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Year : 2014  |  Volume : 49  |  Issue : 2  |  Page : 140-145

Results of biological fixation for subtrochanteric femoral fractures with a beveled dynamic condylar screw

Sohag University Hospital

Correspondence Address:
Shazly S Mousa
Sohag University Hospital

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1110-1148.145388

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Background Subtrochanteric femoral fractures are fraught with certain anatomic, biologic, and biomechanical challenges. Surgical treatment is the preferred method for management of such fractures; however, comminuted subtrochanteric femoral fractures may be associated with a high incidence of nonunion and implant failure. The types of extramedullary and intramedullary implant techniques continue to evolve. Intramedullary nailing is the mainstay in the surgical treatment of subtrochanteric femoral fractures, but nailing is often unsuitable for difficult fracture patterns with comminution or when the medullary canal is narrow. Biological fixation decreases the complication rate while preserving soft tissue vascularity by encouraging rapid callus formation, which buttresses the medial cortex. Objective The aim of the study was to assess the benefits and effectiveness of a beveled dynamic condylar screw (DCS) using biological fixation the treatment of comminuted subtrochanteric fractures in terms of radiological and functional outcome, operative time, operative blood loss volume, and intraoperative and postoperative complications. Patients and methods From 2006 to 2010, 24 patients (16 male and 8 female patients) with a mean age of 33 years (range 17-66 years) presented with comminuted subtrochanteric femoral fractures and were treated with indirect reduction and biological plate fixation using a beveled DCS at Sohag University Hospital. An overall 83% of the fractures were caused by traffic accidents and falls from a height, whereas 17% were due to simple falls. Results The average follow-up period was 3 years. The average operation time was 45 min. The average blood loss was 250 ml. Partial and full weight bearing was recommended at an average postoperative period of 3.3 and 4.8 months, respectively. The fractures united at a mean of 4.6 months postoperatively in 23 patients (96%), whereas one patient (4%) encountered complications with nonunion but achieved union after undergoing an open graft technique. One patient with a prominent lag screw required removal of the DCS after healing. One patient had loosening of the compression screw, which required removal. Two patients had a lower limb shortening of 1 and 2 cm. There was no significant statistical difference between the injured and noninjured femoral neck-shaft angle. According to the criteria of Radford and Howell, 18 patients showed excellent results, four patients showed good results, one patient showed fair results, and one patient encountered failure. Conclusion Use of a beveled DCS and biological bridge plating offers the significant advantage of being less technically demanding with a high percentage of subtrochanteric fracture union without major complications.

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