Technical aspects of the use of dynamic condylar screw in biological fixation of comminuted subtrochanteric fractures

• Published in: European journal of orthopaedic surgery & traumatology 2009, Vol.19 (1), p.33-37
• Main Authors: Rohilla, Rajesh, Singh, Roop, Magu, Narender Kumar, Sangwan, Sukhbir Singh, Devgun, Ashish, Siwach, Ramchander
• Format: Article
• Language: English
• Subjects: Fractures; Medicine; Medicine & Public Health; Original Article; Surgical Orthopedics; Traumatic Surgery
• ISSN: 1633-8065; 1432-1068
• DOI: 10.1007/s00590-008-0369-7

Background Indirect reduction and biological internal fixation using dynamic condylar screw (DCS) yield acceptable results in comminuted subtrochanteric fractures. An analysis of the technical difficulties of the procedure with the tricks to prevent these is presented. Materials and methods Forty-eight consecutive patients with the mean age of 44.5 years with comminuted subtrochanteric fractures were treated with a DCS and biological reduction methods. Results All fractures united without bone grafting at average union time of 16.16 weeks. Average Harris hip score was 87.97 points. We observed technical difficulties in six patients like inaccurate placement of guide pin in two; difficulty in sliding the plate due to obesity in one; difficulty in gliding barrel plate over condylar screw in one; and technical failure in two patients. Malunion (coxa vara) leading to limp occurred in one patient. A mean limb length discrepancy of 1.46 cm was detected in 5 patients at last follow up. We improvised the technique to overcome these difficulties. Conclusions Accurate placement of the guide pin is the key to avoid technical difficulties during the procedure. Surgeon should not proceed further until completely satisfied with the position of the guide pin. Few tricks in the technique make use of dynamic condylar screw in biological fixation of comminuted subtrochanteric fractures easier.