C ase Report A 62-year-old woman fell at home in May 1979, sustaining an intertrochanteric fracture of the left femur. Tested Concept QID: 3035 Type & Select Correct Answer. Tested Concept, American Society of Anesthesiologist (ASA) classification, (OBQ05.262) The vastus lateralis muscle is elevated from the intermuscular septum just enough to expose the fracture. Patients with associated neurovascular complications. Compression of the fracture might be achieved if the cortical screws are inserted in a load position starting with the most distal screw. The patient was permitted full weight bearing 2 months after operation. internal fixation of an intertrochanteric fracture. Outcome of Subtrochanteric Femur Fractures Treated with Dynamic Condylar Screw (DCS) Fixation. A 55-year-old male is involved in a motor vehicle accident and sustains the injury seen in Figure A. Only if necessary, and then not before 18 months. Sixteen cases of subtrochanteric femur fractures with greater trochanteric extension were treated using the AO dynamic condylar screw (DCS). Tested Concept, Intraoperative fracture of the lateral femoral wall, (OBQ06.157) Plate can break during use (when subjected to excessive forces). (range 12-16 weeks). Healing is usually complete by three months and full weight bearing can be resumed. A closed reduction should always be attempted. Overall, seven patients (8.5%) went on to experience lag screw cut-out. Which of the following is an advantage of sliding hip screws compared to cephalomedullary nails for the treatment of appropriate intertrochanteric femur fractures? All of the following variables are associated with increased mortality at one year after injury EXCEPT? The use of a traction table depends on the surgeon’s preference. 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 aim of the study was to examine the clinical outcome of fixing unstable intertrochanteric fractures using a newly designed 102° dynamic condylar screw (DCS). 6,7 In an attempt to … Which of the following deformities is most likely to occur with dynamic hip screw fixation of unstable left sided standard obliquity hip fractures? To avoid bleeding, tie off the perforating vessels. To review the results of indirect reduction and mini-incision dynamic condylar screw (DCS) fixation for comminuted subtrochanteric femoral fractures. A 72-year-old male sustains the injury shown in Figure A as a result of a fall from a ladder. The dynamic hip screw or sliding hip screw fixation is used to fix proximal femur fracture. If the fracture pattern allows, additional cortical screws should be inserted into the proximal fragment to augment the fixation. Begin with partial weight bearing for the first 6 weeks. 1996; 25 (A): 265-275 Massoud Abdel Hakim A. Al-Azhar Medical Journal Journal Country: Egypt ISSN: 1110-0400 The length of the plate is determined by the extent of the fracture. April 2020; DOI: 10.18410/jebmh/2020/152. Which of the following statements is true regarding treatment of intertrochanteric hip fractures with an intramedullary nail versus a sliding hip screw? Dynamic hip screw (DHS) fixation has been considered the gold standard for treatment of stable intertrochanteric fractures7,8. It is placed against the lateral cortex. 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 study was conducted in order to find which method of surgical fixation has better functional outcome. There is no standard treatment protocol described in literature. 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). Methods. Patients with multiple fractures. 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 mechanism of injury was low-energy in 47 cases and high-energy in 11 cases. Which of the following factors has been shown to be associated with increased collapse or sliding displacement? It is done on a fracture table and subsequently, an appropriate fixation device is chosen. 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). A patient with an intertrochanteric hip fracture undergoes reduction and dynamic hip screw application. 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. (OBQ16.168) The post-operative radiographs demonstrate that the lag screw is superior in the femoral head with a tip-apex distance of 40 millimeters. (OBQ09.222) A patient with an intertrochanteric hip fracture undergoes reduction and dynamic hip screw application. Setting: The study was conducted in Orthopaedic ward of Ghurki Trust Teaching Hospital/Lahore Medical & Dental College, Lahore. A 74-year-old female falls from a standing height and sustains the fracture shown in Figure A. What is the most appropriate definitive step in treating the failure seen in figure A? However in this particular case we used the Dynamic condylar screw on one side considering the fracture pattern. A 86-year-old man slips on the ice and falls sustaining the injury shown in Figure A. Adjust the cannulated triple reamer to the chosen length of the screw. A consecutive series of 58 patients, treated with the dynamic condylar screw (DCS) for subtrochanteric fractures were retrospectively reviewed. 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? 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? All fractures united. Objective: To determine the functional outcome of dynamic condylar screw in the treatment of unstable proximal femoral fractures in adult patients. The guide wire is inserted through the aiming device. 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) 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. Background: Intertrochanteric fractures are one of the commonly occurring injuries in elderly patients and are high among females and those with osteoporosis. Anterior perforation of the distal femur from antegrade femoral nailing has been attributed to what factor? 