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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
104° SPLLOT CONGRESS
Proximal femur fractures in the elderly: New “Fast and up” strategies
Hip arthroplasty: state of the art
Genoa, November 30 - December 1, 2007
Minerva Ortopedica e Traumatologica 2007 December;58(6):589-94
The nail-screw DCS treatment in perthrocanteric and subthrocanteric fractures
Lazzara D., Petrini A.
UO Ortopedia e Traumatologia Nuovo Ospedale S.Giovanni di Dio Azienda Sanitaria Firenze, Firenze, Italia
Aim. Introduced by the AO/ASIF in the early 1980s, the Dynamic Condylar Screw system (DCS, Synthes, USA) was developed for the treatment of supracondyloid fractures and later for unstable complex fractures of the proximal femur.
Methods. Twenty-five DCS were implanted in patients aged 74.5 years (mean age) at our Department between 2003 and 2006. In 17 cases the operation was performed for fresh fractures and in 8 for failed osteosynthesis. All patients underwent clinical and radiographic examination before and after the operation, and then every 40 days until clinical and radiographic demonstration of healing. The fractures were classified by AO and Seinsheimer criteria.
Results. Twenty-one (84%) patients healed without complications.
Conclusion. The DCS system may be considered a valuable option for treating complex fractures of the proximal femur. In expert hands, minimally invasive osteosynthesis may also be carried out by applying a sliding plate, thus reducing operating time, tissue exposure (bleeding), deperiostization and need for bone grafting, especially in severely comminuted fractures. Fundamental factors in proper healing are gradual functional recovery (loading) depending on bone quality, medial wall strength, and comminution of the focus. However, this is often not possible with patients in advanced age and frail general condition (mental and organic), who are subsequently more likely to experience delayed consolidation or failed bone synthesis than younger patients, at least in our clinical experience.