DHS /DCS ® ®

Dynamic Hip
and Condylar
Screw System

TECHNIQUE GUIDE

Original Instruments and Implants of the Association for the Study of Internal Fixation—A0 ASIF
Contents
Introduction to the Dynamic Hip Screw—DHS . . . . . . . . . . . . . . 2
DHS TECHNIQUE
Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Plate Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Surgical Technique. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Introduction to the Dynamic Condylar Screw—DCS . . . . . . . . . . 8

DCS TECHNIQUE
Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Surgical Technique. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

SPECIAL TECHNIQUES
Using the DCS for Subtrochanteric Fractures
Indications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Preoperative Considerations . . . . . . . . . . . . . . . . . . . . . 13
Surgical Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Assembling the Instrumentation
Triple Reamers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Tap Assembly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Lag Screw Insertion Assembly . . . . . . . . . . . . . . . . . . . 20
Reinserting the DHS/DCS Guide Pin . . . . . . . . . . . . . . . . . 21
Removing the Implants . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Recommended Reading. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Product Information
The DHS Plates, DCS Plates, and DHS/DCS Lag Screws . 23
Instrument and Implant Sets . . . . . . . . . . . . . . . . . . . . . . . 24
 Introduction to the Dynamic Hip Screw—DHS
The Dynamic Hip Screw is designed to provide
strong and stable internal fixation of a variety of
inter-trochanteric, subtrochanteric and basilar neck
fractures, with minimal soft tissue irritation.

Strong
• The DHS Plates are made of 316L stainless steel and
are cold-worked for strength.

Stable
• The number of screw holes per plate length is
maximized, without compromising plate strength.
This allows an increased number of fixation points
with a smaller incision.

• DCP® (Dynamic Compression Plate) holes in the

DHS side plate:
— allow angulation of 4.5 mm Cortex Screws, for lag
screw fixation of medial fragments, and
— allow axial compression and multiple-screw fixation
of the main fragment in subtrochanteric fractures
with shaft extension.

• Two flats within the DHS Plate barrel correspond to the

two-flat design of the DHS/DCS Lag Screw, preventing
rotation of the lag screw within the barrel. The two-flat
design also eases insertion of the plate over the
DHS/DCS Lag Screw.

Minimal Soft Tissue Irritation

• The DHS Plates have a low-profile design, reducing the
risk of trochanteric bursitis.

The DHS Plates are available in a wide range of

sizes and barrel angles, with standard or short barrels,
for varied clinical situations.

The DHS/DCS Lag Screw, available from 50 mm to

145 mm lengths, easily glides within the DHS Plate
barrel for controlled collapse and impaction of frag-
ments. When the fracture requires additional intra-
operative compression, the DHS/DCS Compression
Screw can be used; only one size compression screw
is needed.

The DHS instruments provide direct measurements

throughout the DHS procedure, allowing proper ream-
ing, tapping and lag screw insertion depth. The built-
in stop and locking nut on the DHS Triple Reamers
prevent over-reaming.

2
 DHS TECHNIQUE

DHS TECHNIQUE
Indications The DHS is indicated for stable fractures, and unstable
fractures in which a stable medial buttress can be
The DHS is indicated for the following fractures of the reconstructed. The DHS provides controlled collapse and
proximal femur: compression of fracture fragments. This results in stable
fixation and prevents undue stress concentration on
• Intertrochanteric fractures the implant.
• Subtrochanteric fractures*
*For certain subtrochanteric fractures, a 95° device is the
• Basilar neck fractures implant of choice. (See “Using the DCS for Subtrochanteric
Fractures,” page 13.)

Plate Selection
• Barrel length. The standard 38 mm barrel length is
most commonly indicated.
The 25 mm short barrel is indicated for specific clinical
situations, including:
—Cases in which the standard barrel may not provide
sufficient glide for the lag screw; i.e., a long
impaction distance is expected.
—A medial displacement osteotomy.
—Unusually small femurs.

• Barrel angle. An evaluation of the angle subtended

between the femoral neck and shaft axes (C.C.D., or
collum-center-diaphysis, angle) of the uninjured femur will
aid in the selection of the most appropriate barrel angle.
The 135° barrel angle is most commonly indicated.

Note: Greater barrel angles may produce biomechanical

advantages in unstable cases; i.e., better gliding
characteristics and reduced bending stresses on the
plate/barrel junction, although correct placement of the
implant becomes technically more difficult as barrel
angles increase.1

38 mm barrel 25 mm barrel

1
P. Regazzoni, Th. Rüedi, R. Winquist, and M. Allgöwer, The Dynamic Hip Screw
Implant System (Berlin: Springer-Verlag, 1985) 5.

3
 DHS Technique (Continued)
Note: This procedure requires image intensification.

Surgical Technique
1 Reduce the fracture. Determine anteversion by placing
a DHS/DCS Guide Pin anteriorly along the femoral neck,
using the appropriate DHS Angle Guide. Gently hammer
the pin into the femoral head. This anteversion pin will
later allow correct placement of the central guide pin in
the center of the femoral head.

2 Align the appropriate DHS Angle Guide along the axis of

the femoral shaft, and place it on the femur. Point the guide
tube toward the center of the femoral head. Predrilling of the
lateral cortex with the 2.0 mm Drill Bit is recommended in
dense bone. Insert a DHS/DCS Guide Pin through the
appropriate DHS Angle Guide, parallel to the anteversion
pin and directed toward the center of the femoral head. This
point of introduction varies with barrel angle. When a 135°
barrel angle is used, the guide pin enters the proximal femur
approximately 2.5 cm distal to the vastus ridge.

Notes:
Because it is designed for use with the DHS/DCS
instruments and implants, the DHS/DCS Guide Pin, and
not an alternate pin, must be used.
This guide pin remains in place throughout the procedure.
If it is inadvertently withdrawn, reinsert it immediately.
(See “Reinserting the DHS/DCS Guide Pin,” page 21.)

3 Confirm placement of the DHS/DCS Guide Pin under

image intensification. It must lie along the axis of the
femoral neck in both the A-P and lateral views, and parallel
to the anteversion pin. If its position is incorrect, insert a
new DHS/DCS Guide Pin. Remove and discard the
anteversion pin.

