Ten out of 11 young patients, (nine with high-energy injuries), united primarily. Plate can break during use (when subjected to excessive forces). A consecutive series of 58 patients, treated with the dynamic condylar screw (DCS) for subtrochanteric fractures were retrospectively reviewed. Although this device was designed for use in the distal femur, it has features which make it attractive for use in subtrochanteric fractures.
It is placed against the lateral cortex. Which of the following is an advantage of sliding hip screws compared to cephalomedullary nails for the treatment of appropriate intertrochanteric femur fractures? The guide wire is advanced into the subchondral bone and its tip should lie 10 mm off the joint. 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 … What is the most appropriate treatment for this type of injury? The patient was permitted full weight bearing 2 months after operation. 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. 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. 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.
Intraoperative fluoroscopy is seen in figure C. When attempting to remove the guide wire, there is a mechanical block, impeding its extraction. Tested Concept, (OBQ07.246)
The post-operative radiographs demonstrate that the lag screw is superior in the femoral head with a tip-apex distance of 40 millimeters. 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. 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. Five patients died before fracture healing. A patient with an intertrochanteric hip fracture undergoes reduction and dynamic hip screw application. Its position should be checked using image intensification in an AP view, according to the anticipated position of the guide wire. The use of a traction table depends on the surgeon’s preference. 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. Two days later, a 135° dynamic hip screw and side plate were used to internally fix the fracture. The length of the plate is determined by the extent of the fracture.
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). 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 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.
Patient ages ranged from 79 to 92 years. All of the following implants offer adequate fracture fixation of the injury shown in Figure A EXCEPT:
Tested Concept, Mismatch of the radius of curvature of implant and bone, (OBQ07.86)
If at six weeks healing is progressing uneventfully, more loading might be allowed. 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. Dynamic hip screw (DHS) fixation has been considered the gold standard for treatment of stable intertrochanteric fractures7,8. 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? To review the results of indirect reduction and mini-incision dynamic condylar screw (DCS) fixation for comminuted subtrochanteric femoral fractures.
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. Dynamic Condylar Screw Plate Warnings. J.
The vastus lateralis muscle is elevated from the intermuscular septum just enough to expose the fracture. Tested Concept, American Society of Anesthesiologist (ASA) classification, (OBQ05.262)
The study was conducted in order to find which method of surgical fixation has better functional outcome. after dynamic hip screw fixation of intertrochanteric fracture. (OBQ16.168)
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. To avoid bleeding, tie off the perforating vessels. We routinely use the sliding-screw plating systems for intertrochanteric fractures. The mean time to union was 16 (range, 13-22) weeks. Biological fixation of subtrochanteric intertrochanteric femoral fractures using dynamic condylar screw Al-Azhar Med. Which of the following is not an appropriate implant for treatment of the fracture seen in Figure A? What is the most appropriate definitive step in treating the failure seen in figure A? A 72-year-old male sustains the injury shown in Figure A as a result of a fall from a ladder. On the axial view it should be parallel to the axis of the neck and in the middle of the neck. 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. Which of the following factors has been shown to be associated with increased collapse or sliding displacement? They were treated with either dynamic hip screw (DHS) fixation or proximal femoral nailing (PFNA2) here at our institution.
Tested Concept, Revision open reduction and internal fixation, (OBQ07.153)
Healing is usually complete by three months and full weight bearing can be resumed. 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.
Anterior perforation of the distal femur from antegrade femoral nailing has been attributed to what factor? This should be controlled under image intensification.The second step is internal rotation of the leg.
Tested Concept, Trochanteric entry point cephalomedullary nail, Piriformis fossa entry point cephalomedullary nail, (OBQ05.161)
The dynamic hip screw or sliding hip screw fixation is used to fix proximal femur fracture.
