Abstract: Introduction: The absolute majority of the trochanteric and subtrochanteric hip fracture patients are fragile patients with a tendency to fall and an increased risk of major morbidity and mortality. It is important to provide adequate management to these patients and the treatment of choice is normally surgical with internal fixation. The surgical options for these fractures commonly include plating with sliding hip screw or intramedullary nailing, with nailing today being the predominant procedure in many parts of the world. The rationale of operative treatment of subtrochanteric fracture should be to obtain adequate reduction, achieve stability and to provide adequate fracture fixation. The final aim of treatment remains early union in anatomical position with early, active, pain free mobilization and the patient returning to his routine activitiesat the earliest. During the last century several implants have been tried to treat these fracturessurgically. The very fact that several implants have been tried proves that no one implant is found suitable in all cases. Extramedullary implants like Dynamic HipScrew and Dynamic Condylar Screw were used to fix the fracture. Dynamic Hip Screw often fails to prevent lateral drift of the proximal fragment which leads to implant failure. Dynamic Condylar screw provides better stability because of the fixation of proximal fragment with an additional screw in the calcar region, it also facilitates vertical load transmission.The dynamic condylar screw (an extra medullaryimplant) which exerts vertical forces on weight bearing is a better option as it provides strong fixation in the cancellous bone of the neck and head with considerable rotational stability.
Material and Methods: We evaluated the functional outcome of subtrochanteric fractures treated with Dynamic Condylar Screw in 12 patients from October 2015 to September 2017 at Kamineni Institute of Medical Sciences in a prospective study.
Results: Mean age of the patients in the was 58.9 years. Mode of injury - 75% (9) patients sustained injury due to road traffic accidents and 25% (3) patients sustained injury due to fall.66.67% (8) patients were males and 33.33% (4) patients were females.
There was almost an equal distribution in regards to side of injury. Average radiological union duration was 17 weeks. Duration of follow up was 6months.8.33% (1) patient had superficial infection.8.33% (1) patient had lag screw cut through for which secondary procedure was done. Modified Harries Hip score at the end of the follow up was 58.34% (7) patients with excellent score, 33.33% (4) patients with good score and 8.33% (1) patient had poor score.
Conclusion: Subtrochanteric fractures of the Femur pose a challenge to the surgeon in the view of its peculiarities of anatomy, biomechanical forces acting across the fracture site and technical difficulties of reduction and application of a suitable implant. Many implants both Intramedullary and Extramedullary have been tried by various surgeons in different time periods with varying results. In this study Dynamic Condylar Screw and plate for selected patients and results were compared with other available references. DCS is a good implant when applied in a correct manner and yields good results in terms of fracture healing with minimal complications.