4 Slide the Direct Measuring Device over the guide pin to

determine guide pin insertion depth. Calibration on the
measuring device provides a direct reading.

4
 DHS TECHNIQUE
5 To calculate reaming depth, tapping depth and lag screw
length, subtract 10 mm from the reading. For example:
a. Direct reading . . . . . . . . . . . . . . . . . . 105 mm
b. Reamer setting . . . . . . . . . . . . . . . . . . 95 mm
c. Tapping depth (optional) . . . . . . . . . . . 95 mm
Lag screw length . . . . . . . . . . . . . . . . 95 mm

6 Assemble the appropriate DHS Triple Reamer (for either

the standard or short barrel DHS Plate). (See “Assembling
the Instrumentation,” page 18.) Set the reamer to the
correct depth. Insert the DHS Triple Reamer into the
Power Drive using the Large Quick Coupling attachment.
Slide the reamer over the guide pin to simultaneously drill for
the lag screw, ream for the plate barrel, and countersink for
the plate/barrel junction to the preset depth. When reaming in
dense bone, continuously irrigate the DHS Triple Reamer to
prevent thermal necrosis.

7 If necessary, tap to the predetermined depth using the

Tap Assembly. (See “Assembling the Instrumentation,” page
19.) Tapping depth can be seen through the window in the
Short Centering Sleeve.

5
 DHS Technique (Continued)
8 Select the DHS/DCS Lag Screw and assemble the Lag
Screw Insertion Assembly. (See “Assembling the Instrumen-
tation,” page 20.) Slide the assembly over the guide pin and
into the reamed hole. Seat the Long Centering Sleeve in the
hole to center and stabilize the assembly. Insert the lag
screw by turning the handle clockwise, until the zero mark
on the assembly aligns with the lateral cortex. The threaded
tip of the lag screw now lies 10 mm from the joint surface.
The lag screw may be inserted an additional 5 mm in porotic
bone, for increased holding power and additional controlled
collapse.

Note: Keep continuous forward pressure on the DHS/DCS

Wrench while advancing the lag screw.

9 Before removing the assembly, align the handle so it is in

the same plane as the femoral shaft (parallel to the femoral
shaft axis when viewed laterally). This allows proper place-
ment of the DHS Plate onto the lag screw.

10 Remove the DHS/DCS Wrench and Long Centering

Sleeve. Slide the appropriate DHS Plate onto the guide
shaft/lag screw assembly until it contacts the lateral cortex.
Loosen and remove the Coupling Screw and Guide Shaft.
Use the Power Drive in reverse, with the Jacobs Chuck
attachment, to withdraw the DHS/DCS Guide Pin.

6
 DHS TECHNIQUE
11 Gently seat the plate with the DHS/DCS Impactor. The
vastus ridge may be chiseled to further seat the plate on
bone.

12 Using AO ASIF standard screw insertion technique, fix

the DHS Plate to the femur with 4.5 mm Cortex Screws.

13 For further, intraoperation compression of the trochanteric

fracture, the DHS/DCS Compression Screw may be inserted
into the lag screw. The DHS/DCS Compression Screw may be
used in unstable fractures to prevent disengagement of the lag
screw from the plate barrel in non-weightbearing patients.

Note: Use of the Compression Screw may cause stripping of

the lag screw thread in porotic bone.

7
 Introduction to the Dynamic Condylar Screw—DCS
The Dynamic Condylar Screw is designed to provide
strong and stable internal fixation of certain distal
femoral and subtrochanteric fractures, with minimal
soft tissue irritation.

Strong
• The DCS Plates are made of 316L stainless steel and
are cold-worked for strength.

Stable
• The two holes closest to the barrel accept 6.5 mm
Cancellous Bone Screws. This enhances stability
by allowing:
— fixation of the most distal condylar fracture
fragments with two or more screws, or
— fixation of the most proximal subtrochanteric
fracture fragment with two or more screws.

• DCP holes in the DCS side plate allow angulation of

4.5 mm Cortex Screws and axial compression across
a shaft fracture.

• The number of screw holes per plate length is maxi-

mized, without compromising plate strength. This
allows an increased number of fixation points with
a smaller incision.

• Two flats within the DCS Plate barrel correspond to

the two-flat design of the lag screw, preventing
rotation of the DHS/DCS Lag Screw within the barrel.
The two-flat design also eases insertion of the plate
over the DHS/DCS Lag Screw.

Minimal Soft Tissue Irritation

• Low-profile design reduces risk of iliotibial band
irritation (distal femoral fractures) and trochanteric
bursitis (subtrochanteric fractures).

The DCS Plates are available with 6 to 16 holes, for

varied clinical situations. The DHS/DCS Lag Screw is
available in 50 mm to 145 mm lengths. The DHS/DCS
Compression Screw can be used for additional
compression; only one size compression screw
is needed.

The DCS instruments also provide direct measure-

ments throughout the DCS procedure, allowing proper
reaming, tapping, and lag screw insertion depth. The
built-in stop and locking nut on the DCS Triple
Reamer prevent over-reaming.

8
 DCS TECHNIQUE
Indications *The following anatomic conditions should exist:
The DCS is indicated for the following fractures of the • 4cm of distal femur should remain intact to provide
distal femur: support for the implant.
• A distal portion of the medial condyle should be intact for
• Intercondylar fractures* the DHS/DCS Lag Screw to gain good purchase.
• Supracondylar fractures*
If these conditions do not exist, a SYNTHES 95° Condylar
• Unicondylar fractures* Plate or Condylar Buttress Plate should be considered.

Note: This procedure requires image intensification.

Surgical Technique
1 Reduce the fracture. The fracture can be temporarily
stabilized with DHS/DCS Guide Pins or Steinmann pins.
Place these pins so they do not interfere with subsequent
positioning of the DCS implant assembly. (See illustrations
accompanying step 3 for proper implant positioning.) In
intercondylar fractures, the pins should be replaced with
independent 6.5 mm Cancellous Bone Screws with washers.

