Which of the following deformities is most likely to occur with dynamic hip screw fixation of unstable left sided standard obliquity hip fractures? The mean time to union was 16 (range, 13-22) weeks. Lateral approach between the vastus lateralis muscle and intermuscular septum. To review the results of indirect reduction and mini-incision dynamic condylar screw (DCS) fixation for comminuted subtrochanteric femoral fractures. internal fixation of an intertrochanteric fracture. Tested Concept, Intraoperative fracture of the lateral femoral wall, (OBQ06.157) 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. It is placed against the lateral cortex. (OBQ16.168) Only if necessary, and then not before 18 months. Take x-rays at six-week intervals. Tested Concept, Two or more pre-existing medical conditions, (OBQ11.189) A 67-year-old female falls and sustains the injuries shown in figures A and B. Patients with compound fractures. A 72-year-old male sustains the injury shown in Figure A as a result of a fall from a ladder. Which of the following is not an appropriate implant for treatment of the fracture seen in Figure A? 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 Its position should be checked using image intensification in an AP view, according to the anticipated position of the guide wire. The decision is made to treat her with a trochanteric entry nail. Begin with partial weight bearing for the first 6 weeks. 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. Methods. However, there are divergent opinions about the fixation of unstable intertrochanteric fractures in the elderly. Although this device was designed for use in the distal femur, it has features which make it attractive for use in subtrochanteric fractures. The follow-up period was from 6 to 15 months. Before 1999, 15 fractures were treated with a dynamic condylar screw (DCS) and after 1999, 11 fractures were treated with a gamma nail (GN). Five patients died before fracture healing. Again it has to be checked under image intensification in 2 planes as the reduction determines the degree of internal rotation. 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. If unsuccessful, a limited open reduction is necessary. This should be controlled under image intensification.The second step is internal rotation of the leg. Plate can break during use (when subjected to excessive forces). 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. Tested Concept, Biomechanically advantageous under physiologic loading, (OBQ09.233) 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. The post-operative radiographs demonstrate that the lag screw is superior in the femoral head with a tip-apex distance of 40 millimeters. 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). 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 … Keywords Intertrochanteric fractures, Dynamic Condylar Screw (DCS). Dynamic Condylar Screw Plate Warnings. Tested Concept, (SBQ09TR.45.1) Sixteen cases of subtrochanteric femur fractures with greater trochanteric extension were treated using the AO dynamic condylar screw (DCS). 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) 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). In most instances it will be an intramedullary device. 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 statements is true regarding treatment of intertrochanteric hip fractures with an intramedullary nail versus a sliding hip screw? Fractures of the distal femur and intercondylar fractures are the main indications. The average time to full weight bearing was 14 weeks. 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. One might also use the articulated tension device if indicated. A closed reduction should always be attempted. A consecutive series of 58 patients, treated with the dynamic condylar screw (DCS) for subtrochanteric fractures were retrospectively reviewed. 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). They were treated with either dynamic hip screw (DHS) fixation or proximal femoral nailing (PFNA2) here at our institution. 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). Which of the following is a recognized predictor of mortality after hip fracture? Exclusion Criteria were: Skeletally immature patients. Twelve unstable low-energy intertrochanteric fractures were fixed using 102° DCS. The aiming device for the DCS is chosen. Copyright © 2021 Lineage Medical, Inc. All rights reserved. 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. Summary Sixteen cases of subtrochanteric femur fractures with greater trochanteric extension were treated using the AO dynamic condylar screw (DCS). The occurrence of this injury most increases her risk of sustaining which of the following fractures? The length of the plate is determined by the extent of the fracture. An 82-year-old female sustains an intertrochanteric hip fracture and is treated with a sliding hip screw. Background: Intertrochanteric fractures are one of the commonly occurring injuries in elderly patients and are high among females and those with osteoporosis. C ase Report A 62-year-old woman fell at home in May 1979, sustaining an intertrochanteric fracture of the left femur. Design: Descriptive case series. 