The dynamic condylar screw in the management of subtrochanteric fractures: does judicious use of biological fixation enhance overall results?

摘要

Subtrochanteric fractures are fraught with certain anatomic, biologic and biomechanical challenges. Evolution of implants like the Gamma nail, fixed-angle nail plates, compression hip screws and dynamic hip screws with trochanteric stabilization plates underlines a persistent quest for a better implant. We studied the dynamic condylar screw DCS as an implant on a series of 30 consecutive patients with subtrochanteric fractures. Our purpose was to assess this implant as a panacea for subtrochanteric fractures. All cases of AO type A and B were anatomically fixed, whereas type C was biologically plated. The idea was to assess the applicability and adaptability of the DCS. Fractures in 29 cases united, with one patient suffering from an implant failure. There were 17 excellent, 5 good, 5 fair and 3 poor results. The DCS is a definite advance over previous methods of treatment; when combined with the utilization of biological fixation techniques for comminuted fractures, can be relied upon to treat all types of subtrochanteric fractures.