DCS TECHNIQUE
2 To determine direction of the central guide pin, flex the
knee to 90°, and mark the axis of the knee joint by placing a
K-wire distally over the condyles (A). Place a second K-wire
anteriorly over the condyles (B).

Note: Placement of the DHS/DCS Guide Pin determines

placement of the DCS implant assembly. Misplacement of
the guide pin can result in varus/valgus or rotational
B malalignment of the fracture fragments.

3 Using the DCS Drill Guide, insert the central guide pin
(C) parallel to the distal K-wire (A) in the A-P view, and
parallel to the anterior K-wire (B) in the axial view. Do not
insert the guide pin too far medially; consider the inclination
of the medial wall of the distal femur. In the sagittal plane,
the central guide pin enters the distal femur at a point
A-P view: C sisparallel
paralleltotoAA anterior to the midline between the condyles, and in line
with the shaft axis, approximately 2 cm from the knee joint.
Confirm placement of the central guide pin under image
intensification. If it is not parallel to the knee joint axis,
Axial view: C is parallel to B
insert a new DHS/DCS Guide Pin.
Notes:
Because it is designed for use with the DHS/DCS
instruments and implants, the DHS/DCS Guide Pin, and
not an alternate pin, must be used.
This guide pin remains in place throughout the procedure.
If it is inadvertently withdrawn, reinsert it immediately.
(See “Reinserting the DHS/DCS Guide Pin,” page 21.)
9
 DCS Technique (Continued)
4 Slide the Direct Measuring Device over the guide pin, and
determine guide pin insertion depth. Calibration on the
measuring device provides a direct reading.

5 To calculate reaming depth, tapping depth and lag screw

length, subtract 10 mm from the reading. For example:
a. Direct reading . . . . . . . . . . . . . . . . . . 80 mm
b. Reamer setting . . . . . . . . . . . . . . . . . 70 mm
c. Tapping depth (optional) . . . . . . . . . . 70 mm
Lag screw length . . . . . . . . . . . . . . . . 70 mm*

*If the Compression Screw will be used, allow for additional

compression of the fracture by selecting a lag screw 5 mm
shorter (in this case, 65 mm) and inserting it an additional
5 mm.

6 Assemble the DCS Triple Reamer. (See “Assembling the

Instrumentation,” page 18.) Set the reamer to the correct
depth. Insert the DCS Triple Reamer into the Power Drive
using the Large Quick Coupling attachment. Slide the reamer
over the guide pin to simultaneously drill for the lag screw,
ream for the plate barrel, and countersink for the plate/barrel
junction to the preset depth. When reaming in dense bone,
continuously irrigate the DCS Triple Reamer to prevent
thermal necrosis.

7 If necessary, use the Tap Assembly to tap to the

predetermined depth, which can be seen through the window
in the Short Centering Sleeve. (See “Assembling the
Instrumentation,” page 19.)

10
8 Select the correct length DHS/DCS Lag Screw and
assemble the Lag Screw Insertion Assembly. (See “Assem-
bling the Instrumentation,” page 20.) Slide the assembly
over the guide pin and into the reamed hole. Seat the Long
Centering Sleeve in the hole to center and stabilize the
assembly.

Note: Keep continuous forward pressure on the DHS/DCS

Wrench while advancing the lag screw.

9 Insert the lag screw by turning the handle clock-

wise until the 0 mark on the assembly aligns with the
lateral cortex. The threaded tip of the lag screw now lies
10 mm from the medial cortex. The lag screw may be
inserted an additional 5 mm in porotic bone, for increased
holding power.

Note: If a lag screw 5 mm shorter than reaming and

tapping depth is used (in this case, 65 mm), insert it an
additional 5 mm, until the 5 mark on the assembly aligns
with the lateral cortex.

DCS TECHNIQUE
10 Before removing the assembly, align the handle so
it is parallel with the femoral shaft axis when viewed
laterally. This allows proper placement of the DCS Plate
onto the lag screw.

11 Remove the DHS/DCS Wrench and Long Centering

Sleeve. Slide the appropriate DCS Plate onto the guide
shaft/lag screw assembly. Loosen and remove the Coupling
Screw and Guide Shaft. Use the Power Drive in reverse,
with the Jacobs Chuck attachment, to withdraw the guide
pin.

12 Gently seat the plate with the DHS/DCS Impactor. The

lateral condylar cortex may be chiseled to further seat the
plate on bone.

11
 DCS Technique (Continued)
13 If the joint fragments were not previously reduced with
independent 6.5 mm Cancellous Bone Screws, the DHS/DCS
Compressing Screw may be inserted into the lag screw. In
porotic bone, insert the screw very carefully to avoid strip-
ping the lag screw thread.

14 Further interfragmentary compression can be achieved

by using two 6.5 mm Cancellous Bone Screws through the
distal round holes of the DCS Plate.

15 Once an approximate anatomic reduction is achieved,

use the Articulated Tension Device to produce final compres-
sion between the femoral shaft and distal fragments. To
facilitate reduction of the diaphyseal fragment, particularly
in cases of medial comminution with shortening, the tension
device can also be used as a distractor.

16 Using AO ASIF standard screw insertion technique, fix

the DCS Plate to the femur with 4.5 mm Cortex Screws.

12
 SPECIAL TECHNIQUES
Using the DCS for Subtrochanteric Fractures
Indications
The DCS is indicated for the following fractures of the • Long oblique subtrochanteric fractures. When using the
proximal femur: 135° DHS Plate to treat long oblique subtrochanteric
• Transverse subtrochanteric fractures* fractures, use of the proximal plate screws can prohibit
• Short oblique subtrochanteric fractures* compression. With the 95° DCS Plate, however, stable
• Long oblique subtrochanteric fractures* fixation can be achieved by lagging the fracture through
the plate, since controlled collapse is not anticipated.
The design of the DCS Plate can enhance fixation of
selected, stable subtrochanteric fractures because it permits
stable fixation in the proximal fragment.3 The DCS Plate has
a 95° barrel angle, allowing it to enter the femur more
proximally than the DHS Plate and allowing insertion of Note: When used in the proximal femur, the DCS Plate can
two or more screws into the calcar. Further, its two round only be used to treat stable fractures; i.e., fractures that can
proximal plate holes permit insertion of 6.5 mm Cancellous be directly reduced and anatomically reassembled to allow
Bone Screws, for stable proximal fixation. restoration of the bony medial buttress. Because the DCS
Plate has a 95° barrel angle, it does not allow for controlled
• Stable transverse and short oblique subtrochanteric fractures. collapse and compression.
When using the DCS Plate for these fractures, the plate
can act as a tension band against normal medial *With the lesser trochanter avulsed or on the distal
compressive forces.4 fragment (femoral shaft).2

Preoperative Considerations
Plate Selection
Select the DCS Plate so there are four screws (eight cor-
tices) distal to the fracture in hard diaphyseal bone, or five
screws (ten cortices) in porotic bone.

