Static cycling without load, as well as firm passive range of motion exercises of the knee, allow the patient to regain optimal range of motion. dynamic condylar screw-plates (DCS-Plates) on the distal femur. The dynamic condylar screw (DCS) was originally designed for use in fractures of the distal femur and intercondylar fractures, but has found increasing application in proximal femoral fractures, particularly subtrochanteric ones. Shortening is due to the pull of the quadriceps and hamstring muscles, while the varus and extension deformity is caused by the unopposed pull of the adductors and gastrocnemius, respectively. Screw available holes: 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 105, 110, 115, 120, 125, 130, 135, 140 and 145. Implant removal is not essential but should be discussed with the patient if there are implant-related symptoms after consolidated fracture healing. The Dynamic condylar screw is an impressive mode of treatment with advantages of early and good range of motion, stable internal fixation and maintenance of anatomical reduction but the main disadvantage is that it can only be used when atleast 4 cms of … The DCS Plates are made of 316L stainless steel and are cold-worked for strength. We have used dynamic condylar screw fixation to stabilize subtrochanteric fractures in our set –up. The cord is stretched from the iliac spine across the patella to the cleft between the first and second toes. Due to the pull of the gastrocnemius muscle, the distal fragment tends to be displaced into extension at the metaphyseal fracture area, when distraction is applied. 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. Emphasis should be placed on progressive quadriceps strengthening and straight leg raises. The surgeon must take care not to use excessive stripping at this point to ensure adequate fracture healing. screws.15 Dynamic condylar screws (DCS) simplify fixation and require less-exacting technique than CBPs.16 We aimed to review the results of indirect reduction and mini-incision DCS fixation for comminuted subtrochanteric femoral fractures. Some surgeons find it useful to use an external fixator (or femoral distractor) from the proximal femur to the proximal tibia. The aim of this study was to determine the amount of cortex loss in the distal femur when inserting a DCS-Plate. The dynamic condylar screw (DCS) is like the DHS in its design and concept. A 5.0 mm or 6.0 mm Schanz pin in the medial and/or lateral femoral condyle to act as a joystick. To ensure that femoral length has been restored, many options exist: Determine the correct position for the DCS with the help of guide wires around the joint. The popliteal vessels, the tibial nerve, and the common peroneal nerve lie near the posterior aspect of the distal femur. A bolster in the supracondylar region to reduce the hyperextension deformity of the distal femoral articular block. Pointed reduction forceps, or large pelvic reduction clamps, to clamp from medial to lateral across the intercondylar split. Dynamic Condylar Screw Fixation for Comminuted Proximal Femur Fractures Fig II: Same fracture two months postoperative after fixation with dynamic condylar screw construct. At the posterior aspect of the knee lie the popliteal artery, nerve, and vein. 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. By continuing you agree to the use of cookies. Remember that the cross section of the distal femoral condylar mass is trapezoidal and slopes markedly on the medial side. Instant access to the full article PDF. A Schanz screw is inserted in the distal femoral articular block and used to counter the pull of the gastrocnemius. Impediments to the restoration of full knee function after distal femoral fracture are fibrosis and adhesion of injured soft tissues around the metaphyseal fracture zone, joint capsular scarring, intra-articular adhesions, and muscle weakness. Dynamic Condylar Screw (DCS Screw) is designed to provide strong and stable internal fixation of certain distal femoral and subtrochanteric fractures, with minimal soft tissue irritation. The patients were operated under spinal anaesthesia. https://doi.org/10.1016/S0020-1383(02)00319-4. Average follow-up was 3 years (range 14–65 months). Touch-down weight-bearing progresses to full weight-bearing gradually, over a period of 2 to 3 weeks (beginning at 6–10 weeks postoperatively). The DCS plate does not allow for controlled collapse and compression. 2. The mechanism of injury was low-energy in 47 cases and high-energy in 11 cases. There are no significant arteries, veins, or nerves on the lateral side of the knee. Pass a second guide wire over the anterior surface of the knee to indicate the plane of the patello-femoral condyles (green). This axis can be checked intraoperatively by using a piece of cable, such as the diathermy cord. The compression screw may be utilized to couple the screw to the plate. It may not be used in situations of severe metaphyseal comminution and/or osteoporosis. The average operating time was 2 h and blood loss averaged 430 ml. After tapping, insert the DCS over the guide wire, so that its outer end is still visible 2-3 mm outside the lateral cortex of the distal femur. Insert the proximal and distal fixator (distractor) pins carefully in order not to conflict with the later plating procedure. Usually, one to two additional K-wires are inserted, either from medial to lateral, or lateral to medial. 