Distal femur Extraarticular fracture, multifragmentary

Closed reduction internal fixation (CRIF); dynamic condylar screw (DCS)

MIO - dynamic condylar screw (DCS)

Indication summary: Displaced reducible fracture, Surgeon's preference

Skill: Highly experienced and skilled surgeon
Equipment: Full specialized surgical and imaging resources

No evidence exists proving the superiority of the use of either the DCS, the Condylar LCP, or the LISS with such fractures. The DCS may have a lesser purchase in the distal femoral fragment, if there is a short distal segment and or osteoporosis, and a locking plate option may need to be considered.

Indications

  • All extraarticular multifragmentary metaphysis fractures
  • Closed fractures, where a closed reduction is possible
  • Some periprosthetic fractures

Contraindications

  • Polytrauma patient in unstable condition
  • Medically unfit for surgery
  • Image intensifier unavailable
  • Early pregnancy (up to 12 weeks gestation; risks of intraoperative ionizing radiation)
  • Local soft-tissue compromise

Advantages

  • Fracture reduction
  • Less invasive procedure
  • Minimizes secondary soft-tissue damage
  • High union rates
  • Definitive procedure
  • Fracture stabilization allows early patient mobilization
  • Can be used in cases of pulmonary compromise
  • Less visible scarring

Disadvantages

  • Closed reduction is more difficult than open reduction
  • Difficult control of distal femoral fracture fragment
  • Higher rate of malreduction
  • Technically demanding procedure
  • Frequent use of image intensifier – risk of increased exposure to ionizing radiation
  • Risk of infection
  • Risk of implant related complications

Legend

*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

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v1.0 2008-12-03