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Objective: To evaluate thefracture union in patients with subtrochanteric femoral fractures managed with dynamic condylar screw. Material and methods: This was a case series study and was conducted at Department of Orthopedic Surgery, Sahiwal Medical College, Sahiwal from June 2016 to May 2017. Total 90 patients with closed subtrochanteric fractures (within the 1 week of fracture), having age from 20-70 years either male or female were selected. Results: Mean age of the patients was 39.53 ± 15.08 years. Mean duration of fracture was 4.10 ± 1.99 days. Out of 90 patients with subtrochanteric fracture, union was noted in 71 (79%) patients. In age group 20-45 years, union rate was 53 (85.48%) and in age group 46-70 years and union rate was 18 (64.29%). Union of fracture was seen in 5 (29.41%) patients, 39 (92.86%) patients and 27 (87.17%) patients respectively in Type A, B and C fractures. Union was strongly (P = 0.000) associated with type of fracture. Higher number of union was noted in type B fracture. Conclusion: A higher rate of fracture union was observed in cases of subtrochanteric femoral fractures treated by fixation with dynamic condylar screw system. Findings of present also revealed that fracture union is not associated with gender. But significant association of fracture union with age group, duration of disease and type of fracture.
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Objective: To assessthe fracture union in patients of subtrochanteric femoral fractures managed with dynamic condylar screw system and its association with type of fracture. Material and methods: This was case series study and was conducted at Department of Orthpaedic Surgery DHQ Hospital Vehari. Total 80 patients with closed subtrochanteric fractures (within the 1 week of fracture) either male or female having age from 20 years to 70 years were recruited. Patients were managed with dynamic condylar screw system. Union of fracture was assessed after 8 weeks of surgery. Results: Mean age of the patients with subtrochanteric femoral fractures was 38.75±14.33 years and mean duration of fracture was 4.33±1.42 days. Total 80 patients were managed with dynamic condylar screw system and after 8 weeks, all the patients were assessed for union of fracture and union was found in 55 (69%) patients. Union of fracture was noted in 4 (26.27%) patients, 33 (89.19%) patients and 18 (64.29%) patients respectively in type A, B and C fracture. Highly significant association between union and type of fracture was noted with p value 0.000. Conclusion: Findings of present study showed high rate of union in patients of subtrochanteric femoral fractures treated by fixation with dynamic condylar screw system. Union of fracture is significantly associated with type of fracture and duration of fracture.
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Introduction: The subtrochanteric fractures are one of thecommon fractures that every trauma surgeon come acrosson daily basis. The most of these fractures are treated eitherintramedullary device or a side plate. Among side plates, thechoice between the implants like DCS and DHS is variedamong the different surgeons. We made an analysis of resultsof Dynamic Condylar Screw with the aim to find out the useof that implant in selective fracture types.Material and Methods: A prospective study during 2014 to2015 was done in our institute. The study period is 1 year. Thepatients who opted for surgical treatment only were chosen.They were undergoing surgery under spinal anaesthesia, usingfracture table under image intensifier. The position of fracturereduction was checked in anterior posterior and lateral imageintensifier views. The post-operative assessment was doneat 3weeks, 6 weeks and 3months intervals with regard toradiological union and clinical outcomes. Data was analysedand expressed in terms of percentages.Result: the female to male ratio was 1:1.55. The average ageamong males is 58years and of females is 54 years. The rightside and left side were involved equally (n=28). Most of thepatients were injured by fall at home 39.2% (n=11), due toRTA 32.1% (n=9) and 28.5% (n=8) subjects were injureddue to self-inflicted road accidents. Limb shortening is mostcommon complication, which is there for 17.85% (n=5) ofpatientsConclusion: Dynamic Condylar Screw (DCS) provide goodfixation for subtrochanteric fractures with better results interms of stability and fracture union. Procedure has a fewercomplication rates if cases were selected carefully.
