The scope and importance of hip fractures is almost incomprehensible. With a world wide incidence of close to 2 million cases per year, these fractures pose a daunting challenge to our ability to ...affect and treat this epidemic. Basics for operative treatment of proximal and distal femur fractures: Clear surgical indication, short planning and preparation < 24 h, full weight bearing osteosynthesis, early mobilisation and physiotherapy. In comprehensive form the book presents the usage of a meanwhile well installed implant (DMS) for osteosynthesis technique in the peritrochanteric region. The 'double dynamic' stabilization (sliding tongue principle and angle adapted contoured fit) means a state of the art fracture treatment procedure. It is a convincing alternative to achieve a biological osteosynthesis at the femur. The system includes an infinitely adjustable, flexible angle, dynamic plate with a tubular distal part.
The aim of this study was to determine whether the fixation device known as the dynamic Martin screw (DMS) offers a reasonable alternative for stabilizing intracapsular femoral neck fractures.
A ...total of 63 patients with intracapsular femoral neck fractures, stabilized between 1993 and 1997 with the DMS, were followed up in this retrospective study in both 1999 and 2002. The patients were on average 64 years of age, with 30 younger and 33 older than 65. The main outcome measurements consisted of union, non-union, aseptic osteonecrosis of the femoral head and implant failure.
We determined an overall osteonecrosis rate of 19% (12 of 63) for our patient group after an observation period on average of 83 months. The osteonecrosis rate for undisplaced fractures was 13.2% (5 of 38), and 28% (7 of 25) for displaced fractures. Non-union occurred in 4.8% (3 of 63) and union in 95.2% (60 of 63) of the patient cases. An implant-associated complication involving deep infection occurred in one case, but no example of implant breakage was recorded.
As a method for stabilizing intracapsular femoral neck fractures, the DMS provides treatment results comparable to other sliding hip screws or cannulated screw.
Closing remarks Dittel, K. -K.
The Double Dynamic Martin Screw (DMS),
2008
Book Chapter
Since the first implantation of a Dynamic Martin Screw (DMS) on the 15th of November 1992 (70 years old female with a combined inter- and subtrochanteric femur fracture) the implant has started its ...worldwide success.
In the last 2000 years, life expectancy has increased from 25 years to about 80 years. The changing worldwide age demographics have led to an inordinate increase of proximal femur fractures (in ...addition to other fractures). Approximately 150.000 inhabitants of Germany over 65 years of age suffer from fractures at the hip joint requiring acute surgery every year. Besides the difficulties involved in treating such fractures adequately as well as the increase in the number of cases we are now seeing makes it a tremendous challenge to provide the highest quality of surgical care. Frequent concomitant and complicating conditions in hip fracture patients include advanced age, pronounced osteoporosis and multiple morbidity. Fracture type and subsequent selection of stabilization method and implant are only some of the factors that relate to outcomes and complications. In addition to technical considerations, there is enormous economic impact and a requirement for coordination of peri-operative and post-operative care given in order to improve the rate of successful results (Fig. 1.1).
The surgeon can notice severe arthrotic changes of the articulating surfaces of the hip joint during the osteosynthesis procedure. Facing a fracture of the proximal femur the surgeon should as first ...treat the fracture, then wait until its bony consolidation afterwards he has to decide what to do to cure the arthrotic hip. Normally the implant should be completely removed after a period of 12 months when a solidly fracture healing can be found and a so-called conventional hip prosthesis (cemented or cementless) has to be implanted. All these femoral components are fixed in the intramedullary cavity of the proximal femur. In a lot of cases when the DMS or a similar device is removed a well incorporated plate and a stable connection between the plate and the bone is found. This frequent intraoperative observation led to the idea to leave this bone-implant connection untouched, to remove only the lag screw and place the DMP over it thus resulting a total hip replacement with an extramedullary fixation of the femoral part of the prosthesis.
Operative procedure Rapp, M.; Dittel, K. -K.
The Double Dynamic Martin Screw (DMS),
2008
Book Chapter
The osteosynthetic supply potentials with the DMS are not restricted to the traditional indicative areas in the pertrochanteric region. Within the framework of the standard indications, all ...intertrochanteric femur fractures (type 31 A 1.1-3 and 32 A 2.1-3) can be ideally treated by means of the DMS. After the application of the supporting screw, the valgisation angle can be adjusted to the required angular degree according to the specific requirements of each patient with an intact lateral corticalis by the means of an adjustable worm gear. Thus additional infractions and fractures in the trochanteric or subtrochanteric area can be avoided.