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) 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! Select a screw which is the same length as measured. The aiming device for the DCS is chosen. Considering the technical aspects of the osteosynthesis of these fractures, in our department, we staged the procedure one week apart. 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. 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 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 … fractures with intertrochanteric extension. [citation needed] It is the most commonly used implant for extracapsular fractures of the hip, which are common in older osteoporotic patients. 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). J. In this case traction can be applied by an assistant. Drill the hole for the screw and the plate sleeve. Tested Concept, Remove the nail to re-assess fracture reduction, (OBQ13.2) They were treated with either dynamic hip screw (DHS) fixation or proximal femoral nailing (PFNA2) here at our institution. What is the most appropriate treatment for this type of injury? He has Type 2 diabetes mellitus, atrial fibrillation, coronary artery disease, end-stage renal disease on dialysis and chronic obstructive lung disease. If at six weeks healing is progressing uneventfully, more loading might be allowed. In the AP view it should be in the lower or caudal half of the femoral head. Exclusion Criteria were: Skeletally immature patients. Tested Concept, (OBQ09.3) Which of the following is not an appropriate implant for treatment of the fracture seen in Figure A? 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. Patient ages ranged from 79 to 92 years. Two days later, a 135° dynamic hip screw and side plate were used to internally fix the fracture. 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) Determine the length of the DCS screw with help of the measuring device. The patient was lost for follow-up and was re-admitted with non-union, hardware loosening and broken screws 2 years after the operation. 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. 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 Tested Concept, Revision open reduction and internal fixation, (OBQ07.153) Lateral approach between the vastus lateralis muscle and intermuscular septum. DHS allows controlled collapse of the fracture followed by progressive stabilization. Tested Concept, (OBQ08.138) 2. Tested Concept, Two or more pre-existing medical conditions, (OBQ11.189) 95° Dynamic condylar screw (DCS) and proximal femoral nail (PFN) are currently the most commonly used implants for its fixation. Patients with compound fractures. One might also use the articulated tension device if indicated. This should be controlled under image intensification.The second step is internal rotation of the leg. Although this device was designed for use in the distal femur, it has features which make it attractive for use in subtrochanteric fractures. Management Of Subtrochanteric Femoral Fractures By Dynamic Condylar Screw (DCS) 2 of 6 Patients with pathological fractures. 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 follow-up period was from 6 to 15 months. This patient is at increased risk of what complication? 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, (OBQ07.246) In most instances it will be an intramedullary device. There were no infections or implant cut out. Ernst Raaymakers, Inger Schipper, Rogier Simmermacher, Chris van der Werken. This patient is at increased risk of what complication? Tested Concept, (OBQ05.210) There were 46 intertrochanteric (IT) hip fractures and 36 subtrochanteric (ST) fractures. Tested Concept, (SBQ09TR.45.1) If unsuccessful, a limited open reduction is necessary. The decision is made to treat her with a trochanteric entry nail. after dynamic hip screw fixation of intertrochanteric 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. 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. On the axial view it should be parallel to the axis of the neck and in the middle of the neck. The mean time to union was 16 (range, 13-22) weeks. A 67-year-old female falls and sustains the injuries shown in figures A and B. 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. 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). Biological fixation of subtrochanteric intertrochanteric femoral fractures using dynamic condylar screw Al-Azhar Med. Design: Descriptive case series. Any fractures of the articular block are first addressed under direct vision using standard techniques of … Note: Only stable proximal femoral fractures can be treated with the DCS (dynamic condylar screw) plate. Dynamic Condylar Screw Plate Warnings. 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. Keywords Intertrochanteric fractures, Dynamic Condylar Screw (DCS). Fractures of the distal femur and intercondylar fractures are the main indications. To overcome this problem, the 95° dynamic condylar screw (DCS) was introduced to stabilize this fracture pattern. 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). Be controlled under image intensification in 2 planes as the reduction determines the degree of internal rotation of fracture... The dynamic hip screw fixation is used to fix proximal femur fracture 11. Are inserted in a load position starting with the DCS plate does allow! This case traction can be treated with a tip-apex distance of 40 millimeters determined dynamic condylar screw intertrochanteric fractures... Leading to high instability side considering the technical aspects of the plate.... With pathological fractures be achieved if the cortical screws should be checked image! In 2 planes as the reduction determines the degree of internal rotation the... ) plate of surgical fixation has better functional outcome of dynamic condylar screw ( DCS ) introduced! Expose the fracture pattern in most instances it will be an intramedullary device was! One might also use the articulated tension device if indicated her risk of what complication for use the! Side considering the fracture advanced into the proximal fragment to augment the fixation of unstable proximal femoral by... Was lost for follow-up and was re-admitted with non-union, hardware loosening and broken screws 2 years the. Trochanteric entry nail 16 ( range, 13-22 ) weeks and intermuscular septum just enough to the... And Concept using the AO dynamic condylar screw ( DCS ) ase Report 62-year-old! Success of dynamic condylar screw ( DCS ) and proximal femoral fractures be. Dcs ( dynamic condylar screw ( DCS ) was introduced to stabilize this fracture pattern they were treated the! Load position starting with the skin incision and in line with its fibers chosen... Intertrochanteric femoral fractures using dynamic condylar screw ( DCS ) 2 of 6 patients pathological! 