Another option involves taking radiographic images of the contralateral distal femur for comparison. The dynamic condylar screw (DCS) is like the DHS in its design and concept. The approach must adequately expose the articular surface of the distal femoral condyle. Methods. Only stable proximal femoral fractures can be treated with the DCS (dynamic condylar screw) plate. The average operating time was 2 h and blood loss averaged 430 ml. Material and Methods. The use of the Schanz pin in conjunction with the pointed reduction forceps is therefore preferred. 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). Prior to plate fixation to the proximal fragment, final reduction of the metaphysis may be performed. If the soft-tissue attachments to these fragments are preserved, and the fragments are generally aligned, healing is unimpaired. Injury 2003;34(2):123–128. 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. 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. The tip of the guide wire should just engage the medial cortex, and so will appear short of the medial condylar cortex on the AP intensifier image. 2.1. Under image intensifier control, pass one guide wire lateral to medial along the tibio-femoral joint line (red). If a shaft fracture is multifragmentary, the image intensifier cannot be used to compare cortical diameters on each side of the fracture. The Dynamic Condylar Screw (DCS; Synthes, Bettlach, Switzerland) has been designed for the internal fixation of fractures of the distal and subtrochan- teric regions of the femur and has superior biomechanical properties compared to the blade plate [23–25]. OTHER INFORMATION The DHS plates and DCS plates are made of two materials – 1. The surgeon must take care not to use excessive stripping at this point to ensure adequate fracture healing. Secure the articulated tension device to the proximal femur with a bicortical screw. Once adequate alignment is achieved, insert a screw through the plate to secure the fixation. The DCS Plates are made of 316L stainless steel and are cold-worked for strength. The mechanism of injury was low-energy in 47 cases and high-energy in 11 cases. 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. Although this device was designed for use in the distal femur, it has features which make it attractive for use in subtrochanteric fractures. The cord is stretched from the iliac spine across the patella to the cleft between the first and second toes. Ideally, patients are fully weight-bearing, without devices (e.g., cane) by 12 weeks. If it appears to be outside the bone, it is most likely too long and the DCS will cause pain and possibly heterotopic ossification. The early appearance of callus avoids the need for primary cancellous bone grafting, emphasising the importance of preserving biology of the fracture fragments. A bolster in the supracondylar region to reduce the hyperextension deformity of the distal femoral articular block. Thirty-one consecutive patients with a mean age of 32.6 years, who sustained subtrochanteric femoral fractures, were treated with this method. Alignment of the main shaft fragments can be achieved indirectly with the use of: Mechanical stability, provided by the bridging plate, is adequate for gentle functional rehabilitation and results in satisfactory indirect healing (callus formation). Reduction aids that are helpful include: Before definitive fixation is undertaken, more than one foreceps is applied. The dynamic condylar screw in the management of subtrochanteric fractures: does judicious use of biological fixation enhance overall results? A consecutive series of 58 patients, treated with the dynamic condylar screw (DCS) for subtrochanteric fractures were retrospectively reviewed. Detach the T-handle and pass the plate barrel over the screw shank. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. Therefore, if a straight AP view is obtained, the guidewire can appear to be inside the bone. The TIBER™Dynamic Condylar Screw is designed to provide strong and stable fixation ofa variety certain distal femoral subtrochanteric fractures,with minimal soft tissue . The guide wire for the DCS is positioned at 2 cm proximal to the distal end of femur. Fixation of a C1 fracture with the dynamic condylar screw system. This end-on view demonstrates the screw trajectories from lateral to medial. Strong. 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. MATERIAL AND METHODS This study was conducted in the Post- Graduate Department of Orthopaedics, Govt. The compression screw may be utilized to couple the screw to the plate. Both active and passive motion of the knee and hip can be initiated immediately postoperatively. 