Distal femur Extraarticular fracture, multifragmentary

Open reduction internal fixation (ORIF); dynamic condylar screw (DCS)

ORIF - dynamic condylar screw (DCS)

Indication summary: Indirect reduction not possible, image intensification not available, Surgeon's preference

Skill: Highly experienced and skilled surgeon
Equipment: Simple surgical and imaging resources

The advantage of a DCS, when inserted in an open manner, is that the surgeon can use the implant as a reduction aid. By inserting condylar screw into the correct position in the distal femoral block, the surgeon ensures appropriate varus/valgus reduction when the plate is brought down to the bone.

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 and open fractures
  • Closed reduction impossible
  • Some periprosthetic fractures
  • Image intensifier not available
  • Early pregnancy (up to 12 weeks gestation; reduces risks of intraoperative ionizing radiation)

Contraindications

  • Polytrauma patient in unstable condition
  • Patient not medically fit for surgery
  • Local soft-tissue pathology

Advantages

  • Definitive procedure
  • Direct fracture reduction
  • Restoration of mechanical axis
  • Restoration of femoral rotation
  • Fracture stabilization allows early mobilization of patients postoperatively
  • Can be used in cases of pulmonary compromise
  • Less exposure to ionising radiation

Disadvantages

  • Risk of infection
  • Risk of implant related complications
  • Risk of greater blood loss
  • Larger operative soft-tissue trauma
  • More visible scarring

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