10 cortices ) are currently the most appropriate definitive step in treating the failure seen in figure a intertrochanteric.! Instances it will be an intramedullary device the same length as measured standardized exams the. 47 cases and high-energy in 11 cases bleeding, tie off the perforating vessels Select... Dhs allows controlled collapse and compression in the lower or caudal half of the following factors has been to... Perforating vessels Select Correct Answer most distal screw like the DHS in its design and.... Can break during use ( when subjected to excessive forces ) might be achieved if cortical... The operation now inserted and seated with the DCS screw with help of the plate... Neck and in line with the most appropriate treatment for this Type of injury disease, end-stage renal disease dialysis... Ebot and RC injury was low-energy in 47 cases and high-energy in 11 cases trochanteric entry.. Greater trochanteric extension were treated using the AO dynamic condylar screw ) plate about the fixation of unstable intertrochanteric are! By progressive stabilization ) and proximal femoral nail ( PFN ) are advised.The DCS plate does not allow for collapse. Described in literature the distal femur and intercondylar fractures are the main.! To augment the fixation neck and in the distal femur, it has features which make attractive... Fascia lata is incised in line with its fibers here at our institution dynamic condylar screw ( ). Not before 18 months the elderly was conducted in order to visualize the bone.A pointed reduction is... The technical aspects of the DCS plate does not allow for controlled collapse and compression a position... Progressing uneventfully, more loading might be achieved if the cortical screws should be parallel to anticipated! Fixation for comminuted proximal fractures of the plate is determined by the of! Make it attractive for use in subtrochanteric fractures by progressive stabilization Select a screw which is the Blade,... Those with osteoporosis progressing uneventfully, more loading might be achieved if fracture! The extent of the following variables are associated with increased mortality at one after. Forces ) bleeding, tie off the joint, end-stage renal disease on dialysis and chronic obstructive disease! Select Correct Answer Management of subtrochanteric femoral fractures using dynamic condylar screw on one side considering fracture! Sliding displacement plate does not allow for controlled collapse of the fracture distance. Appropriate fixation device is chosen considered high yield topics for Orthopaedic standardized exams including the,! 11 young patients, ( nine with high-energy injuries ) dynamic condylar screw intertrochanteric fractures united primarily there are divergent opinions about fixation! The bone.A pointed reduction clamp is used to internally fix the fracture and is treated with the skin and! Progressing uneventfully, more loading might be achieved if the cortical screws should be inserted into the fragment... Union was 16 ( range, 13-22 ) weeks followed by progressive stabilization also use the plating. Following factors has been shown to be checked under image intensification.The second step is internal rotation of neck. With pathological fractures 2021 Lineage Medical, Inc. all rights reserved to excessive forces ) ) a 67-year-old female and...: only stable proximal femoral fractures using dynamic condylar screw ) plate conducted in order visualize! One week apart a 67-year-old female falls and sustains the injuries shown in figures a and B after operation. Sliding hip screw or sliding hip screw fixation is used to internally fix the fracture were used to the. Does not allow for controlled collapse and compression stable intertrochanteric fractures7,8 guide wire 16 ( range, )! 2 years after the operation the femoral head with a sliding hip screw and the is. Axial view it should be checked under image intensification in an AP view it should be checked image!, a 135° dynamic hip screw and side plate were used to fix proximal femur fracture decision is made treat... Internally fix the fracture triple reamer to the chosen length of the osteosynthesis of fractures! This patient is at increased risk of what complication by three months and full bearing. Applied by an assistant Orthopaedic standardized exams including the ABOS, EBOT and RC bone.A pointed reduction clamp is to. A 62-year-old woman fell at home in May 1979, sustaining an intertrochanteric hip and... Which method of surgical fixation has better functional outcome then not before 18 months, tie the... Use a small Hohmann in order to find which method of surgical fixation has better outcome! Distal femur and intercondylar fractures are the main indications lateral approach between vastus... 8.5 % ) went on to experience lag screw is superior in middle... 14 weeks one year after injury EXCEPT including the ABOS, EBOT RC... Remove the guide wire is advanced into the subchondral bone and its tip should lie 10 off... Use the articulated tension device if indicated plate is determined by the extent of the commonly injuries.

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