Abstract
The principle of open reduction and internal fixation developed during the last few decades provides satisfactory alignment and articular function. The disadvantages of this technique are a large area of surgical exposure with risk of bone avascular necrosis, non-union, infection and stiffness. With LISS (Less Invasive Stabilisation System) the percentage of these problems can be reduced.
Over the period January 2003–March 2004, at the Orthopaedics and Traumatology Operative Unit of Maggiore Hospital in Bologna, Italy, 15 patients with distal femur fractures were treated by the use of LISS. Two of them were excluded at the time of follow-up: they died 2 and 12 months after the operation. Thus, we studied outcome in the remaining 13 patients. The average age was 49.7 years (range 18 to 88). According to the AO classification system we had four type 33.A1 fractures, six type 33.A3 fractures, two type 33.C2 fractures, one type 33.C3 fracture and one type 32.A3 open fracture. The mean follow-up was 9.8 months (range 3 to 17 months). Clinical and radiographic assessment was performed using the Neer-Grantham-Shelton score. The mean final score was 70.9/100. The average time of bony union was 12 weeks. We had three complications. In one patient there was a proximal pull out a few days after surgery; however, a satisfactory bony union was obtained with a second operation by a new LISS and a bone graft performed 1 month after the first operation. In the other two patients we had to remove the LISS because of pain at 2 and 14 months after surgery. These complications can be easily explained by the lack of experience in applying this kind of implant and the peculiarity of the cases.
We conclude that LISS is an effective system for healing distal femur fractures, with no direct surgical exposure of the fracture site, little bleeding, and early mobilisation and union.
