Dynamic Condylar Screw Research Articles

Functional Outcomes of a Dynamic Condylar Screw for Unstable Femoral Intertrochanteric Fractures in Patients Above 50.

Hip fractures areamong the most common fractures encountered in the emergency departments by orthopedic trauma teams. The optimal treatment method and implant choice for unstable intertrochanteric fractures are subject to debate, with various options available, including intramedullary and extramedullary implants. In this descriptive cross-sectional study, the researchers examined patients with unstable intertrochanteric fractures (classified as 31A2 according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification) who had undergone open reduction and internal fixation with a 95° dynamic condylar screw (DCS). The study was conducted at the Gezira Centre for Orthopedic Surgery and Traumatology (GCOST) during the latter half of 2022. Functional outcomes were assessed using the modified Harris Hip Score (mHHS). A total of 30 patients were enrolled in this study, with a mean age of 73 ± 12.27 years. Of these, 11 (36.7%) were male, and 19 (63.3%) were female. The mHHS was 73.6 ± 14.654. Among the surveyed patients, seven (23.3%) reported poor outcomes, 13 (43.3%) reported fair outcomes, six (20%) reported good outcomes, and four (13.3%) reported excellent outcomes. The Kruskal-Wallis test revealed statistically differences in mean mHHS scores between gender groups (p = 0.024) and between age groups (p = 0.04). However, no significant differences were found across different modes of trauma groups (p = 0.73), affected hip groups (p = 0.35), comorbidity groups (p = 0.84), or postoperative complication groups (p = 0.06). Our study found that DCS treatment for unstable intertrochanteric fractures yielded acceptable functional outcomes, making it a viable and effective treatment option.

Comparative efficacy of proximal femoral nail vs dynamic condylar screw in treating unstable intertrochanteric fractures.

Among the most frequent hip fractures are trochanteric fractures, which usually occur from low-energy trauma like minor falls, especially in older people with osteoporotic bones. To evaluate the treatment efficacy of dynamic condylar screws (DCS) and proximal femoral nails (PFN) for unstable intertrochanteric fractures. To find pertinent randomized controlled trials and retrospective observational studies comparing PFN with DCS for the management of unstable femoral intertrochanteric fractures, a thorough search was carried out. For research studies published between January 1996 and April 2024, PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar were all searched. The complete texts of the papers were retrieved, vetted, and independently examined by two investigators. Disputes were settled by consensus, and any disagreements that persisted were arbitrated by a third author. This study included six articles, comprising a total of 173 patients. Compared to the DCS, the PFN had a shorter operation time [mean difference (MD): -41.7 min, 95% confidence interval (95%CI): -63.04 to -20.35, P = 0.0001], higher success rates with closed reduction techniques [risk ratio (RR): 34.05, 95%CI: 11.12-104.31, P < 0.00001], and required less intraoperative blood transfusion (MD: -1.4 units, 95%CI: -1.80 to -1.00, P < 0.00001). Additionally, the PFN showed shorter fracture union time (MD: -6.92 wk, 95%CI: -10.27 to -3.57, P < 0.0001) and a lower incidence of reoperation (RR: 0.37, 95%CI: 0.17-0.82, P = 0.01). However, there was no discernible variation regarding hospital stay, implant-related complications, and infections. Compared to DCS, PFN offers shorter operative times, reduces the blood transfusions requirements, achieves higher closed reduction success, enables faster fracture healing, and lowers reoperation incidence.

Biomechanical analysis of various internal fracture fixation devices used for treating femoral neck fractures: A comparative finite element analysis

IntroductionSeveral internal fixation devices are available for treating Pauwels type I, II and III femoral neck fractures. The present study compared various fixation implants for all Pauwels fracture types using a CT-based subject-specific finite element model of the femur and determined the most effective implant for each fracture type. Materials and MethodsThe analysis included four different configurations of cannulated screw models, Femoral Neck System, Dynamic Hip Screw and Dynamic Condylar Screw (with and without anti-rotational screw). Ti-alloy was considered as the implant material. Heterogeneous bone material property was assigned based on CT grey value. Frictional contact was assumed in the contact interfaces. Peak loading corresponding to normal walking and stair-climbing were considered. Equivalent strain in bone, equivalent stress in the implants, femoral head deformation and rotation, micromotion in the contact interfaces, and strain-shielding in bone were evaluated for each implanted model. ResultsStresses generated in the implants were within the yield limit of the implant material. In Pauwels I and II, the micromotion predicted at the contact regions in all the implanted models was within 100 µm, which is suitable for bone integration. However, in Pauwels III fracture, most of the implanted models other than DHS with AR-screw model exhibited micromotion of more than 150 µm in the contact regions, which is expected to inhibit bone growth. ConclusionsThe DHS with AR-screw implanted model was identified as the most effective in treating Pauwels I and III fractures. However, for Pauwels type II, DCS with an AR-screw implant was deemed superior to the other configurations.

