BACKGROUND: 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.
OBJECTIVE: To evaluate the treatment efficacy of dynamic condylar screws (DCS) and proximal femoral nails (PFN) for unstable intertrochanteric fractures.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.

UNASSIGNED: Fibrous dysplasia (FD) is a benign skeletal disorder characterized by the replacement of normal bone tissue with disorganized fibrous tissue. Fractures are a significant complication of FD, particularly in the proximal femur, where deformities such as Shepherd\'s crook deformity can increase the risk.
UNASSIGNED: We present a case study of a 44-year-old male with unilateral monostotic FD, Shepherd\'s crook deformity, and a pathological femoral shaft fracture. The initial surgical approach involved valgus osteotomy, dynamic condylar screw (DCS) fixation, and multiple osteotomies of the femoral shaft. However, the patient experienced a refracture and implant failure, necessitating a second surgical intervention with a double-angled DCS and additional fixation. Post-operative follow-up revealed successful bone union and deformity correction, although a limb length discrepancy was noted.
UNASSIGNED: This case highlights the challenges in managing FD-related fractures and the importance of addressing deformities and achieving optimal alignment. Individualized treatment approaches, careful implant selection, and post-operative rehabilitation are crucial for successful outcomes in FD-associated fractures.

The locking plate is a common device to treat distal femur fractures. Healing is affected by construct stiffness, thus many surgeon-controlled variables such as working length have been examined for their effects on strain at the fracture. No convenient analytical model which aids surgeons in determining working length has yet been described. We propose an analytical model and compare it to finite element analysis and cadaveric biomechanical testing.
First, an analytical model based on a cantilever beam equation was derived. Next, a finite element model was developed based on a CT scan of a \"fresh-frozen\" cadaveric femur. Third, biomechanical testing in single-leg stance loading was performed on the cadaver. In all methods, strain at the fracture was recorded. An ANCOVA test was conducted to compare the strains.
In all models, as the working length increased so did strain. For strain at the fracture, the shortest working length (35 mm) had a strain of 8% in the analytical model, 9% in the finite element model, and 7% for the cadaver. The longest working length (140 mm) demonstrated strain of 15% in the analytical model, and the finite element and biomechanical tests both demonstrated strain of 14%.
The strain predicted by the analytical model was consistent with the strain observed in both the finite element and biomechanical models. As demonstrated in existing literature, increasing the working length increases strain at the fracture site. Additional work is required to refine and establish validity and reliability of the analytical model.

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 75 kg-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.

OBJECTIVE: The purpose of this historical review is to illustrate the progression and evolution of treatment for distal femur fractures.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.

Trochanteric hip fractures have become very common with 35-40% of these fractures being unstable. Trochanteric fractures, especially unstable ones are associated with high rates of mortality and morbidity and thus remain an inordinate challenge for surgeon to treat these fractures with proper choice of implant. Aim of the study was to compare the proximal femoral nail and dynamic condylar screw in the management of unstable trochanteric fractures. Our study was a prospective comparative study which included 26 patients with fresh (≤3 weeks old) unstable trochanteric fractures AO 31A2 and AO 31A3, with age ≥18 years of both sexes. Eleven patients in DCS and fifteen patients in PFN were included. Harris hip score was used to compare functional outcomes. Average age of patients in DCS group was 59.82±11.59 years and PFN was 54.2±16.22 years. AO 31A2 fracture pattern (63.64%) was more common than AO 31A3 in DCS group and AO 31A3 fracture pattern (60.00%) was more common than AO 31A2 in PFN group. Mean operative time for DCS was 96.36±15.51 minutes and for PFN it was 79.67±12.02 minutes with P-value of 0.003. Two patients in DCS group and 1 patient in PFN group were lost to follow up. Two patients in DCS group and 1 patient in PFN group died. Seven out of 11 (63.64%) patients in DCS group and 13 out of 15 (86.60%) patients in PFN group were available for final follow up. Union seen in 2 (28.57%) patients with DCS and 12 (92.31%) patients fixed with PFN with P-value of 0.007. Mean HHS of 62.29±24.26 in DCS and 86.92±11.65 in PFN with P-value of 0.037. Patients with combined excellent and good HHS in DCS group and PFN group were 2 (28.57%) and 11 (84.62%) respectively. Non-union was seen in 5 (71.43%) patients fixed with DCS and 1 (7.69%) patient fixed with PFN. Implant failure was seen in 3 (42.86%) patients in DCS group in which barrel plate was broken in 2 (28.57%) patients and lag screw cut out through femoral head in 1 (14.29%) patient and 1 (7.69%) patient in PFN group due to varus collapse and complete backout of screw. Varus collapse was seen in 3 (42.86%) patients in DCS group and 4 (30.76%) patients in PFN group. Proximal femoral nail is better implant as compared to dynamic condylar screw which was statistically significant in terms of lesser operative time, higher union rate and better functional outcome. So PFN is a better implant choice for unstable trochanteric fractures when compared with DCS.