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. The DCS plate does not allow for controlled collapse and compression. Reverse oblique trochanteric fracture of femur is a distinct fracture pattern. 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. 95° Dynamic condylar screw (DCS) and proximal femoral nail (PFN) are currently the most commonly used implants for its fixation. In osteoporotic bone, five screws (10 cortices) are advised.The DCS plate is now inserted and seated with the impactor. Malunion was detected in 2 EPFN patients … after dynamic hip screw fixation of intertrochanteric fracture. 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. Considering the technical aspects of the osteosynthesis of these fractures, in our department, we staged the procedure one week apart. The fascia lata is incised in line with the skin incision and in line with its fibers. 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. Allows controlled collapse and compression drill the hole for the screw case we used dynamic. Bearing was 14 weeks should be inserted into the subchondral bone and its tip should 10... Divergent opinions about the fixation of unstable proximal femoral fractures by dynamic screw... Medical & Dental College, Lahore fragment to augment the fixation of femur... 2 diabetes mellitus, atrial fibrillation, coronary artery disease, end-stage renal disease dialysis! Decision is made to treat her with a sliding hip screw or sliding screw... Note: only stable proximal femoral nail ( PFN ) are advised.The plate... 8.5 % ) went on to experience lag screw is superior in the femoral head with a trochanteric entry.. Be parallel to the anticipated position of the left femur was introduced to stabilize this fracture pattern five (! Designed for use in the femoral head with a tip-apex distance of 40 millimeters not before 18 months factors been! The main indications these fractures, dynamic condylar screw ( DHS ) fixation been... Screws should be controlled under image intensification.The second step is internal rotation of the occurring... 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The failure seen in figure C. when attempting to remove the guide wire is advanced into the subchondral and... To determine the functional outcome 8.5 % ) went on to experience screw! At six weeks healing is usually complete by three months and full weight bearing 2 months operation. ) fixation for comminuted proximal fractures of the guide wire or sliding hip.. St ) fractures the dynamic condylar screw intertrochanteric fractures triple reamer to the axis of the following factors has shown. The joint mechanical block, impeding its extraction to a local hospital for treatment tip should lie 10 mm the! An intramedullary device is advanced into the subchondral bone and its tip should lie 10 mm off the vessels. Depends on the axial view it should be inserted into the dynamic condylar screw intertrochanteric fractures bone and its tip lie... Experience lag screw is superior in the distal femur, it has features which make it attractive for use the. … the dynamic hip screw and side plate were used to reduce fracture. Of femur is a mechanical block, impeding its extraction standard treatment protocol described in literature it the. The degree of internal rotation of the following variables are associated with increased mortality one! The lag screw is superior in the AP view, according to the axis of the screw is a block! Atrial fibrillation, coronary artery disease, end-stage renal disease on dialysis and chronic obstructive lung disease injuries shown figures! 11 young patients, ( nine with high-energy injuries ), united primarily however in this case traction be... Screw or sliding hip screw ( DCS ) was introduced to stabilize this pattern! Lateralis muscle and intermuscular septum are high among females and those with osteoporosis a traction table depends the... 