Unlocking the Influence of Age and Fracture Side on Recovery in Unstable Proximal Femoral Fractures: Insights from a Tertiary Care Hospital in a Developing Country

Objective: The aim of our research is to identify the clinical and demographic characteristics that affect the functional results in patients with proximal femur fractures who are treated with dynamic condylar screws. Method: A descriptive cross-sectional survey conducted from September 2019 to March 2022, enrolled 115 patients aged 20-60 years with unstable proximal femoral fractures managed with dynamic condylar screws. The data was collected 12 weeks following the surgery to assess the factors influencing the Harris Hip Score. The data on clinical, demographic, and surgical detail was collected and analyzed employing the SPSS version 22, using the Shapiro-Wilk test. Results: The study revealed significant functional improvement associated with the age group 41-60 years, additionally, patients with left-sided fracture showed statistically significant functional outcomes in comparison to patients with right-sided fractures. No significant association of HHS score was found in relation to clinical, surgical, socioeconomic or occupational factors on postoperative outcomes. The findings highlight a complex interplay of demographic factors following the fracture management for unstable PFF. Conclusion: The uni-variant results yield higher age and left-sided fracture associated with higher functional outcomes following an unstable proximal femur fracture managed with dynamic condylar screws. The statistical results showed no significant association of clinical factors influencing the functional status. The unique demographic finding needs further larger multi-variant research to establish the clinical and demographic factors influencing the functional outcomes following the dynamic condylar screw in patients with proximal femur fracture.

Radiological and Functional Consequences of Open Reduction Internal Fixation with Locking Plate Versus Dynamic Condylar Screw in Type C1 Complete Articular Fracture of Distal Femur

Background: One of the body's main joints for bearing weight is the knee. Its issues are likewise difficult to resolve. Damage to this joint can cause abnormalities in the alignment, stability, and motion of the knee, which impairs function. Objective: To compare the functional and radiological outcome in AO type C1 distal femur fractures fixed with locking plate versus dynamic condylar screw. Methods: The study comprised 94 patients aged 18 to 60 years who had an isolated distal femur fracture and an Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C1 closed fracture. Patients with diabetes mellitus, chronic renal disease, chronic liver disease, ischemic heart disease, pathological fractures, head injuries with a Glasgow coma scale of less than 14, and malignancy were excluded from the sample. The patients were assigned by lottery to groups A and B. In groups A and B, they were treated with dynamic condylar screws (DCS) and locking plate fixation, respectively.. Results: Among 94 patients, 30 (63.8%) were men and 17 (36.2%) were women in Group A; similarly, 33 (70.2%) were men and 14 (29.8%) were women in Group B. Patients in group A had an average age of 38.8±6.19 years, whereas those in group B had an average age of 39.5±7.36 years. 02 patients (4.2%) in Group-A and 05 patients (10.6%) in Group-B experienced infection. The union rate was 45 (95.7%) in group A (locking plate fixation technique) and 40 (85.10%) in group B (dynamic condylar screw technique). 35 (74.46%) in group A, 08 (17.1%) in good, 03 (6.38%) in average, and 01 (2.1%) in poor; in group B, 25 (53.2%) in excellent, 09 (19.2%) in decent, and 10 (21.3%) had average and 03(6.3%) had poor functional outcome. Conclusion: In terms of clinical and radiological evaluation, the type C1 distal shaft femur fixation with locking plate performs better than the dynamic condylar screw, which has a lower infection rate and better union and functional success

Functional Outcomes of Subtrochanteric Femur Fracture Fixed with Dynamic Condylar Screw

