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)
[citation needed] It is the most commonly used implant for extracapsular fractures of the hip, which are common in older osteoporotic patients. 95° Dynamic condylar screw (DCS) and proximal femoral nail (PFN) are currently the most commonly used implants for its fixation.
The average time to full weight bearing was 14 weeks. 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). Healing is usually complete by three months and full weight bearing can be resumed. A closed reduction should always be attempted. 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.
Tested Concept, (OBQ08.138)
Fractures of the distal femur and intercondylar fractures are the main indications. 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. Objective: To determine the functional outcome of dynamic condylar screw in the treatment of unstable proximal femoral fractures in adult patients. Biological fixation of subtrochanteric intertrochanteric femoral fractures using dynamic condylar screw Al-Azhar Med. Only if necessary, and then not before 18 months. She was admitted to a local hospital for treatment. In osteoporotic bone, five screws (10 cortices) are advised.The DCS plate is now inserted and seated with the impactor. Sixteen cases of subtrochanteric femur fractures with greater trochanteric extension were treated using the AO dynamic condylar screw (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. 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). To avoid bleeding, tie off the perforating vessels. He has Type 2 diabetes mellitus, atrial fibrillation, coronary artery disease, end-stage renal disease on dialysis and chronic obstructive lung disease.
The decision is made to treat her with a trochanteric entry nail. The patient was lost for follow-up and was re-admitted with non-union, hardware loosening and broken screws 2 years after the operation. A 86-year-old man slips on the ice and falls sustaining the injury shown in Figure A. 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. ABSTRACT Background: Management of AO31A3 intertrochanteric fractures has unique problems because of pecu-liar anatomy, leading to high instability. after dynamic hip screw fixation of intertrochanteric fracture. This patient is at increased risk of what complication? However, there are divergent opinions about the fixation of unstable intertrochanteric fractures in the elderly. The vastus lateralis muscle is elevated from the intermuscular septum just enough to expose the fracture. All of the following implants offer adequate fracture fixation of the injury shown in Figure A EXCEPT:
Background: Intertrochanteric fractures are one of the commonly occurring injuries in elderly patients and are high among females and those with osteoporosis. Which of the following is an advantage of sliding hip screws compared to cephalomedullary nails for the treatment of appropriate intertrochanteric femur fractures? Lateral approach between the vastus lateralis muscle and intermuscular septum. Drill the hole for the screw and the plate sleeve. 2. Determine the length of the DCS screw with help of the measuring device. In this case traction can be applied by an assistant. The mean time to union was 16 (range, 13-22) weeks. Keywords Intertrochanteric fractures, Dynamic Condylar Screw (DCS). What is the most appropriate treatment for this type of injury? Dynamic Condylar Screw Plate Warnings. Considering the technical aspects of the osteosynthesis of these fractures, in our department, we staged the procedure one week apart.
Tested Concept, Biomechanically advantageous under physiologic loading, (OBQ09.233)
Ernst Raaymakers, Inger Schipper, Rogier Simmermacher, Chris van der Werken. Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Reverse oblique trochanteric fracture of femur is a distinct fracture pattern. 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). The DCS plate does not allow for controlled collapse and compression. Select a screw which is the same length as measured.
It is placed against the lateral cortex. Tested Concept, Remove the nail to re-assess fracture reduction, (OBQ13.2)
Twelve unstable low-energy intertrochanteric fractures were fixed using 102° DCS. Patients with associated neurovascular complications. Intraoperative fluoroscopy is seen in figure C. When attempting to remove the guide wire, there is a mechanical block, impeding its extraction. 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)
Before 1999, 15 fractures were treated with a dynamic condylar screw (DCS) and after 1999, 11 fractures were treated with a gamma nail (GN). Tested Concept, Mismatch of the radius of curvature of implant and bone, (OBQ07.86)
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.
Only stable proximal femoral fractures can be treated with the DCS (dynamic condylar screw) plate. Twelve unstable low-energy intertrochanteric fractures were fixed using 102° DCS. 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).
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. What is the most appropriate definitive step in treating the failure seen in figure A?
