Touch-down weight-bearing progresses to full weight-bearing gradually, over a period of 2 to 3 weeks (beginning at 6–10 weeks postoperatively). Ten out of 11 young patients, (nine with high-energy injuries), united primarily. A line is drawn from the anterior aspect of the lateral femoral condyle to the anterior aspect of the medial femoral condyle (patellofemoral inclination) that slopes approximately 10°. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. These screws must be countersunk and recessed beneath the articular surface. 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. Consideration must be given to fracture reduction in: Reduction can be performed with a single reduction tool (eg, large distractor), or by combining several steps (for example fracture table +/- external fixator, +/- reduction via the implant, etc) to achieve the final reduction. A Schanz screw is inserted in the distal femoral articular block and used to counter the pull of the gastrocnemius. The surgeon must take care not to use excessive stripping at this point to ensure adequate fracture healing. OTHER INFORMATION The DHS plates and DCS plates are made of two materials – 1. 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. 10. Dynamic Condylar Screw used for fixation of: a, a subtrochanteric fracture, and b, a supracondylar fracture of the femur. 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. However, this maneuver is not absolutely necessary, and some surgeons do not perform it. US$ 39.95. BibTex; Full citation; Publisher: Springer Science and Business Media LLC. Stainless Steel (Grade SS 316L) 2. This device has some technical advantages over the AO condylar blade plate. Alignment of the main shaft fragments can be achieved indirectly with the use of: Mechanical stability, provided by the bridging plate, is adequate for gentle functional rehabilitation and results in satisfactory indirect healing (callus formation). There may be bleeding from the lateral genicular arteries, which will need to be controlled using diathermy. 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. Reduction using axial traction on a fracture table was used in 24 cases , . 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 Dynamic Condylar Screw is designed to provide strong and stable internal fixation of certain distal femoral and subtrochanteric fractures, with minimal soft tissue irritation. Dynamic Condylar Screw is cost-effective and procedure relatively easy to perform and affords a rigid internal fixation. Implant removal is not essential but should be discussed with the patient if there are implant-related symptoms after consolidated fracture healing. 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. Complete the fixation of the plate to the femur with sufficient screws, using neutral insertion of the screws in the plate holes. The dynamic condylar screw (DCS) is like the DHS in its design and concept. When reduced, a temporary cerclage wire is used to lock the position of the Schanz screw relative to the distractor. Thirty-one consecutive patients with a mean age of 32.6 years, who sustained subtrochanteric femoral fractures, were treated with this method. The mechanism of injury was low-energy in 47 cases and high-energy in 11 cases. 2.1. This will allow the plate to sit against distal femur. Emphasis should be placed on progressive quadriceps strengthening and straight leg raises. In order to avoid joint penetration, these devices should be placed parallel to both the patellofemoral and femorotibial joints planes. This is a preview of subscription content, log in to check access. Insert the guide wire under image intensifier control all the way across the femur. 11. Use the impactor to bring the plate down to the bone, with the barrel sliding over the screw shank. Alternative: Some surgeons reconnect T-handle to the screw to help to adjust the position the plate. If rotation is correct, this cord will pass over the midline of the patella, and slightly medial to the tibial eminence. Fixation with compression should be applied when possible in fracture patterns where there is contact between the proximal and distal main fragments. The Dynamic Condylar Screw and plate are designed to provide strong and stable internal fixation of certain distal femoral and subtrochantericfractures, with minimal soft tissue irritation. A Schanz screw is inserted in the distal femoral articular block and used to counter the pull of the gastrocnemius. The early appearance of callus avoids the need for primary cancellous bone grafting, emphasising the importance of preserving biology of the fracture fragments. Remember that the cross section of the distal femoral condylar mass is trapezoidal and slopes markedly on the medial side. Results of dynamic condylar screw for subtrochanteric fractures. 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. 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. This axis can be checked intraoperatively by using a piece of cable, such as the diathermy cord. https://doi.org/10.1016/S0020-1383(02)00319-4. Another method of assessing rotational reduction is to compare the cortical thickness above and below the fracture. This device has been studied and compared with cannulated screws and fixation with DHS showing inconclusive results. 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. When the DCS is correctly inserted in the distal femur, the plate can be used to assist in the final reduction. Ideally, patients are fully weight-bearing, without devices (e.g., cane) by 12 weeks. 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. Patients were assessed clinically and radiographically with regards to fracture classification, operating time, blood loss, time of union, malunion and other complications. An image intensifier or intraoperative radiography was used for the procedure. Therefore, if a straight AP view is obtained, the guidewire can appear to be inside the bone. This latter orientation ensures that the plate comes to lie flush with the lateral cortex. Few tricks in the technique make use of dynamic condylar screw in biological fixation of comminuted subtrochanteric fractures easier. This is mostly to protect the articular component of the injury, rather than the shaft injury. 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. It may not be used in situations of severe metaphyseal comminution and/or osteoporosis. The regimens suggested here are for guidance only and not to be regarded as prescriptive. Under image intensifier control, pass one guide wire lateral to medial along the tibio-femoral joint line (red). 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 … It is very important to restore the biomechanical axis of the lower limb. The dynamic condylar screw in the management of subtrochanteric fractures: does judicious use of biological fixation enhance overall results? Direct manipulation of intermediate fragments would risk disturbing their blood supply. With stable fracture fixation, the surgeon and the physical therapy staff will design an individual program of progressive rehabilitation for each patient. 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. Check the position of the guide wire carefully to ensure it has been correctly positioned, with the parallelism already described. Both active and passive motion of the knee and hip can be initiated immediately postoperatively. If a large fragment has separated from the fracture zone and impaled the adjacent muscle, direct reduction may be required. Florian Gebhard, Phil Kregor, Chris Oliver, Markku T Nousiainen. This study was conducted to evaluate the results of fixation of this device in our Scenario . There are no significant arteries, veins, or nerves on the lateral side of the knee. Possible in fracture patterns pitfall: it is important to restore the mechanical axis is restored should! 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Used for fixation of comminuted subtrochanteric femoral fractures will provide additional compression across any intraarticular split femur tapers the... Immediately postoperatively useful to use excessive stripping at this point to ensure has! Axes of the plate to sit against distal femur fractures might be approximated to screw... The combination of reduction aids that are helpful include: before definitive fixation is undertaken, than... Trochanter as per the pre-operative planning of 31 ( 6.4 % ) without the for! The final reduction devices ( e.g., cane ) by 12 weeks progresses to weight-bearing. Thirty-One consecutive patients with a mean age of 32.6 years, who sustained subtrochanteric fractures...

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