Abstract: Background: Orthopedic surgeons find it most difficult to manage subtrochanteric femur fractures because of its notorious location, where difficulties might arise. Various techniques, including intramedullary and extramedullary implant stabilization have been tried with varying level of success. Objective: Our study aimed to assess the functional results of dynamic condylar screws in sub trochanteric femur fractures in order to aid the underprivileged masses in our area. Materials and Methods: This prospective observational study was conducted in Akbar Medical Center Dabgari Garden Peshawar, Pakistan from September, 2018 to August, 2022. All patients of either gender having age above 20 years with proximal femoral fracture without concomitant fracture, with negative hepatitis profile and no diabetes were managed using a dynamic condylar screw. Functional outcome of the surgery was evaluated using Harris Hip Score. Result: There were total 88 patients in the study with male to female ratio of 3:1 having mean age of 33.96±9.63. Postoperative functional outcome in terms of Harris hips score range from 64 to 94 with a mean of 83.87 ±7.27 SD. Excellent functional outcome were observed in 14.8% patients, good results in 64.8% patients, fair outcomes in 11.4% and poor outcome were observed in 9.1% patients. Conclusion: DCS results are excellent and good functional outcome in majority of patients. Therefore, it can be used as a good alternative to other intra and extramedullary implants fixation. Keywords: Dynamic condylar screw, Femur, Fractures, Harris hip scores, Subtrochanteric, Medullary devices.

Functional and Radiological Outcomes of Distal Femur Fractures treated with Less Invasive Stabilization System versus Dynamic Condylar Screw

Introduction: Fractures in the distal femur are quite rare, comprising around 0.4% of all fractures and 3% of femoral fractures. Managing distal femur fractures has been a subject of debate, but recent developments favor indirect reduction and minimally invasive approaches. The objective is to find a harmonious equilibrium between the mechanical stability of the fractured segments and their biological viability. Given their elevated complication rate, achieving optimal restoration of functional anatomy and ensuring stable fixation is imperative for prompt recovery from distal femoral fractures. Comparison of less invasive stabilization system versus dynamic condylar screw fixation in treatment of distal femur fractures is subject of ongoing debate as to which one is better. Aims and Objectives: To compare the functional and radiological outcomes of distal femur fractures treated with less invasive stabilization system versus dynamic condylar screw fixation. Place and Duration of study: A randomized clinical trial was conducted in the Orthopedic Department of Sheikh Zayed Hospital, Lahore, from July 2, 2020, to January 1, 2021. Material and Methods: A randomized clinical trial was conducted at Sheikh Zayed Hospital in Lahore over a six-month duration. In total 104 patients who fulfilled the inclusion criteria were admitted to the Orthopedic Department via Emergency and OPD. Demographic data and medical histories were taken. The sample size consisted of 52 patients in each group, with random allocation to either the LISS (A) or DCS (B) groups determined by a lottery method. Follow-up appointments were scheduled for all patients at one month, three months, and six months post-surgery. Radiological outcome was evaluated at each follow-up visit while functional outcome assessed at sixth monthly follow up. Data analysis was performed using the SPSS: version 22, considering p ? 0.05 as significant. Results: Frequency of functional outcome was i.e. excellent (32.7%), good (14.4%), fair (2.9%) in group A and excellent (27.9%), good (31.7%), fair (7.7%) in group B (p-value&gt;0.05). Mean fusion time was 18.67±3.04 in group A and 19.62±4.36 in group B (p-value&gt;0.05). Conclusion: Our findings indicate no substantial distinction between the two groups. Using DCS or LISS, both methods yield favorable outcomes with negligible complications in the management of distal femoral fractures. Both systems effectively reduce soft tissue injury.

Radiographic Union Assessment in Surgically Treated Distal Femur Fractures: A Systematic Review.

