林心畬莊太元廖宜賢王普光吳柏林何為斌2026-05-272026-05-272009https://203.71.86.71/handle/123456789/38717【Introduction】 The management of unstable subtrochanteric fracture is challenging to each orthopaedic surgeon. There was a controversy over the choice of implants between intra-medullary or extra-medullary devices. This topic presented our prospective series with unstable subtrochanteric fractures treated with dynamic condylar screws (DCS). 【Materials and Methods】 From 2003 through 2008, 118 peritrochanteric fractures were treated surgically by one surgeon. Twenty of them using DCS under indication of Seinsheimer classification (for subtrochanteric fractures) type IIC, III, IV, and V . Fracture union by serial X-ray evaluation was made monthly, and change of neck-shaft angle and medial migration were also estimated. Functional tests with Harris hip score were also evaluated. 【Results】 Eighteen of the 20 patients were followed for an average of 35.1 months (range 8-58 months). Functional outcome was excellent (>90 points) in 13 (13/18), good (80-99 points) in 2 (2/18), and fair (70-79 points) in 3(3/18). The primary union rate was 94% (17/18) in 12 weeks, and implants failure rate was 6% (1/18) which received revised surgery. Superficial wound infection was noted in one case. 【Discussion】 Unstable subtrochanteric fractures are difficult to treat due to high compression and tension force in the medial cortex with high failure rate of internal fixation. The most common devices for internal fixation include intra-medullar nail (IM nail), trochanteric stabilized plate (THS), and DCS. Dynamic hip screw had obviously higher failure rate and wasn't suggested in such fracture type. Although IM nail showed better then DCS in biomechanical studies, literature review showed great variation of results, and no large randomized control trial comparing available. There is some limitation of IM nail, including severe comminuting with intertrochantericen-US萬芳醫院科部：骨科類別：期刊論文article