Tested Concept, (SBQ09TR.45.1)
Tested Concept, (OBQ05.210)
Summary Sixteen cases of subtrochanteric femur fractures with greater trochanteric extension were treated using the AO dynamic condylar screw (DCS). Any fractures of the articular block are first addressed under direct vision using standard techniques of … A 55-year-old male is involved in a motor vehicle accident and sustains the injury seen in Figure A. Patients with compound fractures. Setting: The study was conducted in Orthopaedic ward of Ghurki Trust Teaching Hospital/Lahore Medical & Dental College, Lahore. 6,7 In an attempt to … Ernst Raaymakers, Inger Schipper, Rogier Simmermacher, Chris van der Werken. 95° Dynamic condylar screw (DCS) and proximal femoral nail (PFN) are currently the most commonly used implants for its fixation. Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. One might also use the articulated tension device if indicated. A 67-year-old female falls and sustains the injuries shown in figures A and B.
Considering the technical aspects of the osteosynthesis of these fractures, in our department, we staged the procedure one week apart.
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). There is no standard treatment protocol described in literature. 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 (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 guide wire is inserted through the aiming device. Tested Concept, Two or more pre-existing medical conditions, (OBQ11.189)
Outcome of Subtrochanteric Femur Fractures Treated with Dynamic Condylar Screw (DCS) Fixation. There were no infections or implant cut out. Take x-rays at six-week intervals.
If the fracture pattern allows, additional cortical screws should be inserted into the proximal fragment to augment the fixation. In this case traction can be applied by an assistant. Patients with multiple fractures. A closed reduction should always be attempted. Keywords Intertrochanteric fractures, Dynamic Condylar Screw (DCS).
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. Overall, seven patients (8.5%) went on to experience lag screw cut-out. Note: Only stable proximal femoral fractures can be treated with the DCS (dynamic condylar screw) plate. ABSTRACT Background: Management of AO31A3 intertrochanteric fractures has unique problems because of pecu-liar anatomy, leading to high instability. Drill the hole for the screw and the plate sleeve. Objective: To determine the functional outcome of dynamic condylar screw in the treatment of unstable proximal femoral fractures in adult patients. The fascia lata is incised in line with the skin incision and in line with its fibers. The average time to full weight bearing was 14 weeks. Tested Concept QID: 3035 Type & Select Correct Answer. It Is The Blade Plate, You Just Don’t Know How To Do It! 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). Tested Concept, Remove the nail to re-assess fracture reduction, (OBQ13.2)
Which of the following statements is true regarding treatment of intertrochanteric hip fractures with an intramedullary nail versus a sliding hip screw?
1996; 25 (A): 265-275 Massoud Abdel Hakim A. Al-Azhar Medical Journal Journal Country: Egypt ISSN: 1110-0400
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). Which of the following deformities is most likely to occur with dynamic hip screw fixation of unstable left sided standard obliquity hip fractures? Begin with partial weight bearing for the first 6 weeks. 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? Adjust the cannulated triple reamer to the chosen length of the screw. Exclusion Criteria were: Skeletally immature patients. The mechanism of injury was low-energy in 47 cases and high-energy in 11 cases. April 2020; DOI: 10.18410/jebmh/2020/152.
Background: Intertrochanteric fractures are one of the commonly occurring injuries in elderly patients and are high among females and those with osteoporosis. 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 dynamic condylar screw (DCS) is like the DHS in its design and concept. Lateral approach between the vastus lateralis muscle and intermuscular septum. 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 fractures united. Reverse oblique trochanteric fracture of femur is a distinct fracture pattern. The DCS plate does not allow for controlled collapse and compression. It is done on a fracture table and subsequently, an appropriate fixation device is chosen. Twelve unstable low-energy intertrochanteric fractures were fixed using 102° DCS. The DCS plate does not allow for controlled collapse and compression. 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). C ase Report A 62-year-old woman fell at home in May 1979, sustaining an intertrochanteric fracture of the left femur.
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.
Management Of Subtrochanteric Femoral Fractures By Dynamic Condylar Screw (DCS) 2 of 6 Patients with pathological fractures. 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)
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