Distal femur fractures are known to have challenging nonunion rates. Despite various available treatment methods aimed to improve union, optimal interventions are yet to be determined. Importantly, there remains no standard agreement on what defines radiographic union. Although various proposed criteria of defining radiographic union exist in the literature, there is no clear consensus on which criteria provide the most precise measurement. The use of inconsistent measures of fracture healing between studies can be problematic and limits their generalizability. Therefore, this systematic review aims to identify how fracture union is defined based on radiographic parameters for surgically treated distal femur fractures in current literature. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Medline, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science Core Collection databases were searched from inception to October 2022. Studies that addressed surgically treated distal femur fractures with reported radiographic union assessment were included. Outcomes extracted included radiographic definition of union; any testing of validity, reliability, or responsiveness; reported union rate; reported time to fracture union; and any functional outcomes correlated with radiographic union. Sixty articles with 3,050 operatively treated distal femur fractures were included. Operative interventions included lateral locked plate (42 studies), intramedullary nail (15 studies), dynamic condylar screw or blade plate (7 studies), dual plate or plate and nail construct (5 studies), distal anterior-posterior/posterior-anterior screws (1 study), and external fixation with a circular frame (1 study). The range of mean follow-up time reported was 4.3 to 44 months. The most common definitions of fracture union included "bridging or callus formation across 3 of 4 cortices" in 26 (43%) studies, "bony bridging of cortices" in 21 (35%) studies, and "complete bridging of cortices" in 9 (15%) studies. Two studies included additional assessment of radiographic union using the Radiographic Union Scale in Tibial fracture (RUST) or modified Radiographic Union Scale in Tibial fracture (mRUST) scores. One study included description of validity, and the other study included reliability testing. The reported mean union rate of distal femur fractures was 89% (range 58%-100%). The mean time to fracture union was documented in 49 studies and found to be 18 weeks (range 12-36 weeks) in 2,441 cases. No studies reported correlations between functional outcomes and radiographic parameters. The current literature evaluating surgically treated distal femur fractures lacks consistent definition of radiographic fracture union, and the appropriate time point to make this judgement is unclear. To advance surgical optimization, it is necessary that future research uses validated, reliable, and continuous measures of radiographic bone healing and correlation with functional outcomes. Level IV. See Instructions for Authors for a complete description of levels of evidence.

Biomechanical evaluation of intramedullary retrograde nail and dynamic condylar screw used in unstable distal femoral fractures.

Distal femur fractures are a common problem in orthopedics. Intramedullary retrograde nails (IRN) and dynamic condylar screws (DCS) are generally used for the treatment of these fractures. In this study, it was aimed to mechanically evaluate and compare these two implants used for the treatment of distal femur fractures. In this study, an AOOTA 33C1.3 fracture was created on the intact femur obtained from computed tomography images. The fractures were fixed with DCS and IRN. Then the created models were imported into the ANSYS Workbench for finite element analysis to determine the most convenient mechanical fixation type. The distal region of the femur was loaded considering 75kg-f, and the created models were constrained in all directions from the femoral head. The intact femur was also analyzed to compare it with the DCS and IRN fixation models. The von Mises stress, strain, and displacement results were examined to determine the damage risk. According to the results, the risk of damage is lower in the model of fixation with IRN. The normal strain distribution in the model fixed with IRN is closer to the model of an intact femur. For this reason, the risk of stress shielding in IRN fixation is less than in DCS fixation. However, the fracture lines were more stable in the fixation with the DCS. In conclusion, fracture fixation with IRN is mechanically more suitable for distal femur fractures in terms of fracture healing.

Comparative study between effectiveness of proximal femoral nail and dynamic condylar screw in fixation of subtrochanteric femur fracture

Comparative study between effectiveness of proximal femoral nail and dynamic condylar screw in fixation of subtrochanteric femur fracture

Fixation of Sub-Trochanteric Fracture Femur by Dynamic Condylar Screw versus Proximal Femoral Nail, A prospective randomized study

Fixation of Sub-Trochanteric Fracture Femur by Dynamic Condylar Screw versus Proximal Femoral Nail, A prospective randomized study

Comparison of Proximal Femoral Nail versus Dynamic Condylar Screw in Treating Reverse Oblique Intertrochanteric Femoral Fractures