Insertion of the DHS/DCS Guide Pin

Though the general insertion area of the guide pin
is known, the precise insertion point varies with the CCD
angle, or the angle subtended between the femoral neck and
shaft axes. Assessment of the CCD angle will allow subse-
quent placement of the lag screw in its optimal position—in
the center of the femoral neck and in the inferior half of the
femoral head. (See illustration.) This insertion point should
be determined preoperatively with the aid of planning
templates.
SPECIAL TECHNIQUES

The insertion point of the guide pin will vary with CCD angle
(angle subtended between the femoral neck and shaft axes), as
depicted by this valgus femur (dotted lines). Example is exag-
gerated for clarity.
2 Roy Sanders and P. Regazzoni, “Treatment of Subtrochanteric Femur
Fractures Using the Dynamic Condylar Screw,” Journal of Orthopaedic Trauma
vol. 3, no. 3 (New York: Raven Press, 1989) 211.
3 ibid 206–213.
4 ibid 212.

13
 Using the DCS for Subtrochanteric Fractures (Continued)
Note: This procedure requires image intensification.

Surgical Technique
1 Reduce the fracture. Determine anteversion by placing a
DHS/DCS Guide Pin anteriorly along the femoral neck, gently
hammering it into the femoral head. This anteversion pin
will ensure correct placement of the central guide pin.

2 Place the DCS Drill Guide along the axis of the femoral
shaft so the central guide pin will enter the femur slightly
anterior to the midpoint of the greater trochanter, near
the vastus ridge. The precise level at which the guide pin
enters the femur should be determined preoperatively. (See
“Preoperative Considerations,” page 13.) Insert the central
guide pin parallel to the anteversion pin in the lateral view.
Predrilling of the lateral cortex with the 2.0 mm Drill Bit is
recommended in dense bone.
Notes:
Because it is designed for use with the DHS/DCS
instruments and implants, the DHS/DCS Guide Pin, and
not an alternate pin, must be used.
This guide pin remains in place throughout the procedure.
If it is inadvertently withdrawn, reinsert it immediately.
(See “Reinserting the DHS/DCS Guide Pin,” page 21.)

3 Confirm placement of the central guide pin under image

intensification, in two views. In the A-P view, the pin should
lie in the center of the neck and in the inferior half of the
femoral head. In the lateral view, it should lie in the middle
of the femoral head. The tip of the guide pin should just
engage the subchondral bone. If its position is incorrect, insert
a new guide pin. Remove and discard the anteversion pin.

4 Slide the Direct Measuring Device over the guide pin

to determine guide pin insertion depth. Calibration on the
measuring device provides a direct reading.

14
 5 To calculate reaming depth, tapping depth and lag screw
length, subtract 10 mm from the reading. For example:
a. Direct reading . . . . . . . . . . . . . . . . . . . 95 mm
b. Reamer setting . . . . . . . . . . . . . . . . . . 85 mm
c. Tapping depth (optional) . . . . . . . . . . . 85 mm
Lag screw length . . . . . . . . . . . . . . . . 85 mm

6 Assemble the DCS Triple Reamer. (See “Assembling the

Instrumentation,” page 18.) Set the reamer to the correct
depth. Insert the DCS Triple Reamer into the Power Drive
using the Large Quick Coupling attachment. Slide the reamer
over the guide pin to simultaneously drill for the lag screw,
ream for the plate barrel, and countersink for the plate/barrel
junction to the preset depth. When reaming in dense bone,
continuously irrigate the DCS Triple Reamer to prevent
thermal necrosis.

7 Secure the proximal fragment with a bone forceps to

➛ 85 mm ➛ prevent rotation in the sagittal plane. If necessary, tap
to the predetermined depth using the Tap Assembly. (See
“Assembling the Instrumentation,” page 19.) Tapping depth
can be seen through the window in the Short Centering
Sleeve.

8 Select the lag screw and assemble the Lag Screw

SPECIAL TECHNIQUES
Insertion Assembly. (See “Assembling the Instrumentation,”
page 20.) Slide the assembly over the guide pin and into the
reamed hole. Seat the centering sleeve in the hole to center
and stabilize the assembly, and insert the lag screw by
turning the handle clockwise until the 0 mark on the
assembly aligns with the lateral cortex. The threaded tip
of the lag screw now lies 10 mm from the medial cortex.
The lag screw may be inserted an additional 5 mm in
porotic bone, until the 5 mm mark aligns with the lateral
cortex, for increased holding power.

15
 Using the DCS for Subtrochanteric Fractures (Continued)

Surgical Technique (Continued)

9 Before removing the assembly, align the handle so it
is in the same plane as the femoral shaft (parallel with the
femoral shaft axis when viewed laterally). This allows
correct placement of the DCS Plate onto the lag screw.

10 Remove the DHS/DCS Wrench and Long Centering

Sleeve. Slide the appropriate DCS Plate onto the guide
shaft/lag screw assembly.

11 Loosen and remove the Coupling Screw and Guide Shaft.

Use the Power Drive in reverse, with the Jacobs Chuck
attachment, to withdraw the guide pin. Gently seat the plate
with the DHS/DCS Impactor. The vastus ridge can be
chiseled to further seat the plate on bone.