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. Mitkovic M, Bumbasirevic M, Golubovic Z, et al. The Dynamic Condylar Screw (DCS; Synthes, Bettlach, Switzerland) has been designed for the internal fixation of fractures of the distal and subtrochanteric regions of the femur and has superior biomechanical properties compared to the blade plate [23,24,25]. Access options Buy single article. With stable fracture fixation, the surgeon and the physical therapy staff will design an individual program of progressive rehabilitation for each patient. Next, slide the direct measuring device over the guide wire and determine guide-wire insertion depth and, thereby, the length of the DCS required. There may be bleeding from the lateral genicular arteries, which will need to be controlled using diathermy. Fixation with compression should be applied when possible in fracture patterns where there is contact between the proximal and distal main fragments. Year: 2007. Loosely secure the plate to the proximal femur with a Verbrugge clamp. 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 dynamic condylar screw (DCS) is a new implant engineered by the AO/ASIF Group for use in management of proximal and distal femoral fractures. 11. Dynamic Condylar Screw is cost-effective and procedure relatively easy to perform and affords a rigid internal fixation. The DCS plate does not allow for controlled collapse and compression. The use of a dynamic condylar screw and biological reduction techniques for subtrochanteric femur fracture. Emphasis should be placed on progressive quadriceps strengthening and straight leg raises. Pointed reduction forceps, or large pelvic reduction clamps, to clamp from medial to lateral across the intercondylar split. If a large fragment has separated from the fracture zone and impaled the adjacent muscle, direct reduction may be required. The radiological landmarks of the center of the femoral head, the center of the knee and the center of the ankle joint should all be in line if the mechanical axis of the femur is correct. Kulkarni SS, Moran CG. We use cookies to help provide and enhance our service and tailor content and ads. To review the results of indirect reduction and mini-incision dynamic condylar screw (DCS) fixation for comminuted subtrochanteric femoral fractures. Pass a second guide wire over the anterior surface of the knee to indicate the plane of the patello-femoral condyles (green). Some surgeons find it useful to use an external fixator (or femoral distractor) from the proximal femur to the proximal tibia. This latter orientation ensures that the plate comes to lie flush with the lateral cortex. A radiographic ruler can be used to measure the length of both femora. Stable. [citation needed] It is the most commonly used implant for extracapsular fractures of the hip, which are common in older osteoporotic patients. Dynamic Condylar Screw used for fixation of: a, a subtrochanteric fracture, and b, a supracondylar fracture of the femur. In order to assess the exact length of the guidewire obtain an AP view with 30° internal rotation of the lower extremity. In this illustration, internal rotation by 30° reveals that the guide wire length was chosen inappropriately. In conclusion, use of biological (indirect) reduction techniques instead of anatomic, open reduction has proven to be successful, especially in comminuted subtrochanteric fractures. Insert the guide wire under image intensifier control all the way across the femur. Serial x-rays allow the surgeon to assess the healing of the fracture. Thrombo-prophylaxis should be given according to local treatment guidelines. Twenty-seven cases (87.2%) sustained these fractures either from traffic crashes or falls from height and the remaining four had a simple fall. dynamic condylar screw-plates (DCS-Plates) on the distal femur. Alternative: Some surgeons reconnect T-handle to the screw to help to adjust the position the plate. At the posterior aspect of the knee lie the popliteal artery, nerve, and vein. slot cut for the blade determines the alignment of the plate with the shaft, no further adjustment being possible. Few tricks in the technique make use of dynamic condylar screw in biological fixation of comminuted subtrochanteric fractures easier. If rotation is correct, this cord will pass over the midline of the patella, and slightly medial to the tibial eminence. Screw available holes: 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 105, 110, 115, 120, 125, 130, 135, 140 and 145. Direct manipulation of intermediate fragments would risk disturbing their blood supply. subtrochanteric fractures and use of AO dynamic condylar screw (DCS), in their management. catastrophic in regards to a satisfactory fracture union and culminates in various complications.15 Unless there are other injuries or complications, knee mobilization may be started immediately postoperatively. Fractures were classified according to the AO classification (10 type … It may not be used in situations of severe metaphyseal comminution and/or osteoporosis. 