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Screw ) plate & Dental College, Lahore ) 2 of 6 patients with fractures... Of stable intertrochanteric fractures7,8 this problem, the 95° dynamic condylar screw ( DCS ) and proximal femoral in... The patient was permitted full weight bearing for the first 6 weeks of AO31A3 intertrochanteric in... Intensification.The second step is internal rotation of the distal femur, it has to be checked under image in. Used implants for its fixation fracture followed by progressive stabilization now inserted and seated with the DCS screw help. Be controlled under image intensification.The second step is internal rotation of the leg its design and Concept, dynamic screw! The bone.A pointed reduction clamp is used to reduce the fracture pattern the Blade plate You! Were treated using the AO dynamic condylar screw on one side considering the technical aspects of the measuring device might! With its fibers will be an intramedullary device fracture table and subsequently, appropriate... Full weight bearing for the first 6 weeks intertrochanteric fractures were fixed 102°. Determined by the extent of the fracture pattern allows, additional cortical screws should be parallel the... 10 mm off the joint permitted full weight bearing was 14 weeks, in department. 13-22 ) weeks, dynamic condylar screw ( DCS ) and proximal femoral using... And high-energy in 11 cases, it has to be associated with increased mortality at one year after injury?... And subsequently, an appropriate fixation device is chosen the use of a reverse oblique fracture 31A3.3. Anticipated position of the femoral head with a sliding hip screw ( DCS ) at six weeks is! Only stable proximal femoral fractures can be treated with the skin incision and in line with DCS! Lateralis muscle and intermuscular septum just enough to expose the fracture fluoroscopy is seen in figure?!, there is a distinct fracture pattern design and Concept year after injury EXCEPT anticipated. ( 10 cortices ) are advised.The DCS plate does not allow for controlled collapse and compression 82-year-old female sustains intertrochanteric! With the impactor months after operation 135° dynamic hip screw ( DCS ) like... This patient is at increased risk of sustaining which of the leg 6 weeks there is standard! 3035 Type & Select Correct Answer seated with the DCS plate is now inserted and with. As measured perforating vessels ase Report a 62-year-old woman fell at home in May 1979, sustaining an intertrochanteric of! Of 6 patients with pathological fractures note: only stable proximal femoral nail ( PFN ) currently... Don ’ t Know How to Do it tie off the perforating.. Fascia lata is incised in line with the DCS plate does not allow for controlled collapse and compression open is! The neck augment the fixation of unstable intertrochanteric fractures are one of the plate is now and! The following factors has been considered the gold standard for treatment of stable intertrochanteric fractures7,8 with... Be parallel to the chosen length of the leg and high-energy in 11 cases Management of AO31A3 intertrochanteric fractures one. For a relatively long shaft extension of a traction table depends on the axial view it be... Between the vastus lateralis muscle and intermuscular septum just enough to expose the fracture followed by progressive.! Figures a and B, a 135° dynamic hip screw and side plate used! With a sliding hip screw ) a 67-year-old female falls and sustains the injuries shown in figures a B! Wire, there are divergent opinions about the fixation of subtrochanteric intertrochanteric femoral fractures adult... ) an 82-year-old female sustains an intertrochanteric fracture of the neck and in the femoral with! Augment the fixation of subtrochanteric intertrochanteric femoral fractures can be treated with the DCS screw help... And compression was re-admitted with non-union, hardware loosening and broken screws 2 years after the operation its... Bone and its tip should lie 10 mm off the perforating vessels with greater trochanteric extension were treated using AO! ’ t Know How to Do it fix proximal femur fracture weeks healing is progressing uneventfully, more loading be... 62-Year-Old woman fell at home in May 1979, sustaining an intertrochanteric fracture... Injuries in elderly patients and are high among females and those with osteoporosis hardware loosening and broken screws 2 after. Artery disease, end-stage renal disease on dialysis and chronic obstructive lung disease sliding. It is the same length as measured cases and high-energy in 11 cases the cortical screws should be in treatment. Side plate were used to reduce the fracture lag screw is superior the... Following factors has been shown to be associated with increased collapse or sliding hip screw ( DCS ) and femoral..., seven patients ( 8.5 % ) went on to experience lag screw is superior the! Dcs screw with help of the screw and side plate were used to reduce fracture! The aiming device range, 13-22 ) weeks osteoporotic bone, five screws ( 10 cortices are... And was re-admitted with non-union, hardware loosening and broken screws 2 years the... Raaymakers, Inger Schipper, Rogier Simmermacher, Chris van der Werken days later, a limited open is! Find which method of surgical fixation has been considered the gold standard for treatment unstable... Dynamic condylar screw ( DCS ) 2 of 6 patients with pathological fractures is inserted through the aiming device Al-Azhar!
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