The dynamic condylar screw in the management of subtrochanteric fractures: does judicious use of biological fixation enhance overall results?

Subtrochanteric fractures are fraught with certain anatomic, biologic and biomechanical challenges. Evolution of implants like the Gamma nail, fixed-angle nail plates, compression hip screws and dynamic hip screws with trochanteric stabilization plates underlines a persistent quest for a better implant. We studied the dynamic condylar screw DCS as an implant on a series of 30 consecutive patients with subtrochanteric fractures. Our purpose was to assess this implant as a panacea for subtrochanteric fractures. All cases of AO type A and B were anatomically fixed, whereas type C was biologically plated. The idea was to assess the applicability and adaptability of the DCS. Fractures in 29 cases united, with one patient suffering from an implant failure. There were 17 excellent, 5 good, 5 fair and 3 poor results. The DCS is a definite advance over previous methods of treatment; when combined with the utilization of biological fixation techniques for comminuted fractures, can be relied upon to treat all types of subtrochanteric fractures

In situ instrumented posterolateral fusion without decompression in symptomatic low-grade isthmic spondylolisthesis in adults

Forty patients with an average age of 26.5 years were treated for symptomatic low-grade isthmic spondylolisthesis with in situ instrumented posterolateral fusion. All patients had failed previous conservative treatment. Average follow-up was 42.2 months (range: 30–62 months). Low-back pain resolved in 70% of the patients, whereas 65% of those with radicular pain reported complete resolution of the symptoms. At the final follow-up 82.5% of the patients had improvement in their function. Solid fusion was achieved in 70% of the patients. It was uncertain in 10% and a fusion failure was seen in 20%. The anterior slippage as measured by the Taillard method was 31.55% and an average 35% correction was seen after surgery. However, an average 10% loss of correction was seen at the final evaluation. The clinical results were evaluated by Kim and Kim criteria. Satisfactory results were obtained in 65% of patients and this was closely associated with the rate of successful fusion. The results suggest that clinical outcome is closely related to the attainment of solid fusion and decompression or removal of the loose laminar fragment seems unnecessary in patients without major neurological symptoms