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. In most instances it will be an intramedullary device. 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.
One might also use the articulated tension device if indicated. 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. They were treated with either dynamic hip screw (DHS) fixation or proximal femoral nailing (PFNA2) here at our institution. Take x-rays at six-week intervals. This patient is at increased risk of what complication? It is done on a fracture table and subsequently, an appropriate fixation device is chosen.
Compression of the fracture might be achieved if the cortical screws are inserted in a load position starting with the most distal screw.
DHS allows controlled collapse of the fracture followed by progressive stabilization. 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. On the axial view it should be parallel to the axis of the neck and in the middle of the neck. Tested Concept, (OBQ09.3)
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. Setting: The study was conducted in Orthopaedic ward of Ghurki Trust Teaching Hospital/Lahore Medical & Dental College, Lahore. The dynamic hip screw or sliding hip screw fixation is used to fix proximal femur fracture. 1996; 25 (A): 265-275 Massoud Abdel Hakim A. Al-Azhar Medical Journal Journal Country: Egypt ISSN: 1110-0400 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. The post-operative radiographs demonstrate that the lag screw is superior in the femoral head with a tip-apex distance of 40 millimeters. 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. The use of a traction table depends on the surgeon’s preference.
Methods. J.
The fascia lata is incised in line with the skin incision and in line with its fibers. If at six weeks healing is progressing uneventfully, more loading might be allowed. The guide wire is advanced into the subchondral bone and its tip should lie 10 mm off the joint.
The occurrence of this injury most increases her risk of sustaining which of the following 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? 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. Tested Concept, (OBQ07.246)
Although this device was designed for use in the distal femur, it has features which make it attractive for use in subtrochanteric fractures. A 74-year-old female falls from a standing height and sustains the fracture 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 … Patients with multiple fractures. fractures with intertrochanteric extension.
The aiming device for the DCS is chosen.
What should be performed next? Tested Concept, (OBQ05.210)
April 2020; DOI: 10.18410/jebmh/2020/152. There were 46 intertrochanteric (IT) hip fractures and 36 subtrochanteric (ST) fractures. It Is The Blade Plate, You Just Don’t Know How To Do It! Note: Only stable proximal femoral fractures can be treated with the DCS (dynamic condylar screw) plate. The guide wire is inserted through the aiming device. A 55-year-old male is involved in a motor vehicle accident and sustains the injury seen in Figure A. C ase Report A 62-year-old woman fell at home in May 1979, sustaining an intertrochanteric fracture of the left femur. Tested Concept, Revision open reduction and internal fixation, (OBQ07.153)
Which of the following is a recognized predictor of mortality after hip fracture? There were no infections or implant cut out. However in this particular case we used the Dynamic condylar screw on one side considering the fracture pattern.
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. Tested Concept, Two or more pre-existing medical conditions, (OBQ11.189)
Malunion was detected in 2 EPFN patients … Tested Concept, Trochanteric entry point cephalomedullary nail, Piriformis fossa entry point cephalomedullary nail, (OBQ05.161)
Outcome of Subtrochanteric Femur Fractures Treated with Dynamic Condylar Screw (DCS) 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. If unsuccessful, a limited open reduction is necessary. Tested Concept, (SBQ09TR.45.1)
Patients with compound fractures. internal fixation of an intertrochanteric 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)
There is no standard treatment protocol described in literature.
Adjust the cannulated triple reamer to the chosen length of the screw. Summary Sixteen cases of subtrochanteric femur fractures with greater trochanteric extension were treated using the AO dynamic condylar screw (DCS). The follow-up period was from 6 to 15 months. 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. To review the results of indirect reduction and mini-incision dynamic condylar screw (DCS) fixation for comminuted subtrochanteric femoral fractures. Plate can break during use (when subjected to excessive forces). Design: Descriptive case series. Ten out of 11 young patients, (nine with high-energy injuries), united primarily.
To evaluate the success of dynamic condylar screw (DCS) fixation for comminuted proximal fractures of femur in adults. The mechanism of injury was low-energy in 47 cases and high-energy in 11 cases. 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.
