The Double Dynamic Martin Screw (DMS): Adjustable Implant System for Proximal and Distal Femur Fractures

185 Pages·2008·38.58 MB·English

by  Prof. K. -K. Dittel M.D. (auth.)

K.-K. Dittel (cid:2) M. Rapp (cid:2) (Eds.)
The Double Dynamic Martin Screw (DMS)
Adjustable Implant System for Proximal and Distal Femur Fractures
K.-K. Dittel M. Rapp
(Eds.)
The Double Dynamic
Martin Screw (DMS)
Adjustable Implant System
for Proximal and Distal Femur Fractures
In collaboration with
W. Abendschein, A. Ateschrang, S. Decker-Burgard,
M.-R. Felenda, K.K. Förster, D. Janssen, B. Marquardt,
W. Miller, K.M. Peters, R. Plank, S. Uppenbrink, R. Zirn
With 287 Figures in 400 separate Illustrations
and 24 Tables
(cid:2) (cid:3)
Karl-Klaus Dittel, Prof. M.D.
Matthias Rapp, M.D.
Clinic of Orthopaedic Surgery,
Traumatology and Reconstructive Surgery
Marienhospital Stuttgart –
Academic Hospital of the University of Tübingen, Germany
Böheimstraße 37, D-70199 Stuttgart
ISBN 978-3-7985-1841-4 Steinkopff Verlag
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Freedom of movement:
Its value will be only recognized,
when it is restricted
Sir J. Charnley, 1957
Foreword
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. The incidence of
these fractures is predicted to grow to 6 million in 2050 including a near term baby
boom spike.
Add the hospital mortality rate of up to 4% and the one mortality of from 8% to
20% and the life ending effect of these fractures becomes a glaring reality.
Of those who initially survive their fracture, about 50% never walk the same
again. The social problem in the care of these elderly people is enormous.
Of course, any real solution to this problem will include education, prevention,
surgical and hospital treatment protocols, long term rehabilitative efforts, social ad-
justments and a generous contribution of money.
This publication is primarily directed to the amplification of a new treatment
modality that addresses only a fraction of the problem. It is, however, a quantum
leap in the evolution of fixation with compression hip screws which are still the
gold standard for surgical stabilization of pertrochanteric hip fractures.
The Dynamic Martin Screw (DMS) addresses the issue of adjustability of the
fixation angle with appropriate mechanical strength characteristics that were lack-
ing in its historical predecessors.
It exhibits the unique ability to allow the surgeon to improve the reduction to a
more advantageous valgus angle even after it is rigidly attached to the femur. This
provides a more stable construct that will allow for a more successful recovery of
the patient to their previous ambulatory life.
In addition, the device is ideally suited for a new challenge in hip fractures, the
MRI fracture. These are undisplaced fractures diagnosed almost entirely by mag-
netic resonance imaging. Since they are, by definition, undisplaced, the infinite ad-
justment of the femur neck angle of this device is the perfect solution.
The variable angle system has been adapted for paediatric use. While useful for
fracture fixation, it is an excellent option for fixation in the varus femoral osteoto-
my for dysplastic hips and subluxation in childrenwith cerebral palsy.
Further on the supracondylar version is very valuable for distal femur fractures.
The supracondylar version with cable extraordinarily is suited for the devastating
periprosthetic femoral fracture in the total hip patient. This situation, by the way,
is a new epidemic!
Washington D.C., Summer 2008 Walter Abendschein, M.D.
Preface
Much has been written about changes in medicine – mankind has gone through –
changes which influenced the development of medical speciality decisively and
surely many more changes will continue to take place in coming years.
Obviously only some of the advances in the treatment of fractures and degenera-
tive diseases of the human motor system may be regarded as milestones in the de-
velopment of orthopaedic and trauma related surgery. Major advances have been
made specially in the treatment of femur fractures over the last five decades. There
is no doubt that one milestone in the middle of the last century can be attributed
to Ernst Pohl, a genious engineer from Kiel, who developed the first sliding device
for osteosynthesis of hip fractures. He opened a new area in the field of conven-
tional hip joint reconstruction, consequently embettering and developing an im-
plant system, enabling the patient to walk with full weight bearing at an early time,
reducing complications decisively and functional deficits to a minimum.
Our book deals with trauma surgery at the hip joint and it includes all kinds of
fractures from the femoral neck area as well as the intertrochanteric and the sub-
trochanteric area. We know that there is no single method of treatment existing
which could be used adequately for all type of fractures at the proximal femur. We
believe on the other side that with the development of the DMS since 1993 and the
experiences we have made personally with the new implant a spectrum of indica-
tions for its implantation has been opened which is broader than the spectrum of
many other implants which are used for fracture fixation at the hip. This does not
mean that we belong to the type of surgeons who claim that one could use a single
implant for all type of fractures. It is obvious that the better option is to use the
best implant for an existing problem. We have made the attempt to give a tailor-
made solution for treatment of joint localised fractures at the femur. Our experi-
ence over 15 years show that a great number of problems can be solved with the
DMS under the special aspect of its unique adjustability and anatomical congru-
ence.
Every year publications about fractures at the proximal femur present new bio-
mechanically embettered or descripted ideal implants. Mostly ideal fractures with
ideal results are presented by expelling the results about problems, complications
and implant failures. That’s why we have included in the book several chapters
which are dedicated to problem cases and pathological fractures for which the sur-
gical management is controversially discussed until our days.
The book finally includes chapters about perioperative antibiotic therapy, throm-
bo-embolism prophylaxis, postoperative physiotherapy and osteoporosis manage-
ment. We have written our book for colleagues who are working in trauma surgery
and we hope that we have fulfilled the demands of objectivity. The reader should
treat our attempt with leniency.
Stuttgart, Summer 2008 Karl-Klaus Dittel
Matthias Rapp
Dedicated to my surgical teachers
Ordinarius Prof. Dr. med. Wolfgang Schiefer
Formerly Medical Director
Neurosurgical University Clinic Erlangen
ReproducedwithkindpermissionfromStadtarchivErlangen
Prof. Dr. med. Friedrich Pampus
Formerly Medical Director
Neurosurgical Clinic
Katharinenhospital Stuttgart
ReproducedwithkindpermissionfromPressefotoKaufmann&Kaufmann,
Stuttgart
Prof. Dr. med. Erwin Kraft
Formerly Medical Director
Surgical Clinic
Marienhospital Stuttgart
ReproducedwithkindpermissionfromPublicRelationsOffice,
MarienhospitalStuttgart
Dedicated tomy surgical teachers (cid:2) XI
Ordinarius Prof. Dr. med. Dr. med. h.c. mult. Siegfried Weller
Formerly Medical Director
BGU and University Clinic of Traumatology Tübingen
In sincere gratitude
The book is dedicated
to Siegfried Weller at the
occasion of his 80th birthday
Karl-Klaus Dittel
Acknowledgments
In the front line we have to notice to be indebted to the authors of this book who
have spent their precious time for preparing, revising, updating, writing and over-
working their chapters. We are thankful for their work which they have done un-
selfishly. They have prepared their contributions and manuscripts reliable in a very
short time and we hope that our readers will give the attentiveness to their chapters
they have earned.
To the companies who have supported the printing we have to express our deep
thank. Without their help the production of this book would not have been possi-
ble.
(cid:2) KLS Martin
(cid:2) Pfizer
(cid:2) Stryker
(cid:2) Codon
(cid:2) Carstens
(cid:2) Aesculap
(cid:2) Cardinal Health
– Thanks for their support in form of a contribution to the print costs.
– Thanks for the support in form of an advertisement.
– Thanks for the support concerning the necessary illustrations
(Mrs. Rose Baumann) which had to be drawn for the book.
(cid:2) Thanks to the Steinkopff Verlag crew (Mrs. Dr. med. Gertrud Volkert, Mrs. Petra
Elster, Mr. Klemens Schwind) for their important advices and comments which
influenced the outcome of the book positively.
(cid:2) Thanks to our secretary Mrs. Reim who showed no tiredness in writing the texts
repeatedly.
(cid:2) Thanks to our colleagues who have stimulated us continuously with their ideas
and mental contributions to do our very best by publishing.
(cid:2) Thanks to the colleagues and friends Bud Abendschein, M.D., Washington D.C.
USA and Don Lyddon, M.D., Rockford USA who did a thoroughly job by trans-
lating some of the german texts into english.
We are very lucky that the printing of the book was possible based on an effective
and trustworthy collaboration with all involved persons who have enabled the com-
pletion in time.
Karl-Klaus Dittel
Matthias Rapp