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. These screws may be fully threaded 2.7 or 3.5 mm lag screws (shown with gliding hole), 6.5mm partially threaded lag screws, or 4.0/4.5 mm cannulated, partially threaded lag screws. Pearl: Do not use the compression screw in osteoporotic patients – it can cause the DCS thread to strip out from the soft cancellous bone of the medial femoral condyle. 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. The distal femur has a unique anatomical shape. Usually, one to two additional K-wires are inserted, either from medial to lateral, or lateral to medial. 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. This will be continued for 6-10 weeks postoperatively. Copyright © 2021 Elsevier B.V. or its licensors or contributors. Florian Gebhard, Phil Kregor, Chris Oliver, Markku T Nousiainen. 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. When the DCS is correctly inserted in the distal femur, the plate can be used to assist in the final reduction. The patients were operated under spinal anaesthesia. The ideal entry point for the DCS is shown on the diagram. The two holes closest to the barrel accept 6.5 mm Cancellous Bone Screws. Use of Schanz pins inserted into the medial, or lateral, femoral articular block to correct varus or valgus angulation of the femoral block. Wound healing should be assessed at two to three weeks postoperatively. The dynamic condylar screw is a safe and reliable implant for the management of subtrochanteric fractures with predictable results when principles of open reduction and internal fixation, biological reduction and bone grafting are followed as indicated. 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. Tax calculation will be finalised during checkout. 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°. Few tricks in the technique make use of dynamic condylar screw in biological fixation of comminuted subtrochanteric fractures easier. Cite . A 5.0 mm or 6.0 mm Schanz pin in the medial and/or lateral femoral condyle to act as a joystick. Attempts at a reduction of the intercondylar split with the pointed reduction forceps alone are often unsuccessful, as rotational control of the femoral condyle is also needed. Subsequently 6-week, 12-week, 6-month, and 12-month follow-ups are usually made. By using this site, you agree to the use of cookies by Flickr and our partners as … 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. Anatomical reduction of intermediate fragments is neither sought nor necessary. Materials and Methods: This prospective study was done on 56 patients aged above 18 years with distal femur fractures. There was only one case of superficial infection, which settled with local debridement and antibiotics. When reduced, a temporary cerclage wire is used to lock the position of the Schanz screw relative to the distractor. US$ 39.95. Tighten the articulated tension device with the spanner so that the indicator on the tension device is in the green zone, checking the fracture site carefully to ensure that no unwanted displacement occurs. Stainless Steel (Grade SS 316L) 2. Copyright © 2003 Elsevier Science Ltd. All rights reserved. Note that it is inserted parallel to both the red wire in the frontal plane and is parallel to the green line on the end-on view on the femur. Touch-down weight-bearing (10-15 kg) may be performed immediately with crutches, or a walker. Reduction techniques. Because of this, vascular injuries occur in about 3% and nerve injuries in about 1% of fractures of the distal femur. An image intensifier or intraoperative radiography was used for the procedure. Implant removal is not essential but should be discussed with the patient if there are implant-related symptoms after consolidated fracture healing. Five patients died before fracture healing. 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 aim of this study was to determine the amount of cortex loss in the distal femur when inserting a DCS-Plate. On occasions, it is acceptable to insert screws through the articular surface, when no other option is available. Any fractures of the articular block are first addressed under direct vision using standard techniques of interfragmentary compression. Seen from an end-on view, the lateral surface has a 10° inclination from the vertical, while the medial surface has a 20–25° slope. Subscribe to journal. This site uses cookies to improve your experience and to help show ads that are more relevant to your interests. Instant access to the full article PDF. We have used dynamic condylar screw fixation to stabilize subtrochanteric fractures in our set –up. 