Aim: Comparison of proximal femoral nail versus dynamic condylar screw in treating reverse oblique intertrochanteric femoral fractures. Study Design: Retrospective study Place and duration of study: CMH Kharian, Allama Iqbal International Hospital Kharian and Madni Hospital Gujrat from 1st January 2020 to 31st December 2022. Methodology: Sixty five patients who had suffered from reverse oblique intertrochanteric femoral fractures and were either treated through proximal femoral nail or by dynamic condylar screw were included. Patients who were treated with proximal femoral nail were placed in group 1 while those treated with dynamic condylar screw were placed in group 2. The comparative outcomes between both groups were than analyzed and documented in a well-structured questionnaire. Results: There was no significant variance in the mean age of the patients in group 1 (proximal femoral nail) and group 2 (dynamic condylar screw) with a value as 65.53±3.1 and 59.35±3.2 years respectively. There were more females in both groups than males however with no significant variance. Non-union and implant breakage observed in the dynamic condylar screw cases were 5/32 and PFN cases 2/33 respectively; with a significant p value difference. The fixation revision was required in 5case with dynamic condylar screw implant failure while it was 2 in cases of proximal femoral nail. The rate of infection was higher in dynamic condylar screw patients. Practical Implication: There was no advantage of open reduction by dynamic condylar screw over the closed proximal femoral nail reduction. Proximal femoral nail reduction and fixation presented to be a better option for treating reverse oblique intertrochanteric femoral fractures. Conclusion:A high rate of non-union is presented in dynamic condylar screw treated cases.Proximal femoral nail fixation presented to be a better option for treating reverse oblique intertrochanteric Femoral Fractures Keywords: Intertrochanteric, Intramedullary, Femur, Reverse Oblique fractures

Dynamic condylar screw functional outcome in the treatment of unstable proximal femoral fractures in adult patients

Objective: The purpose of this study was to assess the functional outcome of dynamic condylar screw (DCS) fixation in the treatment of unstable proximal femoral fractures in adults. Study Place and Duration: This descriptive study was done from March 2021 to November 2022 at MTI Lady Reading Hospital Peshawar. Methods: A descriptive study, employing dynamic condylar screws to treat proximal femur fractures in all adult patients who met the inclusion criteria, was utilized in this in-depth examination (DCS). The Harris Hip Score was used to determine post-surgery mobility. Results: The average age of patients was 63 having standard deviation of 14. Fracture union took 14.3 +/- 3.8 weeks on the average. At 24 months, the typical HHS was 85.2 +/-12.3, and 78.1% of patients reported adequate or outstanding functional performance. Nonunion, malunion, or hardware failure occurred in 13.3% of patients. Complications were unaffected by age, gender, or fracture type. Conclusion: Dynamic condylar screw therapy has demonstrated promising functional and radiological benefits with few adverse effects in people with unstable proximal femoral fractures. DCS fixation, an efficient treatment for such fractures, is one of the best treatment for such fractures.

Distal femur fractures management and evolution in the last century.

The purpose of this historical review is to illustrate the progression and evolution of treatment for distal femur fractures. Scientific literature was searched for descriptions of treatment for distal femur fractures to provide an in-depth overview of the topic, with emphasis on the evolution of surgical constructs used to treat these fractures. Prior to the 1950s, distal femur fractures were treated nonoperatively, resulting in considerable morbidity, limb deformity, and limited function. As principles of surgical intervention for fractures emerged in the 1950s, surgeons developed conventional straight plates to better stabilize distal femur fractures. Angle blade plates and dynamic condylar screws emerged out of this scaffolding to prevent post-treatment varus collapse. Meanwhile, intramedullary nails, and later, in the 1990s, locking screws, were introduced to minimize soft tissue disruption. Treatment failure led to the development of locking compression plates with the advantage of accommodating either locking or nonlocking screws. Despite this advancement, the rare but significant incidence of nonunion has not been eliminated, leading to the recognition of the biomechanical environment as important for prevention and the development of active plating techniques. Emphasis for the surgical treatment of distal femur fractures has incrementally progressed over time, with initial focus on complete stabilization of the fracture while the biological environment surrounding the fracture was ignored. Techniques slowly evolved to minimize soft tissue disruption, allow more ease of implant placement at the fracture site, and attend to the systemic health of the patient, while simultaneously ensuring appropriate fracture fixation. Through this dynamic process, the desired results of complete fracture healing and maximization of functional outcomes have emerged.

The Comparison of Dynamic Condylar Screw Plate to Proximal Femoral Nail in Reverse Oblique and Transverse Intertrochanteric Fractures: A Retrospective Study on 61 Patients.