Background The optimal treatment modality and choice of implant for unstable peritrochanteric fractures is debatable, with multiple options ranging from intramedullary to extramedullary implants. The purpose of this study was to evaluate the radiological and functional outcomes of 95° dynamic condylar screws in unstable intertrochanteric fractures. Patients and methods This is a retrospective review of patients with unstable peritrochanteric fractures (31-A2 and A3 for Association for Osteosynthesis/Association for the Study of Internal Fixation (AO/ASIF) classification) who underwent open reduction and internal fixation with 95° dynamic condylar screw at Recep Tayyip Erdogan Hospital between 2014 and 2018. All the patients had a minimum of one year of follow-up. Clinical outcomes were measured in terms of time to full weight bearing, Harris Hip Score, and time to radiographic union. Results This study comprised 84 patients (including 56 males and 28 females with a mean age of 57.2 ± 9.7 years). The average time to full weight bearing was 4.2 months (range: three to six months). The radiological union was seen at a mean of 5.8 months (range: 4-11 months). Functional outcome in terms of Harris Hip Score was graded as excellent, good, fair, and poor in 18, 45, 16, and five patients, respectively. Implant failure was observed in three patients. One patient sustained a peri-prosthetic fracture, which was treated with a longer plate. Conclusion Dynamic condylar screw proves to be a reliable implant when used in unstable peritrochanteric fractures and results in satisfactory functional and radiological outcomes.

UNASSIGNED: the dynamic condylar screw (DCS) plate is an angular stable fixation (95°) system for distal femur fractures that allows for the ability to apply compression across the femoral condyles. The aim of this study was to evaluate our experience treating distal femur fractures with this device and give the long-term outcome.
UNASSIGNED: a retrospective study was undertaken in our institution during the period from January 2002 to December 2016. A total number of 240 patients with distal femur fractures were managed using DCS plate system and included in the study. The mean follow-up period was 33 months (26 - 62 months). Clinico-radiological progression of fracture union as well as the functional outcome was studied.
UNASSIGNED: most of the fractures were closed injuries in young male patients resulting from traffic accidents. The average time to union was 12.6 weeks (range 11 - 23). Eight patients (3.3%) suffered superficial infection. Five patients (2.1%) developed deep venous thrombosis. Delayed union was observed in nine cases (3.7%) and non union in six cases (2.5%). At final follow-up, the mean range of motion (ROM) of knee was 115.7° (100°-148°). The mean Knee Society Score (KSS) was 84.5 (59 - 94) and the mean Lysholm score was 88.6 (range, 61 - 96), translating to good clinical results.
UNASSIGNED: our study conclusively establishes that excellent functional outcome can be achieved with DCS plate inserted with skilled surgical technique in distal femur fractures including the ones that are communited or occurring in osteoporotic bone with a negligible complication rates.

BACKGROUND: Nonunions of trochanteric femoral fractures are uncommon due to a good blood supply of the cancellous bone of the trochanteric region. Nevertheless, if a nonunion occurs, complex revision procedures usually become necessary. The purpose of this study was to evaluate a series of aseptic trochanteric nonunions in patients aged 60 years or older, looking at outcomes regarding healing rate, implant-related complications and secondary surgeries.
METHODS: We conducted a retrospective chart review of patients with aseptic femoral trochanteric nonunions aged over 60 years. Nonunion treatment consisted of implant removal, debridement of the nonunion, and restoration of the neck shaft angle, followed by DCS plating. An additional 4.5-mm limited contact dynamic compression plate was placed in twelve patients anteriorly. The primary outcome measure was bony healing and time to healing in months. Secondary outcome measures included postoperative complications related to the index procedure, range of motion of the affected hip and postoperative mobility.
RESULTS: A total of 21 patients with a mean age of 69.1 years met the inclusion criteria. After a mean follow-up of 21.62 months, 17 of the 21 nonunions healed successfully. The mean healing time was 6.59 months. A total of six of the 21 patients needed secondary revision surgery. At the final follow-up, a full range of motion of the hip was seen in 17 of the 21 hips.
CONCLUSIONS: DCS treatment and preservation of the patient\'s femoral head can be successful for patients aged over 60 years with a well-preserved femoral head and acetabulum. However, preservation of the hip joint and revision plating might be associated with higher revision rates.

BACKGROUND: Nonunions of the subtrochanteric region of the femur after previous intramedullary nailing can be difficult to address. Implant failure and bone defects around the implant significantly complicate the therapy, and complex surgical procedures with implant removal, extensive debridement of the nonunion site, bone grafting and reosteosynthesis usually become necessary. The purpose of this study was to evaluate the records of a series of patients with subtrochanteric femoral nonunions who were treated with dynamic condylar screws (DCS) regarding their healing rate, subsequent revision surgeries and implant-related complications.
METHODS: We conducted a retrospective chart review of patients with aseptic femoral subtrochanteric nonunions after failed intramedullary nailing. Nonunion treatment consisted of nail removal, debridement of the nonunion, and restoration of the neck shaft angle (CCD), followed by DCS plating. Supplemental bone grafting was performed in all atrophic nonunions. All patients were followed for at least six months after DCS plating.
RESULTS: Between 2002 and 2017, we identified 40 patients with a mean age of 65.4 years (range 34-91 years) who met the inclusion criteria. At a mean follow-up period of 26.3 months (range 6-173), 37 of the 40 (92.5%) nonunions healed successfully (secondary procedures included). The mean healing time of the 37 patients was 11.63 months (± 12.4 months). A total of 13 of the 40 (32.5%) patients needed a secondary revision surgery; one patient had a persistent nonunion, nine patients had persistent nonunions leading to hardware failure, two patients had deep infections requiring revision surgery, and one patient had a peri-implant fracture due to low-energy trauma four days after the index surgery.
CONCLUSIONS: The results indicate that revision surgery of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screws is a reliable treatment option overall. However, secondary revision surgery may be indicated before final healing of the nonunion.