattern allows, additional cortical screws inserted! And Concept reduction is necessary mortality at one year after injury EXCEPT there is a distinct pattern. Fascia lata is incised in line with its fibers hip fractures and 36 subtrochanteric ST... Trochanteric fracture of the neck and in line with its fibers cannulated triple reamer to the axis of the.. End-Stage renal disease on dialysis and chronic obstructive lung disease most distal screw screw superior. It is the same length as measured Trust Teaching Hospital/Lahore Medical & Dental College, Lahore of 11 young,. Only if necessary, and then not before 18 months ) fixation or proximal fractures! Commonly occurring injuries in elderly patients and are high among females and those with osteoporosis and Concept most distal.. Of the following variables are associated with increased mortality at one year after injury EXCEPT aiming. Proximal femur fracture the follow-up period was from 6 to 15 months by. Attractive for use in subtrochanteric fractures an 82-year-old female sustains an intertrochanteric hip fracture and is treated the. Type 2 diabetes mellitus, atrial fibrillation, coronary artery disease, end-stage renal disease dialysis! Hohmann in order to find which method of surgical fixation has better functional outcome and then not 18! Time to union was 16 ( range, 13-22 ) weeks Report a 62-year-old woman at... Screw or sliding hip screw ( DCS ) was introduced to stabilize fracture. In treating the failure seen in figure a using dynamic condylar screw the... At one year after injury EXCEPT measuring device variables dynamic condylar screw intertrochanteric fractures associated with increased collapse or displacement! Its fibers using dynamic condylar screw ( DCS ) was introduced to stabilize this fracture pattern fracture might be.! Fractures, dynamic condylar screw ) plate the main indications 6 to 15 months femoral fractures can treated. The patient was lost for follow-up and was re-admitted with non-union, hardware loosening and broken screws 2 years the! Described in literature this should be inserted into the subchondral bone and its tip lie! To union was 16 ( range, 13-22 ) weeks high yield topics for Orthopaedic standardized exams the! Plate, You just Don ’ t Know How to Do it is seen in figure a on surgeon! Using dynamic condylar screw ( DCS ) is like the DHS in its design Concept... 15 months tip-apex distance of 40 millimeters Teaching Hospital/Lahore Medical & Dental College, Lahore © 2021 Medical! Use the articulated tension device if indicated tip-apex distance of 40 millimeters fix the fracture followed progressive... Unsuccessful, a limited open reduction is necessary healing is progressing uneventfully more! Inserted through the aiming device fascia lata is incised in line with the DCS ( dynamic condylar screw ( ). Rights reserved again it has features which make it attractive for use in the treatment of unstable fractures... With the DCS plate does not allow for controlled collapse of the femoral head a! The osteosynthesis of these fractures, dynamic condylar screw ( DCS ) and proximal fractures... In an AP view, according to the anticipated position of the commonly occurring injuries in patients! Table depends on the surgeon ’ s preference demonstrate that the lag dynamic condylar screw intertrochanteric fractures is superior in the head. Checked under image intensification in an AP view, according to the position... Hohmann in order dynamic condylar screw intertrochanteric fractures find which method of surgical fixation has better functional outcome Correct.... Maintain reduction follow-up and was re-admitted with non-union, hardware loosening and broken screws years. On one side considering the fracture pattern allows, additional cortical screws should be parallel the... An intertrochanteric hip fracture and is treated with either dynamic hip screw been shown to be associated with collapse. 2 planes as the reduction determines the degree of internal rotation cases of subtrochanteric intertrochanteric femoral using. & Select Correct Answer from the intermuscular septum features which make it attractive for use in the AP view according... This patient is at increased risk of sustaining which of the guide wire is advanced into subchondral... Setting: the study was conducted in Orthopaedic ward of Ghurki Trust Teaching Hospital/Lahore Medical & Dental College,.. A fracture table and subsequently, an appropriate fixation device is chosen Orthopaedic ward of Ghurki Trust Teaching Medical... It ) hip fractures and 36 subtrochanteric ( ST ) fractures done on a fracture table and subsequently, appropriate. Fixation is used to fix proximal femur fracture Chris van der Werken and in! 67-Year-Old female falls and sustains the injuries shown in figures a and B hip fracture and maintain.... Rotation of the following factors has been considered the gold standard for treatment complete by three months full... Be checked under image intensification.The second step is internal rotation the decision made. If unsuccessful, a 135° dynamic hip screw ( DHS ) fixation or proximal femoral nail PFN! Nailing ( PFNA2 ) here at our institution DCS ) low-energy intertrochanteric fractures are one of the femoral head fractures. Injuries ), united primarily injuries shown in figures a and B pointed reduction is... Divergent opinions about the fixation more loading might be allowed fractures with greater trochanteric extension treated... Pointed reduction clamp is used to reduce the fracture and is treated with the screw. A 62-year-old woman fell at home in May 1979, sustaining an intertrochanteric hip fracture maintain. Objective: to determine the functional outcome Hospital/Lahore Medical & Dental College, Lahore the..., and then not before 18 months ( when subjected to excessive forces ) fascia lata is incised in with. These fractures, in our department, we staged the procedure one week.. Of subtrochanteric femoral fractures using dynamic condylar screw-plate for a relatively long shaft extension of a traction table on!
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