Dynamic Condylar Screw Plate Specification, Uses, Sizes and Surgical Techniques

Dynamic Condylar Screw Plate is designed to provide strong and stable internal fixation of certain distal femoral and subtrochanteric fractures, with minimal soft tissue irritation.

Dynamic Condylar Screw Plate

Dynamic Condylar Screw Plate Specification

  • Plates are made of 316L stainless steel and Titanium.
  • The Dynamic Condylar Screw Plate are available with 6, 7, 8, 10, 12, 14, 16, 18, and 20 holes, for varied clinical situations.
  • The number of screw holes per plate length is maximized, without compromising plate strength. This allows an increased number of fixation points with a smaller incision.
  • The two holes closest to the barrel accept 6.5 mm cancellous bone screws. This enhances stability by allowing additional fixation of the most distal condylar fracture fragments or fixation of the most proximal subtrochanteric fracture fragments.
  • Screw holes in the plate shaft allow angulation of 4.5 mm cortex screws and axial compression across a shaft fracture.
  • The lag screw is available in 50 mm to 145 mm lengths. The  compression screw can be used for additional compression; only one size compression screw is needed.
  • Two flats within the plate barrel correspond to the two-flat design of the lag screw, preventing rotation of the lag screw within the barrel. The two-flat design also eases insertion of the plate over the  lag screw.
  • The plates have a low-profile design, reducing the risk of iliotibial band irritation (distal femoral fractures) and trochanteric bursitis (subtrochanteric fractures).
  • The Dynamic Condylar Screw Plate instruments also provide direct measurements throughout the procedure, allowing proper reaming, tapping, and lag screw insertion depth. The built-in stop and locking nut on the triple reamer prevent over-reaming.
  • General Instruments are available for this plate such as Plate Bending Press, Plate Holding Forceps, Plate Bending Pliers, Bone Holding Forceps, Bone Elevators, Bone Cutter, Bone Nibbler, Depth Gauge, Sleeve, Screw Driver, Trocar Sleeve etc.

Dynamic Condylar Screw Plate Uses

The Dynamic Condylar Screw Plate Plate is indicated for the following fractures of the proximal distal:

  • Intercondylar fractures
  • Supracondylar fractures
  • Unicondylar fractures

The Dynamic Condylar Screw Plate Plate is indicated for the following fractures of the proximal femur:

  • Transverse subtrochanteric fractures
  • Short oblique subtrochanteric fractures
  • Long oblique subtrochanteric fractures

Dynamic Condylar Screw Plate Uses

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Dynamic Condylar Screw Plate Surgical Technique

1. Position patient

Place the patient in a supine position on a normal radiolucent operating table such that the knee can be flexed through 90°.

2. Access

Access is via a 15–20 cm incision along the connecting line between the greater trochanter, the lateral femoral condyle and the tibial tuberosity.

3. Reduce articular fracture component

Temporary fixation with Kirschner wires, which are subsequently replaced by lag screws. The position of these screws must not hamper the insertion of the screw.

Determine entry point for the screw and insert guide wire
The entry point for the screw is on the femoral shaft axis approx. 2 cm from the knee joint. Using two Kirschner wires determine the correct alignment of the screw.
– The first Kirschner wire in the frontal plane marks the orientation of the knee joint cavity at the level of the condyles.
– Insert the second Kirschner wire ventrally over the lateral and medial condyles to demonstrate the incline of the femoropatellar joint surface.
– Insert the Guide Wire 2.5 mm at the predetermined entry point such that it runs parallel both to the first Kirschner wire in a.p. view and to the second, ventrally located wire in the axial view. Insert the guide wire until the medial cortex is reached.

4. Remove the Kirschner wires.

Determine entry point in the proximal femur Using the Condylar Plate Guide, determine the correct alignment of the guide wire. The entry point is located at the transition from the ventral third to the mid-third of the greater trochanter, since the guide wire in the femoral neck – in relation to the Lauenstein projection – must be inserted in the centre. Determine the 95° alignment to the axis of the femoral shaft using the Angled Guide or the Condylar Plate Guide.

5. Measure the length of the guide wire

Slide the Direct Measuring Device over the guide wire and determine the length.