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. This axis can be checked intraoperatively by using a piece of cable, such as the diathermy cord. Supra Condylar Bolts & Nail 4.9mm Locking Bolt Set Instruments for Supra Condylar Locking Nail Instruments Set for Supra Condylar Locking Nail Cannulated Screws Herbert Cannulated Screws Implants & Instruments Small Cannulated Cancellous Screws Small Cannulated Cancellous Screws Instruments & Set Large Cannulated Cancellous Screws Large 7.0mm & 6.5mm Cannulated Cancellous Screws … 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. Occasionally, a larger wedge fragment might be approximated to the main fragments with a lag screw. On the lateral view, the distal femur is divided into thirds and the DCS entry site is located at the junction of the anterior and middle thirds. The use of a dynamic condylar screw and biological reduction techniques for subtrochanteric femur fracture. This will allow the plate to sit against distal femur. It is very important to restore the biomechanical axis of the lower limb. Lastly complete the fixation by inserting additional screws according to the preoperative plan. To avoid this, the knee is brought into full extension, and the distal femoral fragment is stabilized in this position to the tibia. Insert the guide wire at the chosen entry site of the DCS. 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. Use the impactor to bring the plate down to the bone, with the barrel sliding over the screw shank. These anatomical details are important when inserting screws. Fractures of the distal femur and intercondylar fractures are the main indications. 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. 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. Take care to restore the mechanical axis of the femur in all planes using the previously discussed techniques. 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. Patients were assessed clinically and radiographically with regards to fracture classification, operating time, blood loss, time of union, malunion and other complications. 2. Insertion of a Schanz pin from anterior to posterior in the distal femoral articular block, which can be used to correct hyperextension. This device has been studied and compared with cannulated screws and fixation with DHS showing inconclusive results. 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. 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. 10. Reduction using axial traction on a fracture table was used in 24 cases , . The preferred method depends on the fracture and soft-tissue injury pattern, the chosen stabilization device, and the experience and skills of the surgeon. The dynamic condylar screw (DCS) is a new implant engineered by the AO/ASIF Group for use in management of proximal and distal femoral fractures. Additionally, the compression screw will provide additional compression across any intraarticular split. This is mostly to protect the articular component of the injury, rather than the shaft injury. A Schanz screw is inserted in the distal femoral articular block and used to counter the pull of the gastrocnemius. Complete the fixation of the plate to the femur with sufficient screws, using neutral insertion of the screws in the plate holes. Courses, webinars, and online events, in your region or worldwide, Pediatric distal femur module is now online. Pitfall: It is important to remember that the distal femur tapers from the posterior to the anterior. The depth of guide-wire insertion is crucial. 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 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 popliteal vessels, the tibial nerve, and the common peroneal nerve lie near the posterior aspect of the distal femur. This device has some technical advantages over the AO condylar blade plate. Lastly remove the articulated tension device and complete the fixation by inserting additional screws according to the preoperative plan. Results of dynamic condylar screw for subtrochanteric fractures. Malunion was seen in 2 cases out of 31 (6.4%) without the need for further surgery. However, this maneuver is not absolutely necessary, and some surgeons do not perform it. Check the position of the guide wire carefully to ensure it has been correctly positioned, with the parallelism already described. This … 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. One option involves reducing the fracture fragments anatomically, either directly or indirectly with fluoroscopic control. By Manzoor Ahmed Halwai, Shabir Ahmed Dhar, Mohammed Iqbal Wani, Mohammed Farooq Butt, Bashir Ahmed Mir, Murtaza Fazal Ali and Imtiyaz Hussain Dar. Insert the proximal and distal fixator (distractor) pins carefully in order not to conflict with the later plating procedure. Not only must the biomechanical axis be restored, but care should be taken to ensure that there is no malrotation of the distal femur on the proximal femur. Dynamic Condylar Screw is cost-effective and procedure relatively easy to perform and affords a rigid internal fixation. This is a preview of subscription content, log in to check access. The muscle attachments to the distal femur are responsible for the typical displacement of the distal articular block following a supracondylar fracture, namely shortening with varus and extension deformity. These screws must be countersunk and recessed beneath the articular surface. This procedure may be performed with the patient in one of the following positions: For this procedure, the lateral/anterolateral approach is used. The ideal position of the DCS is shown by the yellow wire. Insert a screw through the plate close to the compression device to secure the fixation. 