Reverse oblique (RO) and transverse intertrochanteric fracture patterns constitute a challenge for the operating surgeon. Currently, no gold standard fixation method exists. This study aimed to retrospectively compare proximal femoral nail (PFN) to dynamic condylar screw (DCS) plating in the treatment of RO and transverse intertrochanteric fractures. A total of 61 patients fixated by PFN or DCS were included. Of these, 36 were treated with PFN (21 females and 15 males; mean age: 65.52 years), and 25 were treated with DCS (12 females and 13 males; mean age: 59.36 years). The mean follow-up time was 33.8 and 42.6 months (range: 24-108). Radiological evaluation included the quality of fracture reduction, neck-shaft angle change, posteromedial support presence, and bone union time. Complications such as mechanical failure, nonunion, and infection were noted. The only significant differences between the fixation methods were the superiority of DCS over PFN in earlier fracture union time (mean values: 8.9 versus14.1 weeks) and the superiority (p=0.007) of PFN in shorter hospital stay (3.4 days versus5.1 days). No significant difference was observed in radiological parameters. While similar mechanical complication rates were found, a significantly higher nonunion rate was detected with the DCS. The most crucial disadvantage of DCS was the high rate of nonunion. Closed fracture reduction in PFN seems to be the most critical parameter to prevent severe complications. The open reduction using DCS showed no advantages over closed reduction and PFN fixation in providing a more anatomical alignment in AO/Orthopaedic Trauma Association (OTA) 31-A3 fractures. However, we recommend PFN application in this type of fracture, since nonunion is more common in DCS.

Comparative Study of Functional and Radiological Outcome of Pertrochanteric Fracture Fixation by Proximal Femoral Nail Antirotation 2 and Old Proximal Femoral Nail

Abstract Context: Pertrochanteric fractures include the fractures in the region which extend from the extracapsular basilar neck region to the region along the lesser trochanter of femur. Pertrochanteric femur fracture accounts for the most common hip fracture. Most of pertrochanteric fractures, in younger as well as in the elderly patients, are unstable and slightly or partially displaced and require operative intervention. There are different types of fixation for pertrochanteric femur fracture such as proximal femoral nail (PFN), proximal femoral nail antirotation-2 (PFNA-2), Dynamic hip screw (DHS), Dynamic condylar screw (DCS), and angled blade plate. The PFNA-2 has been introduced to reduce implant-related complications, operative time, and intraoperative blood loss, especially in elderly osteoporotic individuals. This study was done with the belief that unstable pertrochanteric fractures can be better reconstructed with PFNA-2 designed specifically for the Asian population than with PFN and thereby enhance the functional outcome. Materials and Methods: A total of 40 patients were selected randomly. The fracture pattern included for the study was pertrochanteric fracture of the femur. The selection was based on performed inclusion and exclusion criteria. The functional outcomes and clinical results of the patients were evaluated and graded using the Harris hip score. Statistical Analysis Used: Statistical package for the social sciences software version 22.0 (IBM software package) was used for statistical analysis. Results: In our study, there were 20 (50%) patients who were treated with PFN and 20 (50%) were treated PFN-A2. The mean age in the PFN group was 43.90 ± 16.88 years and in the PFNA-2 group was 47.80 ± 17.25 years. In the PFNA-2 group, the average time of surgery was 67.00 min, and with PFN, the average time of surgery was 90.25 min. Mean intraoperative blood loss, in the PFNA-2 group was 68.25 ± 5.20 mL and in the PFN Group, it was 86.50 ± 10.37 mL. The group with PFN-A2 had a better hip score when compared with the PFN group. The complication rates were significantly lower in the PFN-A2 group. Conclusions: The newer alternative PFNA-2 was found to be much better than PFN in terms of lesser surgical time, small incision resulting in lesser blood loss, lesser number of image intensifier shoots, lesser duration of surgery, and advantage of compression mechanism at fracture site and lesser chances of biomechanical failure compared to PFN.

