Distal Femur Extraarticular fracture, simple

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

DCS vs. Condylar LCP

No evidence exists proving the superiority of either the DCS, or the Condylar LCP for fractures treated in this manner.
Locking plates are superior in osteoporotic 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.

Technically, the step of connecting the DCS side plate to the condylar screw in a submuscular (minimally invasive) manner is much more difficult than insertion of the Condylar LCP. In general, the DCS is less expensive.

Indications

  • Closed fractures where a closed reduction is possible
  • Some periprosthetic fractures

Contraindications

  • Polytrauma patient in highly 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
  • High union rates
  • Definitive procedure
  • Restoration of mechanical axis
  • Restoration of femoral rotation
  • More respectful of soft tissues
  • Fracture stabilization allows early patient mobilization
  • Can be used in cases of pulmonary compromise
  • Less visible scarring

Disadvantages

  • Closed reduction is more challenging than open reduction
  • Risk of infection
  • Risk of implant-related problems
  • Risk of malrotation
  • Risk of varus or valgus malposition
  • Technically demanding procedure
  • Frequent use of image intensifier – risk of increased ionizing radiation exposure

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

Appendix

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v1.0 2008-12-03