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.

CONCLUSION

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.