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. Only stable proximal femoral fractures can be treated with the DCS (dynamic condylar screw) plate. Take care to restore the mechanical axis of the femur in all planes using the previously discussed techniques. Dynamic Condylar Screw is cost-effective and procedure relatively easy to perform and affords a rigid internal fixation. If rotation is correct, this cord will pass over the midline of the patella, and slightly medial to the tibial eminence. This device has been studied and compared with cannulated screws and fixation with DHS showing inconclusive results. Ten out of 11 young patients, (nine with high-energy injuries), united primarily. When reduced, a temporary cerclage wire is used to lock the position of the Schanz screw relative to the distractor. Stainless Steel (Grade SS 316L) 2. Wound healing should be assessed at two to three weeks postoperatively. New biological method of internal fixation of the femur. Early range of motion helps restore movement in the early postoperative phase. The preferred method depends on the fracture and soft-tissue injury pattern, the chosen stabilization device, and the experience and skills of the surgeon. In order to assess the exact length of the guidewire obtain an AP view with 30° internal rotation of the lower extremity. Both active and passive motion of the knee and hip can be initiated immediately postoperatively. The regimens suggested here are for guidance only and not to be regarded as prescriptive. catastrophic in regards to a satisfactory fracture union and culminates in various complications.15 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 and plate are designed to provide strong and stable internal fixation of certain distal femoral and subtrochantericfractures, with minimal soft tissue irritation. To review the results of indirect reduction and mini-incision dynamic condylar screw (DCS) fixation for comminuted subtrochanteric femoral fractures. 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. Anatomical reduction of intermediate fragments is neither sought nor necessary. A radiographic ruler can be used to measure the length of both femora. 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. Anatomical reduction of all fracture segments may not be desired except in simple fracture patterns. Because of this, vascular injuries occur in about 3% and nerve injuries in about 1% of fractures of the distal femur. Patients were assessed clinically and radiographically with regards to fracture classification, operating time, blood loss, time of union, malunion and other complications. One option involves reducing the fracture fragments anatomically, either directly or indirectly with fluoroscopic control. 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). Alignment of the main shaft fragments can then be achieved indirectly, using various aids before application of the plate. 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. Subscribe to journal. For the plate barrel to slide over the screw, the T-handle should be parallel, on the lateral view, to the long axis of the distal fragment. Next, slide the direct measuring device over the guide wire and determine guide-wire insertion depth and, thereby, the length of the DCS required. 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°. This site uses cookies to improve your experience and to help show ads that are more relevant to your interests. This will allow the plate to sit against distal femur. The guide wire for the DCS is positioned at 2 cm proximal to the distal end of femur. Check the position of the guide wire carefully to ensure it has been correctly positioned, with the parallelism already described. Kulkarni SS, Moran CG. 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. Insert the guide wire under image intensifier control all the way across the femur. In oblique, single-plane fractures, an interfragmentary lag screw should be inserted through the plate. A consecutive series of 58 patients, treated with the dynamic condylar screw (DCS) for subtrochanteric fractures were retrospectively reviewed. Insertion of screws in this manner leaves an area free of screw traffic or a "free-zone" of bone into which a laterally based plate system can be inserted (dotted circle). Thrombo-prophylaxis should be given according to local treatment guidelines. 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. Fixation with compression should be applied when possible in fracture patterns where there is contact between the proximal and distal main fragments. Insert a screw through the plate close to the compression device to secure the fixation. A sand bag was used under the ipsilateral hemi pelvis. OTHER INFORMATION The DHS plates and DCS plates are made of two materials – 1. Screws are inserted along the periphery of the articular surface of the lateral femoral condyle going from lateral to medial or from medial to lateral to compress the intercondylar split. A study was designed to examine the outcomes of patients with closed comminuted subtrochanteric femoral fractures fixed with a dynamic condylar screw (DCS) and using biological (indirect) reduction techniques at a tertiary referral centre. An image intensifier or intraoperative radiography was used for the procedure. The depth of guide-wire insertion is crucial. Material and Methods. The approach must adequately expose the articular surface of the distal femoral condyle. These screws must be countersunk and recessed beneath the articular surface. It must be borne in mind that these structures can be damaged by the injury or can be damaged by the surgeon during the reconstruction. Lastly complete the fixation by inserting additional screws according to the preoperative plan. This procedure may be performed with the patient in one of the following positions: For this procedure, the lateral/anterolateral approach is used. Florian Gebhard, Phil Kregor, Chris Oliver, Markku T Nousiainen. 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