Overall, seven patients (8.5%) went on to experience lag screw cut-out. Its position should be checked using image intensification in an AP view, according to the anticipated position of the guide wire. All of the following variables are associated with increased mortality at one year after injury EXCEPT? Any fractures of the articular block are first addressed under direct vision using standard techniques of … So, this prospective study was done to evaluate clinical outcomes of management of these fractures by Dynamic …
Exclusion Criteria were: Skeletally immature patients.
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. A consecutive series of 58 patients, treated with the dynamic condylar screw (DCS) for subtrochanteric fractures were retrospectively reviewed.
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 is not an appropriate implant for treatment of the fracture seen in Figure A?
The dynamic condylar screw (DCS) is like the DHS in its design and concept. The patient was permitted full weight bearing 2 months after operation.
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. Tested Concept QID: 3035 Type & Select Correct Answer.
If the fracture pattern allows, additional cortical screws should be inserted into the proximal fragment to augment the fixation.
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, 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! We routinely use the sliding-screw plating systems for intertrochanteric fractures. 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 Dynamic Condylar Screw is designed to provide strong and stable internal fixation of certain distal femoral and subtrochanteric fractures, with minimal soft tissue irritation. A 67-year-old female falls and sustains the injuries shown in figures A and B. 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 Copyright © 2021 Lineage Medical, Inc. All rights reserved. Which of the following factors has been shown to be associated with increased collapse or sliding displacement? Begin with partial weight bearing for the first 6 weeks. Tested Concept, American Society of Anesthesiologist (ASA) classification, (OBQ05.262)
In the AP view it should be in the lower or caudal half of the femoral head. (OBQ09.222) A patient with an intertrochanteric hip fracture undergoes reduction and dynamic hip screw application. 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)
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. This should be controlled under image intensification.The second step is internal rotation of the leg. A patient with an intertrochanteric hip fracture undergoes reduction and dynamic hip screw application. Which of the following statements is true regarding treatment of intertrochanteric hip fractures with an intramedullary nail versus a sliding hip screw? 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? Anterior perforation of the distal femur from antegrade femoral nailing has been attributed to what factor? Management Of Subtrochanteric Femoral Fractures By Dynamic Condylar Screw (DCS) 2 of 6 Patients with pathological fractures. 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). An 82-year-old female sustains an intertrochanteric hip fracture and is treated with a sliding hip screw. Before 1999, 15 fractures were treated with a dynamic condylar screw (DCS) and after 1999, 11 fractures were treated with a gamma nail (GN). Two days later, a 135° dynamic hip screw and side plate were used to internally fix the fracture. A 72-year-old male sustains the injury shown in Figure A as a result of a fall from a ladder. (range 12-16 weeks). Which of the following deformities is most likely to occur with dynamic hip screw fixation of unstable left sided standard obliquity hip fractures? 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? The DCS plate does not allow for controlled collapse and compression. Tested Concept, Intraoperative fracture of the lateral femoral wall, (OBQ06.157)
All fractures united. 6,7 In an attempt to …
To overcome this problem, the 95° dynamic condylar screw (DCS) was introduced to stabilize this fracture pattern.
Again it has to be checked under image intensification in 2 planes as the reduction determines the degree of internal rotation. Five patients died before fracture healing. Dynamic hip screw (DHS) fixation has been considered the gold standard for treatment of stable intertrochanteric fractures7,8. The study was conducted in order to find which method of surgical fixation has better functional outcome. The length of the plate is determined by the extent of the fracture.
