Publication:

Dynamic condylar screw versus supacondylar nail in the management of supracondylar fracture distal femur

Background Supracondylar femoral fracture poses a considerable therapeutic challenge. Operative treatment has become a standardized procedure. Stabilization has usually been achieved by an osteosynthesis with Dynamic condylar screws or retrograde supracondylar nailing. In this article we are going to compare the results of surgical management of supracondylar nail and dynamic condylar screw.

Methods Prospective study of forty two patients who underwent surgical management for supracondylar fracture of femur between Jan 2011 and Jan 2015. 22 patients underwent retrograde supracondylar nailing and 20 patients underwent DCS fixation. The inclusion criteria were AO type A, C1 and C2 and Gustilo & Anderson Grade I to III B distal femur supracondylar fracture. The exclusion criteria were Patients younger than 19 years, AO type B/C3 and Gustilo & Anderson Grade IIIC. The average age of our patients was 42years. Patients were assessed using Sanders et al scoring systemResults: Patients with supracondylar fracture of femur have a good functional outcome following operative treatment. 15 patients (83.3%) treated with DCS had excellent to good functional outcome. 16 patients (80%) treated with retrograde nailing had excellent to good functional outcome.

Conclusions Dynamic condylar screw with plate fixation and retrograde supracondylar nailing provide good functional outcome in supracondylar fracture of femur.  However in intra articular fractures of distal femur (Type C1 & C2), DCS with plate provides for better functional outcome compared to supracondylar nail. In extra articular fractures of distal femur (Type A), no significant difference in functional outcome was noticed between the patients treated with DCS & supracondylar nail.  However, in view of minimal blood loss & soft tissue dissection required, supracondylar nailing may be a better option in the treatment of extra articular fractures of distal femur.