12 Insert two 6.5 mm Cancellous Bone Screws through

the proximal round holes of the DCS Plate, using lag screw
technique. To do so, drill a hole through the near cortex with
the 4.5 mm Drill Bit. Fully seat the 4.5/3.2 mm Insert Drill
Sleeve into the hole. Drill through the sleeve and penetrate
the far cortex with the 3.2 mm Drill Bit. Measure, tap and
insert the 6.5 mm Cancellous Bone Screw. This technique
will prevent the drill bit from gliding along the calcar.

16
13 Insert the DHS/DCS Compression Screw into the lag
screw. This will prevent disengagement of the lag screw
from the plate barrel.

14 Once an approximate anatomic reduction is achieved,

the Articulated Tension Device may be used to produce final
compression of the fracture. Do not use the tension device if
extensive comminution exists.

15 Using AO ASIF standard screw insertion technique, fix

the DCS Plate to the femur with 4.5 mm Cortex Screws.

SPECIAL TECHNIQUES

17
 Assembling the Instrumentation

Triple Reamers
The components of the triple reamers are sharp and
should be handled carefully.
The triple reamers can be assembled preoperatively.
Reaming depth is set intraoperatively.
To assemble:
• Select the reaming head that corresponds to the chosen
plate (DHS or DCS) and barrel length (DHS standard
or DHS short).

• Align the set screw on the reaming head with the flat on
the drill bit. Slide the cutting end of the reaming head over
the coupling end of the drill bit.
set screw

flat

• Hold the coupling end of the drill bit with one hand, and
continue sliding the reaming head along the drill bit with the
other hand. The proper setting is attained when the non-
cutting end of the reaming head reaches the calculated depth
setting. In this example, the depth setting is 95 mm. (See
inset.)

• Secure the reaming head into the appropriate notch, and lock
it in place with the locking nut.

18
Tap Assembly
To assemble:
• Slide the Short Centering Sleeve over the tap.

• Simultaneously push the quick coupling fitting on the

T-handle and insert the tap into the fitting.

• Release the collar, and check to be sure the tap is securely

seated in the handle.

SPECIAL TECHNIQUES

19
 Assembling the Instrumentation (Continued)

Lag Screw Insertion Assembly

The Lag Screw Insertion Assembly must be assembled
intraoperatively after the proper length lag screw is chosen.
To assemble:
• Insert the Coupling Screw (1) into the DHS/DCS Guide
Shaft (2).

• Screw the Coupling Screw into the end of the lag screw.
The tabs of the Guide Shaft should seat into the slots of
the lag screw.

• Slide the Long Centering Sleeve over the wrench.

• Firmly insert the guide shaft/lag screw assembly into

the wrench until it stops.

20
Reinserting the DHS/DCS
Guide Pin
If the guide pin is inadvertently withdrawn at any time
during the procedure, reinsert it immediately.
To reinsert the guide pin if withdrawn upon
removal of the Triple Reamer:
• Insert a lag screw backwards into the Short Centering Sleeve.

• Place this assembly into the bone, and use it as a guide for
reinsertion of the guide pin. Cannulation in the DHS/DCS Lag
Screw centers the guide pin in the hole.

• Use a hammer to gently reseat the guide pin.

Caution: Do not continue the procedure without the guide

pin, as the risk of misdirecting the Triple Reamer, Tap
Assembly, or DHS/DCS Lag Screw is too great.

Removing the Implants

SPECIAL TECHNIQUES

• Remove the plate.

• Assemble the insertion wrench, using the long Coupling
Screw. The long Coupling Screw allows the surgeon to exert
traction while unscrewing the lag screw.
• Align the flats inside the wrench with the flats of the lag
screw. Slide the wrench over the lag screw until it is well over
the end of the screw.
• Pull on the wrench while turning it counterclockwise.

21
 Recommended Reading
Benum, P. “The Use of Bone Cement as an Adjunct to Internal
Fixation of Supracondylar Fractures of Osteoporotic Femurs.”
Acta Orthopaedica Scandinavica 48 (1977): 52–56.

Johnson, Eric E. “Combined Direct and Indirect Reduction of

Comminuted Four-Part Intraarticular T-Type Fractures of the
Distal Femur:” Clinical Orthopaedics 231 (1988): 154–162.

Mize, Roby D. “Surgical Management of Complex Fractures of

the Distal Femur:” Clinical Orthopaedics and Related Research
240 (1989): 77–86.

Mize, Roby D., Robert W. Bucholz, and Dennis P. Grogan.

“Surgical Treatment of Displaced, Comminuted Fractures of the
Distal End of the Femur.” The Journal of Bone and Joint Surgery
64-A.6 (1982): 871–879.

Müller M.E., M. Allgöwer, R. Schneider, and H. Willenegger.

Manual of Internal Fixation: Techniques Recommended by the
AO-Group. 3rd ed. Berlin: Springer-Verlag, 1990.

Regazzoni, P., Th. Rüedi, R. Winquist, and M. Allgöwer. The

Dynamic Hip Screw Implant System. Berlin: Springer-Verlag, 1985.

Sanders, Roy and P. Regazzoni. “Treatment of Subtrochanteric

Femur Fractures Using the Dynamic Condylar Screw.” Journal of
Orthopaedic Trauma 3.3 (1989): 206–213.

Sanders, Roy, P. Regazzoni, and Th. Rüedi. “Treatment of

Supracondylar-Intracondylar Fractures of the Femur Using
the Dynamic Condylar Screw.” Journal of Orthopaedic Trauma
3.3 (1989): 214–222.

Schatzker, Joseph and Marvin Tile. The Rationale of Operative

Fracture Care. Berlin: Springer-Verlag, 1987.

Schatzker, J., N. Mahomed, K. Schiffman, and J. Kellam.

“Dynamic Condylar Screw: A New Device.” Journal of Orthopaedic
Trauma 3.2 (1989): 124–132.

Seinsheimer, Frank. “Subtrochanteric Fractures of the Femur.”

The Journal of Bone and Joint Surgery 60-A.3 (1978): 300–306.

Siliski, John M., Martin Mahring, and H. Peter Hofer.

“Supracondylar-Intercondylar Fractures of the Femur.” The
Journal of Bone and Joint Surgery 71-A.1 (1989): 95–104.