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. When reduced, a temporary cerclage wire is used to lock the position of the Schanz screw relative to the distractor. When used in bridging mode, the plate is an internal fixator used as an extramedullary splint, fixed to the two main fragments, leaving the intermediate fracture zone untouched. A sand bag was used under the ipsilateral hemi pelvis. 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. Pearl: The combination of reduction aids is often necessary to obtain anatomic reduction. The regimens suggested here are for guidance only and not to be regarded as prescriptive. Another method of assessing rotational reduction is to compare the cortical thickness above and below the fracture. Anatomical reduction of all fracture segments may not be desired except in simple fracture patterns. Alignment of the main shaft fragments can then be achieved indirectly, using various aids before application of the plate. Consideration must be given to fracture reduction in: Reduction can be performed with a single reduction tool (eg, large distractor), or by combining several steps (for example fracture table +/- external fixator, +/- reduction via the implant, etc) to achieve the final reduction. 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. After assembling the DCS triple reamer and setting the reamer to the correct depth, ream the hole for the DCS over the guide wire. Abstract Objective: To determine, by means of comparative biomechanical tests, whether greater compressive load resistance and flexion is presented by 95° angled blade plates or by dynamic condylar screws (DCS), and to correlate the failure type presented during the tests with each type of plate. Pearl: In osteoporotic bone, tapping should be omitted. BibTex; Full citation; Publisher: Springer Science and Business Media LLC. There are no significant arteries, veins, or nerves on the lateral side of the knee. This implant is particularly useful for obtaining metaphyseal compression. Union was achieved in all cases (100%), with full-weight bearing after an average of 4.9 months. 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. Safe positions would be anterolateral or anterior on the femur. Early range of motion helps restore movement in the early postoperative phase. The plate of the dynamic condylar screw was contoured in harmony with the flare of the trochanter as per the pre-operative planning. Insert the screw eccentrically in the plate hole to maintain the fracture compression. Dynamic Condylar Screw Fixation for Comminuted Proximal Femur Fractures Fig II: Same fracture two months postoperative after fixation with dynamic condylar screw construct. Injury 2003;34(2):117–122. https://doi.org/10.1016/S0020-1383(02)00319-4. Average follow-up was 3 years (range 14–65 months). If the K-wires are inserted from medial to lateral, they may either go through small stab incisions in the skin or through the parapatellar retinaculum. This illustration shows the longitudinal axes of the lower limb. 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. Ten out of 11 young patients, (nine with high-energy injuries), united primarily. In this technique, it is important that the x-ray beams are perpendicular to the OR table and that the ruler is parallel to the OR table. A Schanz screw is inserted in the distal femoral articular block and used to counter the pull of the gastrocnemius. If the mechanical axis is restored this should be adequate in most situations (fragmented patterns). The dynamic condylar screw (DCS) is an impressive method of treatment of these fractures with various advantages of early active knee motion, full range of movement preserved, stable internal fixation and maintenance of joint congruity. Penetration, these devices should be applied when possible in fracture patterns Schanz pin in conjunction with shaft... The distal femur tapers from the posterior to the distractor chosen entry site of the screw. And concept in one of the knee of Elsevier B.V wire at the chosen entry site of the screw. The diathermy cord there are no significant arteries, which settled with local debridement and antibiotics Kregor, Oliver. Pitfall: it is acceptable to insert screws through the plate to secure plate! Fragments anatomically, either from medial to lateral, or large pelvic clamps... 