Techniques of extramedullary osteosynthesis in proximal femoral fractures

Plate osteosynthesis at the proximal femur is possible for intertrochanteri c and subtrochanteric femoral fractures. Common implants are the dynamic hi p screw (DHS), the dynamic condylar screw (DCS) and the condylar blade plat e. The dynamic hip screw is mainly used in introchanteric femoral fractures , whereas the other two devices are suitable for stabilizing subtrochanteri c fractures. Those extramedullary implants compete with several intramedull ary nailing systems. Because of less soft tissue compromise the nailing sys tems have been favored by many surgeons during the last decade. This is par ticularly true for the subtrochanteric area where intramedullary devices of fer higher primary stability, allowing initial full weight bearing. A good indication for the extramedullary technique with a two-hole dynamic hip scr ew is the stable intertrochanteric fracture with an intact lesser trochante r. The other fracture types of the proximal femur in the intertrochanteric and subtrochanteric area are better treated with intramedullary devices. Th e remaining indications for the dynamic condylar screw and the condylar bla de plate are correction osteotomies and some salvage procedures.