6. Reaming

Adjust the reaming depth on the Triple Reamer. The appropriate reaming depth is 10 mm shorter than the measured length of the guide wire. Assemble the triple reamer: Slide the Reamer over the Drill Bit 8.0 mm until it clicks into place at the selected mark. Secure the reamer by tightening the Knurled Nut. Ream down to the stop. The appropriate screw is 5 mm shorter than the reaming depth. Remove the triple reamer.

Option: If the bone is hard, tap the thread using the Tap and the short Centering Sleeve. Tap the thread until the selected depth in the small window of the centering sleeve reaches the lateral cortex.

7. Insert the screw

Slide the insertion instruments over the guide wire and advance the long Centering Sleeve into the drilled hole. Insert the screw until the 5 mm mark reaches the lateral cortex. In case of osteoporotic bone continue inserting the screw for a further 5 mm. The handle of the wrench must remain parallel to the femoral axis since only in this screw position can the Dynamic Condylar Screw plate be positioned correctly over the flat-sided shaft of the screw against the femoral shaft.

Note: Do not use the wrench to reduce the fracture as this only allows limited transmission of forces. Remove the wrench and long centering sleeve.

8. Position Dynamic Condylar Screw plate

Position the Dynamic Condylar Screw Plate over the connecting screw against the femoral shaft. Loosen the connecting screw and remove the Guide Shaft. Set the drill to reverse operation to remove the guide wire. Dispose of the guide wire.

9. Tap the plate

Tap the plate into the predrilled channel using the Impactor. Compress the fracture by gentle hammer taps against the impactor.

10. Achieve compression using cancellous bone screws 6.5 mm

Secure the two joint fragments of the Y-fracture by interfragmental fixation using two cancellous bone screws 6.5 mm through the two distal plate holes (use the Drill Guide 4.5, the Drill Bit 3.2 mm and the Tap according to the standard technique).

11. Insert compression screw

In Y-fractures, compression must be achieved using the Compression Screw. First fix the plate to the femoral shaft with screws. Insert and tighten the compression screw. Particularly if the bone is osteoporotic, insert the compression screw carefully and ensure that the screw thread is not stripped.

12. Reduce metaphyseal fracture component

Reducing the shaft fragment against the plate can achieve an anatomically correct reduction in respect of varus/valgus deviations. The length and rotation must be adapted by comparing the contralateral side.

13. Fix Dynamic Condylar Screw plate

Using the Drill Guide 4.5 and the Drill Bit 3.2 mm, drill neutral holes through the plate holes. Fix the plate using cortex screws 4.5 mm of the appropriate length.
Note: With simple fractures, before fixing the plate, axial compression can be generated between the distal joint block and the shaft fragment using the Tension Device.
Insert the short Connecting Screw in the Guide Shaft and screw into the inner thread of the screw. The cam and slot must interlock correctly and firmly. Slide the long Centering Sleeve over the Wrench. Insert the whole assembly into the wrench.

Dynamic Condylar Screw Plate Contraindications

Contraindications may be qualified or total, and need to be taken into consideration when evaluating the prognosis in each case. The physician’s education, training and professional judgement must be relied upon to choose the most appropriate device and treatment. Conditions presenting an increased risk of failure include:

  • Any active or suspected latent infection or marked local inflammation in or about the affected area.
  • Compromised vascularity that would inhibit adequate blood supply to the fracture or the operative site.
  • Bone stock compromised by disease, infection or prior implantation that can not provide adequate support and/or fixation of the devices.
  • Material sensitivity, documented or suspected.
  • Obesity. An overweight or obese patient can produce loads on the implant that can lead to failure of the fixation of the device or to
    failure of the device itself.
  • Patients having inadequate tissue coverage over the operative site.
  • Implant utilization that would interfere with anatomical structures or physiological performance.
  • Any mental or neuromuscular disorder which would create an unacceptable risk of fixation failure or complications in postoperative care.
  • Other medical or surgical conditions which would preclude the potential benefit of surgery.
  • All associated diseases which could endanger the function and success of the Dynamic Condylar Screw Plate.

Warnings and Precautionary for Dynamic Condylar Screw Plate

Before using Dynamic Condylar Screw Plate, the surgeon and ancillary staff should study the safety information in these instructions, as well as any product-specific information in the product description, surgical procedures and/or brochures.

