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

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