This device has been studied and compared with cannulated screws and fixation with DHS showing inconclusive results. The mechanism of injury was low-energy in 47 cases and high-energy in 11 cases. 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). Note that it is inserted parallel to both the red wire in the frontal plane and is parallel to the green line on the end-on view on the femur. 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. Emphasis should be placed on progressive quadriceps strengthening and straight leg raises. Dynamic Condylar Screw used for fixation of: a, a subtrochanteric fracture, and b, a supracondylar fracture of the femur. This latter orientation ensures that the plate comes to lie flush with the lateral cortex. 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 axis can be checked intraoperatively by using a piece of cable, such as the diathermy cord. The regimens suggested here are for guidance only and not to be regarded as prescriptive. The compression screw may be utilized to couple the screw to the plate. Twenty-seven cases (87.2%) sustained these fractures either from traffic crashes or falls from height and the remaining four had a simple fall. Access options Buy single article. Stable. Few tricks in the technique make use of dynamic condylar screw in biological fixation of comminuted subtrochanteric fractures easier. A radiographic ruler can be used to measure the length of both femora. The early appearance of callus avoids the need for primary cancellous bone grafting, emphasising the importance of preserving biology of the fracture fragments. This device has some technical advantages over the AO condylar blade plate. Insert a screw through the plate close to the compression device to secure the fixation. Detach the T-handle and pass the plate barrel over the screw shank. The use of the Schanz pin in conjunction with the pointed reduction forceps is therefore preferred. If the mechanical axis is restored this should be adequate in most situations (fragmented patterns). Supra Condylar Bolts & Nail 4.9mm Locking Bolt Set Instruments for Supra Condylar Locking Nail Instruments Set for Supra Condylar Locking Nail Cannulated Screws Herbert Cannulated Screws Implants & Instruments Small Cannulated Cancellous Screws Small Cannulated Cancellous Screws Instruments & Set Large Cannulated Cancellous Screws Large 7.0mm & 6.5mm Cannulated Cancellous Screws … The TIBER™Dynamic Condylar Screw is designed to provide strong and stable fixation ofa variety certain distal femoral subtrochanteric fractures,with minimal soft tissue . 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. This … OTHER INFORMATION The DHS plates and DCS plates are made of two materials – 1. Courses, webinars, and online events, in your region or worldwide, Pediatric distal femur module is now online. Reduction techniques. Dynamic Condylar Screw is cost-effective and procedure relatively easy to perform and affords a rigid internal fixation. Average follow-up was 3 years (range 14–65 months). 2. Safe positions would be anterolateral or anterior on the femur. Pass a second guide wire over the anterior surface of the knee to indicate the plane of the patello-femoral condyles (green). A 5.0 mm or 6.0 mm Schanz pin in the medial and/or lateral femoral condyle to act as a joystick. To avoid this, the knee is brought into full extension, and the distal femoral fragment is stabilized in this position to the tibia. The aim of this study was to determine the amount of cortex loss in the distal femur when inserting a DCS-Plate. A Schanz screw is inserted in the distal femoral articular block and used to counter the pull of the gastrocnemius. Another method of assessing rotational reduction is to compare the cortical thickness above and below the fracture. Not only must the biomechanical axis be restored, but care should be taken to ensure that there is no malrotation of the distal femur on the proximal femur. Dynamic Condylar Screw Fixation for Comminuted Proximal Femur Fractures Fig II: Same fracture two months postoperative after fixation with dynamic condylar screw construct. It must be borne in mind that these structures can be damaged by the injury or can be damaged by the surgeon during the reconstruction. A cancellous screw can then be inserted into the most distal screw hole of the plate to prevent rotation of the distal femoral articular block around the axis of the DCS. 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. Early range of motion helps restore movement in the early postoperative phase. 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. When reduced, a temporary cerclage wire is used to lock the position of the Schanz screw relative to the distractor. Insert the guide wire under image intensifier control all the way across the femur. New biological method of internal fixation of the femur. Some surgeons find it useful to use an external fixator (or femoral distractor) from the proximal femur to the proximal tibia. The surgeon must take care not to use excessive stripping at this point to ensure adequate fracture healing. Thirty-one consecutive patients with a mean age of 32.6 years, who sustained subtrochanteric femoral fractures, were treated with this method. Pearl: The combination of reduction aids is often necessary to obtain anatomic reduction. Seen from an end-on view, the lateral surface has a 10° inclination from the vertical, while the medial surface has a 20–25° slope. There may be bleeding from the lateral genicular arteries, which will need to be controlled using diathermy. Injury 2003;34(2):117–122. The dynamic condylar screw in the management of subtrochanteric fractures: does judicious use of biological fixation enhance overall results? 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]. Injury 2003;34(2):123–128. In oblique, single-plane fractures, an interfragmentary lag screw should be inserted through the plate. Strong. Screws are inserted along the periphery of the articular surface of the lateral femoral condyle going from lateral to medial or from medial to lateral to compress the intercondylar split. 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. Pearl: In osteoporotic bone, tapping should be omitted. We have used dynamic condylar screw fixation to stabilize subtrochanteric fractures in our set –up. One option involves reducing the fracture fragments anatomically, either directly or indirectly with fluoroscopic control. The dynamic condylar screw (DCS) was originally designed for use in fractures of the distal femur and intercondylar fractures, but has found increasing application in proximal femoral fractures, particularly subtrochanteric ones. Insert the proximal and distal fixator (distractor) pins carefully in order not to conflict with the later plating procedure. Fractures were classified according to the AO classification (10 type … 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. Few tricks in the technique make use of dynamic condylar screw in biological fixation of comminuted subtrochanteric fractures easier. Take care to restore the mechanical axis of the femur in all planes using the previously discussed techniques. Dynamic condylar screw has been found to be less technically demanding and provided good to excellent results as compared to other implants in treating patients with supracondylar and simple intracondylar fractures of the femur.3 Traditionally the DCS has been used by the open technique by exposing the fracture site. catastrophic in regards to a satisfactory fracture union and culminates in various complications.15 The two holes closest to the barrel accept 6.5 mm Cancellous Bone Screws. Year: 2007. This site uses cookies to improve your experience and to help show ads that are more relevant to your interests. Screw available holes: 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 105, 110, 115, 120, 125, 130, 135, 140 and 145. 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. Subscribe to journal. 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 … Remember that the cross section of the distal femoral condylar mass is trapezoidal and slopes markedly on the medial side. Prior to plate fixation to the proximal fragment, final reduction of the metaphysis may be performed. On occasions, it is acceptable to insert screws through the articular surface, when no other option is available. Reduction using axial traction on a fracture table was used in 24 cases , . 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]. At the posterior aspect of the knee lie the popliteal artery, nerve, and vein. 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. Usually, one to two additional K-wires are inserted, either from medial to lateral, or lateral to medial. Material and Methods. If rotation is correct, this cord will pass over the midline of the patella, and slightly medial to the tibial eminence. The distal femur has a unique anatomical shape. [citation needed] It is the most commonly used implant for extracapsular fractures of the hip, which are common in older osteoporotic patients. 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