Bridge plate osteosynthesis using dynamic condylar screw (DCS) or retrograde intramedullary supracondylar nail (RIMSN) in the treatment of distal femoral fractures: comparison of two methods in a prospective randomized study.
BACKGROUND
The treatment of distal femoral fractures remains a significant surgical challenge. With the rigid fixation of the distal femoral fractures, bone grafting is frequently needed. Biological osteosynthesis using dynamic condylar screw (DCS) and retrograde intramedullary supracondylar nail (RIMSN) preserve the blood supply and limit the need for bone grafting.


METHODS
From September 2002 to December 2004, 68 closed fractures of the distal femur were treated by bridge plate osteosynthesis using DCS in 31 and RIMSN in 37. The patients were allocated to one of the two groups randomly and followed for 24-36 months (average: 30 months).


RESULTS
With respect to operation time, the DCS group presented significantly better results than the RIMSN group (p=0.000). However, the blood loss was significantly more in the DCS group (p=0.000). There were no significant differences in terms of cumulative rate of union (p=0.855), range of motion of the knee (p=0.727), overall results (p=0.925) and complications (p=0.927) between the two groups.


CONCLUSIONS
No implant or surgical technique is superior to any other under all circumstances for distal femoral fracture. RIMSN is standard care, yet the biological osteosynthesis using DCS is a very good alternative for the treatment of distal femoral fractures.
Department of Orthopaedics, Government Medical College Srinagar, University of Kashmir, Kashmir, India. drgndar@yahoo.co.in
Gh Nabi
GN
Dar
Shafaat Rashid
SR
Tak
Khursheed Ahmed
KA
Kangoo
Manzoor Ahmed
MA
Halwai
D000328:Adult; D000368:Aged; D001858:Bone Nails; D001860:Bone Plates; D001863:Bone Screws; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005269:Femur / Q000098:blood supply / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult