[Techniques of extramedullary osteosynthesis in proximal femoral fractures]

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