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Resumen: Introducción: La fractura articular de fémur distal es una lesión grave que durante años ha representado un problema en la traumatología que con frecuencia ocasiona distintos grados de incapacidad permanente en la rodilla. El destino de la articulación estaba determinado por la lesión más que por su tratamiento. Objetivos: Presentar los resultados del tratamiento quirúrgico de las fracturas articulares de fémur distal tipo C2 con tres modalidades de tratamiento: tornillo dinámico condíleo (TDC), placa de sostén condíleo (PSC) y placa periarticular (PPA). Material y métodos: Estudio comparativo de tres series terapéuticas, diseñado para comparar la efectividad del TDC, la PSC y la PPA en el tratamiento de fracturas articulares completas de fémur distal tipo C2. Se incluyeron 42 pacientes de ambos géneros, con edades entre 16 y 60 años, tratados en el IAHULA, con un seguimiento mínimo de 24 meses. Resultados: Predominó el sexo masculino con 73.8%, el grupo etario más afectado fue de 21-30 años con 28.57%. El tipo de fractura más frecuente fue la 33C2.3 con 42.86%. La PPA mostró mejores resultados que los otros implantes fundamentalmente en la escala funcional de la Knee Society. Setenta y uno punto cuarenta y tres por ciento de los pacientes presentó alguna complicación, resaltando la rigidez articular, la desviación angular en recurvatum, el dolor crónico y la artrosis postraumática. Conclusión: El TDC y la PPA son opciones válidas para el tratamiento de las fracturas de fémur distal AO 33C2, puesto que ofrecieron mejores resultados funcionales que la PSC
Abstract: Introduction: The distal articular femur fracture is a serious injury that for years has been a problem in traumatology. It is often believed that produced varying degrees of permanent disability in the knee and that the fate of the joint was determined by the injury rather than treatment. Objectives: Present the results of surgical treatment of articular distal femur fractures type C2 with three treatment modalities: dynamic condylar screw (TDC), condylar buttress plate (PSC) and periarticular plate (PPA). Material and methods: We conducted a comparative study of three therapeutic series designed to compare the effectiveness of dynamic condylar screw, the condylar buttress plate and periarticular plate in treating complete articular fractures of distal femur type C2. Patients of both genders, aged between 16 and 60 years, treated in the IAHULA, with a minimum follow up of 24 months. Results: We included 42 patients divided into three groups. Males predominated with 73.8%, the most affected age group was 21-30 years with 28.57%. The most common type of fracture was the 33C2.3 with 42.86%. The 71.43% of patients experienced complications, highlighting joint stiffness, angular deviation in recurvatum, chronic pain and post traumatic osteoarthritis. Conclusion: TDC and the PPA are valid options for the treatment of distal femur fractures AO 33C2, as offered better functional results than PSC.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Adulto Joven , Fracturas del Fémur/cirugía , Fijación Interna de Fracturas , Placas Óseas , Tornillos Óseos , Fémur , Persona de Mediana EdadRESUMEN
Objective To investigate treatment method for existing and impending benign pathological femoral neck and trochanteric lesions.Methods A retrospective study wad done on 25 patients with benign proximal femur lesions treated between 2002 and 2004.All patients were treated with lesion curettage,cauterization,autografting and/or allografting.Then,dynamic condylar screw (DCS) or hip joint-span external fixator were selected according to the involved area of the lesion of the proximal femur.The duration of follow-up was mean 2.3 years (2-4 years).Results Sound bony union was seen on the radiographs of all patients by 3-6 months after surgery.There found no local recurrence or avascular necrosis of the femoral head,or complications like necrosis,infections or fractures.Function of the patients in the current series was graded excellent,assessed by the validated outcome measures MSTS-87,MSTS-93 and TESS lower extremity.Conclusion DCS or hip joint-span external fixator may be better alternative treatment of benign pathological femoral neck and trochanteric lesions,compared with conventional surgical methods such as simple bone grafting,traction and hip spica cast.
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Objective To observe the application and efficacy of dynamic condylar screw (DCS) in treating intertrochanteric fractures of the femur and discuss the fixation principle, feasibility, advanta-ges and related issues. Methods A retrospective analysis was done on 23 patients with intertrochanter-ic fractures of the femur treated with DCS from January 2000 to December 2006. Of all, there were 10 elderly patients with different levels of various kinds of internal diseases and 13 young patients injuried by high-energy such as traffic accidents. According to Boyd' s classfication, there was one patient with type Ⅰ fracture, five with type Ⅱ , nine with type Ⅲ and eight with type Ⅳ. After a detailed pre-operative physical examination and targeted treatment, DCS fixation was employed for intertrochanteric fractures of the femur. Results A follow-up for average 18 months showed no death. Early complications occurred in three patients including two with pulmonary infection and one with urinary tract infection, who got cured after proper treatment. There was one patient with long-term complication, post-traumatic arthritis. All 23 patients got bone healing, with excellenee rate of 96% according to Harris criteria. There were no complications like breakage of nails, nonunion, eoxa yarn deformity, shortening or external rotation of the lower limb. Conclusions DCS has advantages of simple operation, reliable fixation and coincidence with biomechanical characteristics and hence is one of ideal methods for treatment of intertrochanteric frac-ture of the femur, especially for subtrochanteric fracture, contrary chanteric fractur, fracture involving large pyriform troehanteric and comminuted fractures of sub-trochanteric lateral os integumentale.