Simpson, A.H.R.W., K. Varty, and C.A.F. Dodd. “Sliding Hip

Screws: Modes of Failure.” Injury 20 (1989): 227–231.

Singh, Manmohan, A.R. Nagrath, and P.S. Maini. “Changes in

Trabecular Pattern of the Upper End of the Femur as an Index of
Osteoporosis.” The Journal of Bone and Joint Surgery 52-A.3 (1970):
457–467.

Vander Schilden, Jack, Brett Bolnhoffer, Roy Sanders, Donald

Wiss, and Phillip Spiegel “Subtrochanteric Femur Fractures.”
Evarts’ Surgery of the Musculoskeletal System. New York: Churchill
Livingstone, 1990.

Waddell, J.P. “Subtrochanteric Fractures of the Femur: A Review

of 130 Patients.” The Journal of Trauma 19.8 (1979): 582–592.

22
Product Information

The DHS Plates, DCS Plates, and DHS/DCS Lag Screws

DHS Standard Barrel Plates (38 mm barrel)
Barrel Angle
Holes Shaft length (mm) 135° 140° 145° 150°
2 46 281.12 281.202 281.302 281.42
4 78 281.14 281.24 281.34 281.44
5 94 281.15 281.25 281.35 281.45
6 110 281.16 281.26 281.36 281.46
8 142 281.18 281.208 281.308 281.48
10 174 281.10 281.210 281.310 281.40
12 206 281.11 281.212 281.312 281.41
14 238 281.13 281.214 281.314 281.414
16 270 281.17 281.216 281.316 281.416
18 302 281.118 281.418
20 333 281.120 281.420

DHS Short Barrel Plates (25 mm barrel)

Barrel Angle
Holes Shaft length (mm) 135° 140° 145° 150°
4 78 281.54 281.64 281.74 281.84
5 94 281.55 281.65 281.75 281.85
6 110 281.56 281.66 281.76 281.86

DCS Plates
Barrel Angle
Holes Shaft length (mm) 95°

6 114 281.96
8 146 281.98
10 178 281.90
12 210 281.92
14 242 281.93
16 274 281.94
18 306 281.95
20 338 281.97

DHS/DCS Lag Screws

Thread diameter: 12.7 mm
Thread length: 22 mm
Shaft diameter: 8 mm
Pitch: 3.0 mm
Diameter of cannulation: 2.7 mm

Catalog No. Length (mm) Catalog No. Length (mm)

280.50 50 mm 280.00 100 mm
280.55 55 mm 280.05 105 mm
280.60 60 mm 280.10 110 mm
280.65 65 mm 280.15 115 mm
280.70 70 mm 280.20 120 mm
280.75 75 mm 280.25 125 mm
280.80 80 mm 280.30 130 mm
280.85 85 mm 280.35 135 mm
280.90 90 mm 280.40 140 mm
280.95 95 mm 280.45 145 mm

DHS and DCS Plates and DHS/DCS Lag Screws are available nonsterile or sterile-packed. 23
To order sterile product, add S to the catalog number.
 Instrument and Implant Sets

DHS Basic Set with self-tapping screws [105.837]

DHS Basic Set [105.37]

304.250 DHS/DCS Basic Set Graphic Case, for self-tapping screws, with cover (for Set 105.837)
304.257 DHS/DCS Basic Set Graphic Case, with cover (for Set 105.37)
Instruments
310.19 2.0 mm Drill Bit, 100 mm, 322.43 4.5 mm DCP® Hip Drill Guide
quick coupling, 2 ea. 338.00 2.5 mm Threaded Guide Wire,
310.31 3.2 mm Drill Bit, 145 mm, 230 mm, 10 ea.
quick coupling, 2 ea. 338.01– DHS Angle Guides
310.44 4.5 mm Drill Bit, 145 mm, 338.04 1 ea.: 135°, 140°, 145° and 150°
quick coupling, 2 ea. 338.05 DHS/DCS Direct Measuring Device
311.44 T-Handle, with quick coupling 338.06 DHS/DCS Wrench
311.46 Tap for 4.5 mm Cortex and 338.08 DHS/DCS T-Handle
4.5 mm Shaft Screws, 2 ea. 338.13 DHS Triple Reamer, complete
312.46 4.5 mm/3.2 mm Double Drill Sleeve 338.17 DHS/DCS Tap, 12.5 mm dia.
312.48 4.5 mm/3.2 mm Insert Drill Sleeve 338.18 DHS/DCS Centering Sleeve, short
314.11 Holding Sleeve 338.19 DHS/DCS Centering Sleeve, long
314.15 Large Hexagonal Screwdriver Shaft 338.20 DHS/DCS Coupling Screw, short
314.27 Large Hexagonal Screwdriver 338.21 DHS/DCS Guide Shaft
319.10 Depth Gauge for large screws 338.22 DHS/DCS Coupling Screw, long
319.97 Screw Forceps 338.28 DHS/DCS Impactor
338.44 DHS Reaming Head, short

Implants in Set 105.837 Implants in Set 105.37

214.828– 4.5 mm Cortex Screws, self-tapping 214.028– 4.5 mm Cortex Screws
214.854 3 ea.: 28, 30, 48, 50, 52 and 54 mm 214.054 3 ea.: 28, 30, 48, 50, 52 and 54 mm
6 ea.: 44 and 46 mm 6 ea.: 44 and 46 mm
8 ea.: 32, 34, 36, 38 and 42 mm 8 ea.: 32, 34, 36, 38 and 42 mm
10 ea.: 40 mm 10 ea.: 40 mm

Also available: DHS Basic Set with self-tapping screws (105.837J) and DHS Basic Set (105.37J)
With standard drill bits 310.20, 310.32 and 310.45 to fit Jacobs chuck.
DHS Basic Screw Rack with self-tapping screws (105.809)

24
DHS/DCS Basic Set with self-tapping screws [105.831]
DHS/DCS Basic Set [105.31]

304.250 DHS/DCS Basic Set Graphic Case, for self-tapping screws, with cover (for Set 105.831)
304.257 DHS/DCS Basic Set Graphic Case, with cover (for Set 105.31)