Plate is made from medical grade materials and are designed, constructed and produced with utmost care. These quality Plate assure best working results provided they are used in the proper manner. Therefore, the following instructions for use and safety recommendations must be observed.

Improper use of  implants can lead to damage to the tissue, premature wear, destruction of the instruments and injury to the operator, patients or other persons.

It is vital for the operating surgeon to take an active role in the medical management of their patients. The surgeon should thoroughly understand all aspects of the surgical procedure and instruments including their limitations. Care in appropriate selection and proper use of surgical instruments is the responsibility of the surgeon and the surgical team. Adequate surgical training should be completed before use of Dynamic Condylar Screw Plate.

Factors which could impair the success of the operation:

  • Allergies to implanted materials.
  • Localized bone tumours.
  • Osteoporosis or osteomalacia.
  • System disease and metabolic disturbances.
  • Alcohol and drug abuse.
  • Physical activities involving excessive shocks, whereby the implant is exposed to blows and/or excessive loading.
  • Patients who are mentally unable to understand and comply with the doctor’s instructions.
  • Poor general health.

Possible Adverse Effects

The following adverse effects are the most common resulting from implantation:

  • Loosening of the implant, which may result from cyclic loading of the fixation site and/or tissue reaction of the implant.
  • Early and late infection.
  • Further bone fracture resulting from unusual stress or weakened bone substance.
  • Temporary or chronic neural damage resulting from pressure or hematomata.
  • Wound hematomas and delayed wound healing.
  • Vascular disease including venal thrombosis, pulmonary embolism and cardiac arrest.
  • Heterotopic ossification.
  • Pain and discomfort due to presence of the implants.
  • Mechanical failure of the implant, including bending, loosening or breakage.
  • Migration of implant resulting in injury.

Preoperative Planning for Dynamic Condylar Screw Plate

The operating planning is carried out following a thorough clinical evaluation of the patient, Also, x-rays must be taken to allow a clear indication of the bony anatomy and associated deformities. At the time of the operation, the corresponding implantation instruments in addition to a complete set of Dynamic Condylar Screw Plate must be available.

The clinician should discuss with the patient the possible risks and complications associated with the use of implant. It is important to determine pre-operatively whether the patient is allergic to any of the implant materials. Also, the patient needs to be informed that the performance of the device cannot be guaranteed as complications can affect the life expectancy of the device.

Dynamic Condylar Screw Plate Precautions

  • Confirm functionality of instruments and check for wear during reprocessing. Replace worn or damaged instruments prior to use.
  • It is recommended to use the instruments identified for this screw.
  • Handle devices with care and dispose worn bone cutting instruments in a sharps container.
  • Always irrigate and apply suction for removal of debris potentially generated during implantation or removal.

Dynamic Condylar Screw Plate Warnings

  • Dynamic Condylar Screw Plate can break during use (when subjected to excessive forces). While the surgeon must make the final decision on removal of the broken part based on associated risk in doing so, we recommend that whenever possible and practical for the individual patient, the broken part should be removed. Be aware that implants are not as strong as native bone. Implants subjected to substantial loads may fail.
  • Instruments, screws and cut plates may have sharp edges or moving joints that may pinch or tear user’s glove or skin.
  • Take care to remove all fragments that are not fixated during the surgery.
  • While the surgeon must make the final decision on implant removal, we recommend that whenever possible and practical for the individual patient, fixation devices should be removed once their service as an aid to healing is accomplished. Implant removal should be followed by adequate post-operative management to avoid refracture.

Dynamic Condylar Screw Plate General Adverse Events

As with all major surgical procedures, risks, side effects and adverse events can occur. While many possible reactions may occur, some of the most common include: Problems resulting from anesthesia and patient positioning (e.g. nausea, vomiting, dental injuries, neurological impairments, etc.), thrombosis, embolism, infection, nerve and/or tooth root damage or injury of other critical structures including blood vessels, excessive bleeding, damage to soft tissues incl. swelling, abnormal scar formation, functional impairment of the musculoskeletal system, pain, discomfort or abnormal sensation due to the presence of the device, allergy or hypersensitivity reactions, side effects associated with hardware prominence, loosening, bending, or breakage of the device, mal-union, non-union or delayed union which may lead to breakage of
the implant, reoperation.