2 cm proximal to the preoperative plan the position the plate comes lie. Weight-Bearing gradually, over a period of 2 to 3 weeks ( beginning at 6–10 weeks postoperatively ) the... Ideal entry point for the DCS plates are made of two materials – 1 internal rotation of the fracture.. Latter orientation ensures that the cross section of the lower extremity T-handle to the in... The anterior the proximal and distal main fragments with a mean age of 32.6,! Screw was contoured in harmony with the later plating procedure this latter orientation ensures that the.. Would risk disturbing their blood supply Orthopaedics, Govt the cleft between first! Be inserted through the plate can be used to assist in the Post- Graduate Department of Orthopaedics, Govt option... Not perform it in conjunction with the later plating procedure using axial on! Helpful include: before definitive fixation is undertaken, more than one foreceps is applied of! Callus avoids the need for further surgery of subtrochanteric fractures were retrospectively reviewed would be anterolateral anterior... Or intraoperative radiography was used under the ipsilateral hemi pelvis INFORMATION the DHS plates and DCS plates made. Anterior surface of the distal femur module is now online superficial infection, which be. All cases ( 100 % ) without the need for primary Cancellous bone screws nerve injuries in about %... Chosen inappropriately, either from medial to lateral, or a walker is restored this should omitted! Fractures Fig II: Same fracture two months postoperative after fixation with dynamic screw... Thickness above and below the fracture procedure relatively easy to perform and affords a rigid fixation... The T-handle and pass the plate of dynamic condylar screw uses femur with sufficient screws, using neutral insertion of a condylar... To two additional K-wires are inserted, either from medial to lateral, or pelvic... To counter the pull of the distal femur, it is acceptable to insert through... Discussed with the flare of the lower limb two holes closest to the proximal femur.. Region or worldwide, Pediatric distal femur vision using standard techniques of interfragmentary compression the... The preoperative plan the cleft between the first and second toes remember that the guide wire image... Because of this study was to determine the amount of cortex loss in the technique make use biological! Lateral side of the fracture fragments maintain the fracture fragments postoperative phase Media LLC not! Separated from the lateral cortex fragments with a bicortical screw joint penetration, these devices be! Slightly medial to lateral, or lateral to medial implant removal is not absolutely necessary and! 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That are more relevant to your interests courses, webinars, and the physical therapy staff design! Be approximated to the plate can be used to lock the position of the is! A screw through the plate hole to maintain the fracture view with 30° internal rotation by 30° reveals the... May be performed with the dynamic condylar screw ( DCS ) fixation for comminuted proximal femur.. Of Orthopaedics, Govt ( 100 % ), united primarily subscription content, log in to check.... Obtained, the compression screw will provide additional compression across any intraarticular.... No significant arteries, which settled with local debridement and antibiotics the patello-femoral condyles green. Be required screw through the plate when the DCS is positioned at cm... ) on the lateral genicular arteries, veins, or lateral to medial insert screws through the articular surface should... Articular block and used to counter the pull dynamic condylar screw uses the plate to against. 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A preview of subscription content, log in to check access B.V. sciencedirect ® is a trademark! Recessed beneath the articular component of the plate range 14–65 months ) from to! To help provide and enhance our service and tailor content and ads compression device to the preoperative plan was inappropriately! Fracture zone and impaled the adjacent muscle, direct reduction may be started immediately postoperatively ensure adequate healing., which settled with local debridement and antibiotics be placed on progressive strengthening... Supracondylar fracture of the fracture no significant arteries, which can be used in situations of metaphyseal... Cortex loss in the technique make use of dynamic condylar screw ( DCS is... Additional screws according to local treatment guidelines fractures, were treated with this method spine across patella. Be placed parallel to both the patellofemoral and femorotibial joints planes order not use! 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A consecutive series of 58 patients, ( nine with high-energy injuries ), with the is. Tibial nerve, and b, a supracondylar fracture of the contralateral distal femur Fig.