Instruments
310.19 2.0 mm Drill Bit, 100 mm, 338.00 2.5 mm Threaded Guide Wire, 230 mm, 10 ea.
quick coupling, 2 ea. 338.01– DHS Angle Guides
310.31 3.2 mm Drill Bit, 145 mm, 338.04 1 ea.: 135°, 140°, 145° and 150°
quick coupling, 2 ea. 338.05 DHS/DCS Direct Measuring Device
310.44 4.5 mm Drill Bit, 145 mm, 338.06 DHS/DCS Wrench
quick coupling, 2 ea. 338.08 DHS/DCS T-Handle
311.44 T-Handle, with quick coupling 338.13 DHS Triple Reamer, complete
311.46 Tap for 4.5 mm Cortex and 338.17 DHS/DCS Tap, 12.5 mm dia.
4.5 mm Shaft Screws, 2 ea. 338.18 DHS/DCS Centering Sleeve, short
312.46 4.5 mm/3.2 mm Double Drill Sleeve 338.19 DHS/DCS Centering Sleeve, long
312.48 4.5 mm/3.2 mm Insert Drill Sleeve 338.20 DHS/DCS Coupling Screw, short
314.11 Holding Sleeve 338.21 DHS/DCS Guide Shaft
314.15 Large Hexagonal Screwdriver Shaft 338.22 DHS/DCS Coupling Screw, long
314.27 Large Hexagonal Screwdriver 338.28 DHS/DCS Impactor
319.10 Depth Gauge for large screws 338.41 95° DCS Drill Guide
319.97 Screw Forceps 338.44 DHS Reaming Head, short
322.43 4.5 mm DCP® Hip Drill Guide 338.47 DCS Reaming Head

Implants in Set 105.831 Implants in Set 105.31

214.828– 4.5 mm Cortex Screws, self-tapping 214.028– 4.5 mm Cortex Screws
214.854 3 ea.: 28, 30, 48, 50, 52 and 54 mm 214.054 3 ea.: 28, 30, 48, 50, 52 and 54 mm
6 ea.: 44 and 46 mm 6 ea.: 44 and 46 mm
8 ea.: 32, 34, 36, 38 and 42 mm 8 ea.: 32, 34, 36, 38 and 42 mm
10 ea.: 40 mm 10 ea.: 40 mm
292.20 2.0 mm Kirschner Wire, 150 mm 292.20 2.0 mm Kirschner Wire, 150 mm
1 pkg. of 10 1 pkg. of 10

Also available: DHS/DCS Basic Set with self-tapping screws (105.831J), and DHS/DCS Basic Set (105.31J)
With standard drill bits 310.20, 310.32 and 310.45 to fit Jacobs chuck
DHS/DCS Basic Screw Rack with self-tapping screws (105.812)
DHS/DCS Basic Screw Rack with screws (105.12) (not self-tapping)
25
 Instrument and Implant Sets (Continued)

DHS Universal Implant Set [105.35]

305.36 DHS Universal Implant Set Graphic Case, with cover

280.00– DHS/DCS Lag Screws, 12.7 mm dia. thread

280.95 1 ea.: 65, 70, 75, 80, 85, 90, 95, 100, 105, 110, 115, 120, 125,
130, 135, 140 and 145 mm

280.99 DHS/DCS Compression Screw, 36 mm, 3 ea.

281.14– 135° DHS Plates, Standard Barrel

281.16 1 ea.: 4, 5 and 6 holes

281.24– 140° DHS Plates, Standard Barrel

281.26 1 ea.: 4, 5 and 6 holes

281.34– 145° DHS Plates, Standard Barrel

281.36 1 ea.: 4, 5 and 6 holes

281.44– 150° DHS Plates, Standard Barrel

281.46 1 ea.: 4, 5 and 6 holes

281.54 135° DHS Plate, Short Barrel, 4 holes

281.84 150° DHS Plate, Short Barrel, 4 holes

Also available: DHS Universal Implant Set (105.35S), sterile, without graphic case

26
DCS Implant Set [105.32]

304.270 DCS Implant Set Graphic Case

With graphic outlines, autoclavable, perforated, complete with cover

280.50– DHS/DCS Lag Screws, 12.7 mm dia. thread

280.75 2 ea.: 50, 55, 60, 65, 70 and 75 mm

280.99 DHS/DCS Compression Screw, 36 mm, 6 ea.

281.90– 95° DCS Plates

281.98 1 ea.: 12, 14 and 16 holes
2 ea.: 6, 8 and 10 holes

27
 Instrument and Implant Sets (Continued)
Recommended Additions:
321.12 Articulated Tension Device, span 20 mm
105.957 Power Drive Set

321.12

530.100

530.100
Power Drive

530.280

511.731 Jacobs Chuck,

keyless

511.76 Large Quick Coupling

28
Header Right Page

DHS TECHNIQUE

29
Header Left Page
DHS Basic Set with self-tapping screws [105.837]
DHS Basic Set [105.37]
304.250 DHS/DCS Basic Set Graphic
Case, for self-tapping screws, with cover (for Set
105.837)
304.257 DHS/DCS Basic Set Graphic
Case, with cover (for Set 105.37)
Instruments
310.19 2.0 mm Drill Bit, 100 mm,
quick coupling, 2 ea.
310.31 3.2 mm Drill Bit, 145 mm,
quick coupling, 2 ea.
310.44 4.5 mm Drill Bit, 145 mm,
quick coupling, 2 ea.
311.44 T-Handle, with quick coupling
311.46 Tap for 4.5 mm Cortex and
4.5 mm Shaft Screws, 2 ea.
312.46 4.5 mm/3.2 mm Double Drill
Sleeve
312.48 4.5 mm/3.2 mm Insert Drill Sleeve
314.11 Holding Sleeve
314.15 Large Hexagonal Screwdriver
Shaff
314.27 Large Hexagonal Screwdriver
319.10 Depth Gauge for large screws
319.97 Screw Forceps

