The use of a dynamic condylar screw and biological reduction techniques for subtrochanteric femur fracture.

A study was designed to examine the outcomes of patients with closed comminuted subtrochanteric femoral fractures fixed with a dynamic condylar screw (DCS) and using biological (indirect) reduction techniques at a tertiary referral centre.Thirty-one consecutive patients with a mean age of 32.6 years, who sustained subtrochanteric femoral fractures, were treated with this method. Twenty-seven cases (87.2%) sustained these fractures either from traffic crashes or falls from height and the remaining four had a simple fall. Average follow-up was 3 years (range 14-65 months). Patients were assessed clinically and radiographically with regards to fracture classification, operating time, blood loss, time of union, malunion and other complications. Union was achieved in all cases (100%), with full-weight bearing after an average of 4.9 months. The average operating time was 2h and blood loss averaged 430 ml. There was only one case of superficial infection, which settled with local debridement and antibiotics. Malunion was seen in 2 cases out of 31 (6.4%) without the need for further surgery. In conclusion, use of biological (indirect) reduction techniques instead of anatomic, open reduction has proven to be successful, especially in comminuted subtrochanteric fractures. The early appearance of callus avoids the need for primary cancellous bone grafting, emphasising the importance of preserving biology of the fracture fragments.