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 high incidence of non-union and implant failure.
The variety of extramedullary and intramedullary implant continues to evolve. Intramedullary nailing is the mainstay in the surgical treatment of subtrochanteric femoral fractures but nailing is often unsuitable for difficult fractures pattern with comminution or when the medullary canal is narrow.
Biological fixation decreases the complications while preserving soft tissue vascularity by encouraging rapid callus formation, which buttress the medial cortex.
Objective: Assessment of the benefits and effectiveness of beveled dynamic condylar screw using biological fixation technique in treatment of comminuted subtrochanteric fractures in terms of radiological and functional outcome, operative time, operative blood loss volume, intraoperative and postoperative complications.
Patients and Methods: From 2006 to 2010, 24 patients, 16 males and 8 females with a mean age of 33 (17-66) years presented with comminuted subtrochanteric femoral fractures were treated with indirect reduction and biological plate fixation with beveled dynamic condylar screw (DCS), at Sohag University Hospital. 83% of the fractures were caused by traffic accident and fall from height while 17% were due to simple fall.
Results: Average follow up was 3 years. Average operation time was 45 minutes. Average blood loss was 250 ml. Partial and full weight bearing were 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%), while one patient (4%) complicated with non-union but united after open graft technique. One patient with prominent lag screw required removal of the dynamic condylar screw after healing. One patient had loosening of the locking screw required removal. Two patients had a lower limb shortening of 1 and 2 cm. There was no significant statistical difference between the injured and non-injured femoral neck-shaft angle. According to Radford et al criteria, 18 patients had excellent results, 4 patients had good results, one patient had fair results and one patient with failure.
Conclusion: Use of beveled dynamic condylar screw and biological bridge platting technique offers significant advent of being less technically demanding with high percentage of subtrochanteric fracture union without major complications.