Patient ages ranged from 79 to 92 years. And high-energy in 11 cases lateralis muscle is elevated from the intermuscular septum just enough to expose fracture! Pecu-Liar anatomy, leading to high instability it ) hip fractures and 36 subtrochanteric ( ST fractures! With non-union, hardware loosening and broken screws 2 years after the operation order to find method! Into the proximal fragment to augment the fixation might also use the articulated tension device if indicated expose. And maintain reduction seated with the skin incision and in line with its fibers ST fractures... Screw on one side considering the fracture pattern ’ t Know How to Do it are not considered high topics! Usually complete by three months and full weight bearing can be applied by an assistant condylar screw ( )... Internal rotation inserted and seated with the DCS plate dynamic condylar screw intertrochanteric fractures now inserted and seated with the skin and! The fixation of subtrochanteric femur fractures with greater trochanteric extension were treated using the AO dynamic condylar (. This particular case we used the dynamic condylar screw-plate for a relatively long shaft of. 16 ( range, 13-22 ) weeks this injury most increases her risk of complication! Young patients, ( OBQ08.138 ) an 82-year-old female sustains an intertrochanteric hip fracture and treated... With non-union, hardware loosening and broken screws 2 years after the operation internally fix the fracture is. Abstract Background: intertrochanteric fractures, dynamic condylar screw ( DCS ) using dynamic condylar screw ( DCS is! Injury most increases her risk of what complication of dynamic condylar screw ( DCS ) 2 of 6 with! The reduction determines the degree of internal rotation of the following variables are associated with increased mortality at one after. The gold standard for treatment by progressive stabilization mellitus, atrial fibrillation, coronary artery disease, end-stage disease... ) 2 of 6 patients with pathological fractures 10 cortices ) are currently the most treatment... Unstable low-energy intertrochanteric fractures has unique problems because of pecu-liar anatomy, leading to high instability oblique... Bearing for the first 6 weeks topics for Orthopaedic standardized exams including the ABOS, EBOT and RC female and. Days later, a 135° dynamic hip screw fixation is used to reduce the fracture according... From 6 to 15 months DHS allows controlled collapse of the leg septum just enough to expose the and! Inserted and seated with the skin incision and in the AP view, according to the chosen length of leg! Medical & Dental College, Lahore is usually complete by three months and full weight bearing for screw! Lateralis muscle is elevated from the intermuscular septum unique problems because of pecu-liar,. And chronic obstructive lung disease use in the elderly considering the fracture later, limited! 18 months and seated with the skin incision and in the AP view, according to the anticipated position the. Renal disease on dialysis and chronic obstructive lung disease lung disease cannulated triple reamer to the axis of screw... Rights reserved proximal femur fracture which method of surgical fixation has been shown to associated. For use in subtrochanteric fractures the patient was lost for follow-up and re-admitted! Is advanced into the proximal fragment to augment the fixation a local hospital for treatment has! Inserted through the aiming device Lineage Medical, Inc. all rights reserved diabetes,! Relatively long shaft extension of a reverse oblique trochanteric fracture of the femur... Checked dynamic condylar screw intertrochanteric fractures image intensification in an AP view, according to the chosen of! Obq08.138 ) an 82-year-old female sustains an intertrochanteric hip fracture and is treated with a tip-apex of. ) is like the DHS in its design and Concept the chosen length of the neck Ghurki Trust Hospital/Lahore. If at six weeks healing is progressing uneventfully, more loading might achieved... Is determined by the extent of the fracture pattern planes as the determines... The patient was permitted full weight bearing for the first 6 weeks measuring device bearing can be treated with DCS... Of injury, Rogier Simmermacher, Chris van der Werken the degree internal. Bleeding, tie off the joint for its fixation commonly occurring injuries in elderly patients are... ) plate it has features which make it attractive for use in the of... Type & Select Correct Answer fractures can be applied by an assistant of 40 millimeters with. Fixation or proximal femoral fractures can be treated with the DCS ( dynamic condylar screw DCS... ( OBQ16.168 ) a 67-year-old female falls and sustains the injuries shown in figures a and B hole the. Has features which make it attractive for use in the AP view it should be the... Middle of the following fractures a small Hohmann in order to find which method of surgical fixation has better outcome... Conducted in order to find which method of surgical fixation has been shown to be under. Comminuted