Implants in Set 105.837

214.828– 4.5 mm Cortex Screws, self-tap-
ping
214.854 3 ea.: 28, 30, 48, 50, 52 and 54
mm
6 ea.: 44 and 40 mm
8 ea.: 32, 34. 36, 38 and 42 mm
10 ea.: 40 mm

322.43 4.5mm DCP® Hip Drill Guide

338.00 2.5 mm Threaded Guide Wire,
230 mm. 10 ea.
338.01– DHS Angle Guides
338.04 1 ea: 135°, 140°, 145° and 150°
338.05 DHS/DCS Direct Measuring
Device
338.06 DHS/DCS Wrench
338.08 DHS/DCS T-Handle
338.13 DHS Triple Reamer, complete
338.17 DHS/DCS Tap, 12.5 mm dia.
338.18 DHS/DCS Centering Sleeve, short
338.19 DHS/DCS Centering Sleeve, long
338.20 DHS/DCS Coupling Screw, short
338.21 DHS/DCS Guide Shaft
338.22 DHS/DCS Coupling Screw, long
338.28 DHS/DCS Impactor
338.44 DHS Reaming Head, short

30
Header Right Page
Implants in Set 105.37
214.028– 4.5 mm Cortex Screws

DHS TECHNIQUE
214.054 3 ea.: 28, 30, 48, 50, 52 and 54
mm
6 ea.: 44 and 46 mm
8 en.: 32, 34, 36, 38 and 42 mm
10 ea.: 40 mm
Also available: DHS Basic Set with self-tapping
screws (105.837J) and DHS
Basic Set (105.37J)
With standard drill bits 310.20.
310.32 and 310.45 to fit Jacobs
chuck.
DHS Basic Screw Rack with
self-tapping screws (105.809)
DHS/DCS Basic Set with self-tapping screws
[105.831]
DHS/DCS Basic Set [105.31]
304.250 DHS/DCS Basic Set Graphic
Case, for self-tapping screws, with cover (for Set
105.831)
304.257 DHS/DCS Basic Set Graphic
Case, with cover (for Set 105.31)
Instruments
310.19 2.0 mm Drill Bit. 100 mm.

quick coupling, 2 ea.

310.31 3.2 mm Drill Bit, 145 mm.
quick coupling, 2 ea.
310.44 4.5 mm Drill Bit, 145 mm.
quick coupling, 2 ea.
311.44 T-Handle, with quick coupling
311.46 Tap for 4.5 mm Cortex and
4.5 mm Shaft Screws, 2 ea.
312.46 4.5 mm/3.2 mm Double Drill
Sleeve
312.48 4.5 mm/3.2 mm Insert Drill Sleeve
314.11 Holding Sleeve
314.15 Large Hexagonal Screwdriver
Shaft
314.27 Large Hexagonal Screwdriver
319.10 Depth Gauge for large screws
319.97 Screw Forceps
322.43 4.5 mm DCP® Hip Drill Guide
Implants In Set 105.831
214.828– 4.5 mm Cortex Screws, self-tap-
ping
214.854 3 ea.: 28, 30, 48, 50, 52 and 54
mm
6 ea.: 44 and 46 mm
8 ea.: 32, 34, 36, 38 and 42 mm
10 ea.: 40 mm
292.20 2.0 mm Kirschner Wire, 150 mm
1 pkg. of 10

31
Header Left Page

338.00 2.5 mm Threaded Guide Wire,

230 mm, 10 ea.
338.01– DHS Angle Guides
338.04 1 ea.: 135°, 140°, 145° and 150°
338.05 DHS/DCS Direct Measuring
Device
338.06 DHS/DCS Wrench
338.08 DHS/DCS T-Handle
338.13 DHS Triple Reamer, complete
338.17 DHS/DCS Tap, 12.5 mm dia.
338.18 DHS/DCS Centering Sleeve, short
338.19 DHS/DCS Centering Sleeve, long
338.20 DHS/DCS Coupling Screw, short
338.21 DHS/DCS Guide Shaft
338.22 DHS/DCS Coupling Screw, long
338.28 DHS/DCS Impactor
338.41 95° DCS Drill Guide
338.44 DHS Reaming Head, short
338.47 DCS Reaming Head
Implants in Set 105.31
214.028– 4.5 mm Cortex Screws
214.054 3 ea.: 28, 30, 48, 50, 52 and 54
mm
6 ea.: 44 and 46 mm
8 ea.: 32, 34, 36, 38 and 42 mm
10 ea.: 40 mm
292.20 2.0 mm Kirschner Wire, 150 mm
1 pkg. of 10
Also available: DHS/DCS Basic Set with self-
tapping screws (105.831J), and
DHS/DCS Basic Set (105.31J)
With standard drill bits 310.20,
310.32 and 310.45 to fit Jacobs
chuck
DHS/DCS Basic Screw Rack
with self-tapping screws
(105.812)
DHS/DCS Basic Screw Rack
with screws (105.12) (not self-
tapping)
DHS Universal Implant Set [105.35]
305.36 DHS Universal Implant Set
Graphic Case, with cover
280.00– DHS/DCS Lag Screws, 12.7 mm
dia. thread
280.95 1 ea.: 65, 70, 75, 80, 85, 90, 95,
100, 105, 110, 115, 120, 125,
130, 135, 140 and 145 mm
280.99 DHS/DCS Compression Screw, 36
mm, 3 ea.
281.14– 135° DHS Plates, Standard Barrel
281.16 1 ea.: 4, 5 and 6 holes
281.24– 140° DHS Plates, Standard Barrel

32
 SYNTHES (USA) SYNTHES (CANADA) LTD.
1690 Russell Road 111 Brunel Road
Paoli, PA 19301-1262 Suite 110
Telephone: 610-647-9700 Mississauga, Ontario L4Z 1X3
Fax: 610-251-9056 Telephone: 905-568-1711
To order: 800-523-0322 Fax: 905-568-1662
To order: 800-668-1119

DHS, DCS, DCP, ASIF, and SYNTHES are registered trademarks of SYNTHES (USA) and SYNTHES AG Chur.
Graphic Cases are covered under U.S. Patents 4,262,799 and 4,267,939.

©SYNTHES (USA) 1990 Printed in U.S.A. (Rev. 6/01) J3045B