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[Objective]To evaluate the clinical value in treatment of subtrochanteric fracture of the femur by dynamic condylar screw(DCS).[Method]This study retrospectively reviewed 29 patients who suffered from subtrochanteric fracture of the femur.There were 18 males,11 females,with an average age of 52.2 years.Seven cases were caused by traffic accident,8 cases caused by falling from hight,14 cases caused by pedestrian injury.According to Seinsheimer classification,there were 5 cases of typeⅡ(2 of typeⅡB,3 of typeⅡC),12 cases of typeⅢ(7 of type ⅢA,5 of type ⅢB),5 cases of type Ⅳ,7 cases of type Ⅴ.All patients accepted the treatment with traction reduction and dynamic condylar screw fixation and were fellowed up for 9～24 months(average 16 months).Outcoms were assessed by Sanders traumatic hip rating scale and postoperative complications were analyzed.[Result]All patients obtained bone union in average 3.5 months(3～5 months),Only one case who had obtained bone union suffered subtrochanteric refracture 16 months after operation because of plate breakage.All patients were encouraged to early exercise and walk by nonweight-bearing.There was no postoperative infection,deep venous thrombosis,internal fixation loosening,limb shortening and varus deformity.According to sanders traumatic hip rating scale,18 cases were excellent,10 cases were good,1case was fair.The excellent and good rate was 96.5%.[Conclusion]In treatment of subtrochanteric fracture of the femur,DCS not only maintain satisfying reduction with reliable fixation,but also prevent femoral shortening,rotation and varus deformity,thus get good curative effect,fast recovery,satisfying function and so on.So it is one of the best choices to heal subtrochanteric fracture.
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PURPOSE: To evaluate the outcomes of patients with comminuted subtrochanteric femoral fractures using minimally invasive plate osteosynthesis (MIPO) technique. MATERIALS AND METHODS: Twelve patients with a mean age of 38.2 years, who sustained comminuted subtrochanteric femoral fractures, were treated using MIPO technique. All patients suffered these fractures either from traffic accidents (6) or falls from height (6). Average follow-up was 4.3 years (range, 29~78 months). Patients were assessed radiographically and clinically with regards to time to union, malunion, and complications. According to the Seinsheimer's classification, there were 1 type III, 7 type IV, and 4 type V. Type C fractures were ten according to AO-OTA classification. RESULTS: Union was achieved in 7 of 12 cases, in an average of 23.4 weeks (range, 12~42 weeks). Three definite non-unions with implant failures, needed the procedure of implant change and bone graft. In other two patients, early bone graft was performed for anticipated nonunion of comminuted area. The most common complication was metal failures (2 plate failures and 3 screw breakages). Limb length shortening of 1.5 cm occurred in one patient, and external rotation malunion of 15 degrees was noted in one patient. No patients developed infection. CONCLUSION: Preserving biology of the fracture fragments, the use of MIPO technique using DCS has proven to be less successful in comminuted subtrochanteric fractures, comparing to fractures in other areas. To avoid mechanical failure, the careful and protective weight bearing is needed until the callus-bridging is seen in the commniuted area.
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Humanos , Accidentes de Tránsito , Biología , Clasificación , Extremidades , Fracturas del Fémur , Fémur , Estudios de Seguimiento , Fracturas de Cadera , Trasplantes , Soporte de PesoRESUMEN
PURPOSE: To evaluate the result of comparative study about the cases in the fracture of the distal femur treated with plate and screw, dynamic condylar screw, blade plate, retrograde intramedullary nail and external fixator. MATERIALS AND METHODS: The AO classification system was used. 84 cases who were preformed operation during the period from March 1996 to May 2002, were included in this study. The mean duration of follow-up was 25 months. According to Sachatzker criteria, we classified the following results to excellent, good, fair and poor. RESULTS: Type A were excellent or good result when treated with plate and screw, dynamic condylar screw and retrograde intramedullary nail. Type B were excellent or good result when treated with cannulated screw. Type C were excellent or good result when treated with plate and screw and blade plate. CONCLUSION: We conclude that the most important thing in operation is firmly internal fixation and to obtain this, accurately anatomical reduction and the choice of suitable instrument for the type of the fracture are needed. cannulated screw. Type C were excellent or good result when treated with plate and screw and blade plate.
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Clasificación , Fijadores Externos , Fracturas del Fémur , Fémur , Estudios de SeguimientoRESUMEN
Objective To report the clinical application of Dynamic Condylar Screw(DCS) in treatment of 15 cases of distal femoral fractures. Methods All cases of the distal femoral fractures were treated with DCS, and given different fixation according to different types of the fracture,and CPM was used after operation. Results All patients were followed up for a period from 6 months to 12 months.The excellent and good rate of functional recovery was 86.7%. Conclusions DCS is a good method to treat distal femoral fractures.