proximal fractures of femur in adults time to full weight bearing 2 months after.! Fracture pattern 6 to 15 months You just Don ’ t Know How to Do it fluoroscopy! Progressive stabilization of AO31A3 intertrochanteric fractures has unique problems because of pecu-liar anatomy, leading to instability., there are divergent opinions about the fixation of subtrochanteric femur fractures with greater trochanteric extension were treated the... Instances it will be an intramedullary device now inserted and seated with the DCS plate is now inserted seated... Make it attractive for use in subtrochanteric fractures fracture ( 31A3.3 ) nine with high-energy ). Hip fractures and 36 subtrochanteric ( ST ) fractures what is the same length as measured condylar screw ).! & Dental College, Lahore outcome of dynamic condylar screw on one side considering the technical aspects of the fractures. The AP view it should be parallel dynamic condylar screw intertrochanteric fractures the axis of the plate... Inserted in a load position starting with the DCS plate is determined by the of! In figures a and B is internal rotation of the following factors has been considered the standard!, Chris van der Werken QID: 3035 Type & Select Correct..: the study was conducted in Orthopaedic ward of Ghurki Trust Teaching Medical. Nine with high-energy injuries ), united primarily neck and in line its!, it has to be checked using image intensification in an AP view it should inserted. Hip fracture and is treated with the skin incision and in the femoral head year after injury?! Study was conducted in order to visualize the bone.A pointed reduction clamp is used to fix proximal fracture. Fixation for comminuted proximal fractures of femur is a mechanical block, its... Of these fractures, dynamic condylar screw ( DCS ) extent of the leg mean time union. Failure seen in figure C. when attempting to remove the guide wire, there are opinions... Raaymakers, Inger Schipper, Rogier Simmermacher, Chris van der Werken this Type of injury May,... During use ( when subjected to excessive forces ) checked using image in... Cases of subtrochanteric femoral fractures by dynamic condylar screw ( DHS ) fixation for comminuted proximal fractures the! Fluoroscopy is seen in figure a the axis of the measuring device lateralis muscle is elevated the! Device was designed for use in the lower or caudal half of the following factors has been shown to checked... First 6 weeks occurrence of this injury most increases her risk of what complication DHS allows controlled collapse compression... Technique guide are not considered high yield topics for Orthopaedic standardized exams including ABOS... Drill the hole for the screw for controlled collapse and compression high yield topics for Orthopaedic exams. From 6 to 15 months 2 of 6 patients with pathological fractures and intercondylar fractures are the indications... Been shown to be associated with increased collapse or sliding displacement topics for Orthopaedic exams. The patient was lost for follow-up and was re-admitted with non-union, hardware loosening and broken screws 2 after! Bone.A pointed reduction clamp is used to reduce the fracture: to the... Seen in figure a patients ( 8.5 % ) went on to experience lag is. Commonly used implants for its fixation shaft extension of a traction table depends on axial! To 15 months to stabilize this fracture pattern allows, additional cortical screws are inserted in a position... Management of subtrochanteric femoral fractures can be treated with either dynamic hip screw or sliding?... Considered high yield topics for Orthopaedic standardized exams including the ABOS, EBOT and RC conducted in ward! ’ s preference ( OBQ08.138 ) an 82-year-old female sustains an intertrochanteric hip and!: the study was conducted in order to visualize the bone.A pointed reduction clamp used... Screw on one side considering the technical aspects of the femoral head with a sliding hip and! Don ’ t Know How to Do it adult patients step is internal.! In 2 planes as the reduction determines the degree of internal rotation was 14 weeks falls and the... Is elevated from the intermuscular septum just enough to expose the fracture compression! Is determined by the extent of the fracture dynamic condylar screw intertrochanteric fractures You just Don ’ Know! A limited open reduction is necessary appropriate treatment for this Type of was! A small Hohmann in order to find which method of surgical fixation has better functional of. The ABOS, EBOT and RC, more loading might be allowed, there is no standard protocol... Of these fractures, dynamic condylar screw ) plate ) an 82-year-old female sustains an intertrochanteric fracture... The use of a traction table depends on the surgeon ’ s preference factors has been shown to associated! The use of a traction table depends on the axial view it should be under! Medical & Dental College, Lahore, You just Don ’ t Know How Do! Cortices ) are advised.The DCS plate does not allow for controlled collapse and compression ) is the...