Outcomes of Dynamic Condylar Screw Fixation in Subtrochanteric Femoral Fractures

Aim: To determine the union rate in subtrochanteric femoral fractures fixed with dynamic condylar screw system. Study Design: Descriptive study Place and duration of study: This study was conducted in the Department of Orthopaedic Surgery, Shaikh Zayed Hospital, Lahore from June 2019 to December 2021. Methodology: This study included 100 patients with subtrochanteric femoral fractures. Sampling was done with the consecutive sampling technique. Male and female patients were included in this study. The A.O classification was used to classify all the fractures. After 8 weeks, the fracture union was evaluated, and the results (in terms of yes/no) were documented on a pre-designed proforma. Results: This study included 100 patients with subtrochanteric femoral fractures. The patients' average age was 39.56±15.125 years, and the average duration of fracture was 4.10±1.973 days. There were fifty nine female patients (59%), and forty one male patients (41%). Type A fractures were reported in 19(19%) patients, type B in 48 (48%) patients, and type C in 33 (33%). Fracture union was reported in 79 (79%) of the 100 cases. Dynamic condylar screw is regarded as a very good implant for subtrochanteric fractures due to numerous advantages such as ease of availability, stable fixation, increased strength, resistance to stress failure and reduced surgical time. However, the union rate in our local population was not known prior to our research. Therefore, the purpose of this study is to find the union rates in subtrochanteric femoral fractures fixed with dynamic condylar screw. Conclusion: The results of this study revealed an increased union rate in patients with subtrochanteric femoral fractures fixed with DCS (dynamic condylar screw system). There was a significant relationship between patient age, fracture duration, and fracture type. Keywords: Subtrochanteric Femoral Fractures, Internal Fixation, Dynamic Condylar Screw.

Fracture supracondylar femur treated with various modalities of treatment-an exploratory study

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Present study looked at functional outcomes and rate of complications in cases of adult supracondylar-intercondylar femur fractures treated with different treatment modalities at a tertiary care government hospital.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study was conducted over 2 years wherein 23 patients with fracture in intercondylar-supracondylar region were included. The different implants and surgical techniques used in the study were: Condylar blade plate, dynamic condylar screw (DCS) with side plate, buttress plate single, supracondylar nail technique and TARPO technique. Neer’s criteria was used to compare functional outcome with different modalities of treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Eight out of 11 patients treated using DCS with side plate-showed excellent results as per Neer’s criteria. Excellent results were observed in 3 out of 4 fractures fixed with GSH supra-condylar nail, 3 out of 3 in those fixed with TARPO technique, 0 out of 3 in patients managed using buttress plate and 1 out of 2 patients treated with blade plate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Closed method of reduction followed by internal fixation (TARPO technique and GSH nail) is better than open reduction (Buttress plate, DCS with side plate and condylar blade plate) for the management of fracture supracondylar femur. DCS with side plate by open method is at par with GSH nail and TARPO technique for knee ROM and rate of complications. It is recommended that, the Neer’s criteria should not be utilised in isolation for the purpose of comparing outcomes in cases of fracture supracondylar femur.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Management of proximal femur varum deformity in skeletal dysplasia: an illustrative case report

&lt;p&gt;Metaphyseal chondrodysplasia is skeletal dysplasia involving long tubular bones at metaphyseal regions, sparing the epiphysis, predominantly involving lower limbs, hence hindering normal mobilization activity of the individual. Individuals present with pain and deformity due to pathological fracture at the deformity site which necessitates deformity correction and surgical fixation. This is a case of skeletal metaphyseal dysplasia in 47-year female, short statured with bilateral proximal femoral Vara with pathological fracture, treated with deformity correction, surgical fixation. Patient initially presented at 36 years of age with sudden onset left hip pain. She was diagnosed with left femoral neck fracture and coxa Vara deformity. The femoral neck had spontaneously fractured due to increased bending forces acting on the femoral neck due to the coxa Vara deformity. She underwent valgus osteotomy with dynamic hip screw fixation. Further advised for prophylactic corrective osteotomy of contralateral proximal femur however patient was lost to follow-up. At 47 years she presented with pain in the right thigh. She was diagnosed to have right proximal femur pathological fracture due to progressive femur varus deformity for which she underwent right proximal femur valgus closing wedge subtrochanteric osteotomy and fixation using dynamic condylar screw. In our case left proximal femur which was operated did not have any complications. However, right proximal femur which was operated, at four months follow-up revealed no complications except for the foot drop which she developed post-surgery. Hence main aim of the study is to prove that the early prophylactic surgical management of the Vara help to provide successful outcomes.&lt;/p&gt;

Failure of Distal Femoral Locking Plate: Case Report

The Less Invasive Stabilization System (LISS) and titanium distal femoral locking compression plate (DF-LCP) was designed by the AO Group to combine the advantages of both interlocked intra-medullary nailing and biological plating techniques in one system. The stiffness of the construct is similar to a 95° condylar plate, dynamic condylar screw, or condylar buttress plate.&#x0D; We report a case of the DF-LCP and screw breakage. Early weight bearing and lack of callus consolidation precipitated failure of the implant. Non-weight bearing and early autologous bone grafting may be indicated in open distal femoral fractures.