Dynamic condylar screws versus 95º angle blade plate fixation of subtrochantric fractures of femur

Abstract

Background: The purpose of this prospective randomized study was to evaluate the results of dynamic condylar screw (DCS) system and 95º angle blade plate fixation in the management of sub-trochanteric femoral fractures, regarding stability, union time, complication rate and functional out come.Methods: Total 30 consecutive patients with sub-trochanteric fracture were studied. The inclusion criteria were closed sub-trochanteric fractures in adults of both gender aged 18 years or above. Pathological fractures and open fractures were excluded from the study. After fixation of fractures with dynamic condylar screw system and 950 angle blade plate patients were followed up in OPD at an interval of 2 weeks till full weight bearing was started and then after at an interval of 4 weeks. Results of treatment were assessed by the Harris hip score for clinical and radiological assessment at the end of 6 months.Results: Among 30 studied cases, males were 22 (73.30%) and female 8 (26.70%). Most common mode of injury was road traffic accidents that occurred in 17 patients (56.70%) and the rest 13 patients had a history of fall. Patients were divided into two random groups (A &B) of 15 cases each. Group A was treated with DCS and Group B was treated with Angle Blade Plate 95º implants. Radiological union in most of the patients (13 out of 15 cases) treated with 95°angle blade plate occurred between 14-18 weeks, while in cases treated with dynamic condylar screw radiological union in most of the patients (14 out of 15) occurred between 12-16 weeks. According to Harris hip score, good to excellent results were achieved in 10 cases (66.66%) of 95°angle blade plate group and 14 cases (93.33%) of dynamic condylar screw group.Conclusions: Patients with sub-trochanteric fractures treated with dynamic condylar screw had earlier radiological union, better functional outcome, less complications and earlier weight bearing.

Is Dynamic Condylar Screw Better Than (95°) Blade Plate in Management of Subtrochanteric Fracture of Femur?

“…Similarly, Neher et al reported the duration as 108 min of surgery with 95°BP (8) . Also, in agreement with present study, Vashisht et al reported mean duration of surgery for DCS was 82.2 minutes (Range 72-90), mean duration of surgery for 95° BP was 104.47 minutes (Range 95-115) (9) . In present study, regarding blood loss intraoperatively in DCS about 365 cc, while in 95°BP about 440 cc, this due to large incision and more manipulation in BP group.…”

“…Current study found that the mean time of union is 15.75 weeks for group treated with DCS & 17.5 weeks for group treated with 95° BP, there were no significant statistical differences of the mean time union between groups (p value 0.07). This was agreed with Vashisht et al who reported that radiological union in most of the patients (14 out of 15 cases) treated with DCS plate occurred between 12-16 weeks, while in cases treated with 95°BP radiological union in most of the patients (13 out of 15) occurred between 14-18 weeks (9) . Rohilla et al showed that union in 16 weeks (11) , Neogi et al in 15.6 weeks (12) , Laghari et al in 16.5 weeks with DCS (13) .…”

“…this due to excessive manipulation and longer operative time in BP group. This is comparable to Vashisht et al who reported that infection occurred in one (6.67%) case of 95° BP group while none occurred in DCS group (9) . Current study found that the mean time of union is 15.75 weeks for group treated with DCS & 17.5 weeks for group treated with 95° BP, there were no significant statistical differences of the mean time union between groups (p value 0.07).…”

“…In present study, regarding blood loss intraoperatively in DCS about 365 cc, while in 95°BP about 440 cc, this due to large incision and more manipulation in BP group. This comparable to Vashisht et al who reported that average amount of blood loss was 380.33 cc (Range 320-420) in cases treated with 95°BP and 342.67 cc (Range 320-380) in cases treated with DCS (9) . Neher et al showed 418 cc of blood loss during surgery with 95°angle BP (8) , while Mousa reported 250 cc of blood loss during surgery with DCS (10) .…”

“…This study showed that the majority of patients 75% with DCS and 60% with 95° BP had a full weight bearing at 14 weeks. Vashisht et al reported full weight bearing was started at 12-18 weeks in most of the patients (14 out of 15 cases) treated with 95° BP, while in cases treated with DCS full weight bearing was started at 14-20 weeks in most of the patients (13 out of 15) (9) . In present study, functional outcome assessed based on modified Harris hip score, 30% of patients with DCS and 15% of patients with 95° BP showed excellent results.…”