The DCS is indicated for the following fractures of the proximal femur:

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

The design of the DCS Plate can enhance fixation of selected, stable subtrochanteric fractures because it permits stable fixation in the proximal fragment (3). The DCS Plate has a 95° barrel angle, allowing it to enter the femur more prox- imally than the DHS Plate and allowing insertion of two or more screws into the calcar. Further, its two round proximal plate holes permit insertion of 6.5 mm Cancellous Bone Screws, for stable proximal fixation.

• Stable transverse and short oblique subtrochanteric fractures.

When using the DCS Plate for these fractures, the plate can act as a tension band against normal medial com- pressive forces (4).

• Long oblique subtrochanteric fractures.

When using the 135° DHS Plate to treat long oblique subtrochanteric frac- tures, use of the proximal plate screws can prohibit com- pression. With the 95° DCS Plate, however, stable fixation can be achieved by lagging the fracture through the plate, since controlled collapse is not anticipated.

Note: When used in the proximal femur, the DCS Plate can only be used to treat stable fractures; i.e., fractures that can be directly reduced and anatomically reassembled to allow restoration of the bony medial buttress. Because the DCS Plate has a 95° barrel angle, it does not allow for controlled collapse and compression.

Preoperative Considerations

• Plate Selection

  Select the DCS Plate so there are four screws (eight cortices) distal to the fracture in hard diaphyseal bone, or five screws (ten cortices) in porotic bone.

• Insertion of the DHS/DCS Guide Pin

  Though the general insertion area of the guide pin is known, the precise insertion point varies with the CCD angle, or the angle subtended between the femoral neck and shaft axes. Assessment of the CCD angle will allow subse- quent placement of the lag screw in its optimal position-in the center of the femoral neck and in the inferior half of the femoral head. (See illustration below) This insertion point should be determined preoperatively with the aid of planning templates.

Click for enlarged view of image

(2) Roy Sanders and P. Regazzoni, "Treatment of Subtrochanteric Femur Fractures Using the Dynamic Condylar Screw" Journal of Orthopaedic Trauma vol. 3, no. 3 (New York: Raven Press, 1989) 211.

(4) ibid 212.