MINIMAL INVASIVE SURGERY FOR COMMINUTED SUPRACONDYLAR FEMUR FRACTURES WITH LISS: COMPARATIVE STUDY BETWEEN MULTIPLE INJURED AND ISOLATED FEMUR FRACTURES

Abstract

Objectives: The comminuted supracondylar femur fractures are resulted from high energy trauma. Infection and union problems are common complications. LISS is a new generation implant leading to decrease these complications. The aim of this prospective study is to compare the outcomes of distal femoral fractures treated by LISS (Less Invasive Stabilization System) of the multiple injured and isolated fractured cases.

Patients and Methods: This prospective study comprised of twentysix patients, sixteen men and ten women, who had 27 distal femoral fractures. Patients were divided as having multiple injury (group I) or isolated femur distal fractures (group II). There were fourteen supracondylar (AO type A) and thirteen intercondylar (AO type C) fractures. The average Injury Severity Scores (ISS) of group I and II were 26.7 and 9 respectively. Operations were performed according to biological fixation principles by means of submuscular manner. No grafting was performed to enhance the healing. The cases were evaluated based on the criteria of Schatzker–Lambert and modified Hospital for Special Surgery (HSS) scoring system.

Results: The mean hospitalization time was 16 days (range 13–46) in GI mainly depended on the presence of concomitant injuries and 8 days (range 6–12) in GII. The mean age of the patients was 49 years (range 26–80) (51.6 in GI and 45.6 in GII). The mean follow up period was 25.8 months. Union was achieved in all cases. Two cases required debridement procedures due to deep infection in group I. One of them healed completely but the other not resulted in chronic ostemyelitis. Revision surgery was carried out in one case due to screw pull out at second weeks postoperatively.

The average range of knee motion of the group I and II at the last control were 112.8°, 121.8 respectively. The mean modified HSSs were 73.9 and 79.9 respectively. There was no significant difference for HSS scores and range of knee motion (p> 0.05). Based on the criteria described by Schatzker and Lambert, the outcomes were assessed as excellent in 3 cases, good in 8, fair in 3, and poor in 2 in GI and as excellent in 3, good in 7 and fair in 1 in GII. Poor results of GI were because of osteomyelitis in one case and 15° varus deformity in another. The full weight bearing time was longer in group II depending on the concomitant injuries.

Conclusion: We concluded that LISS is effective method to yield satisfactory results for comminuted supracondylar fractures with multi trauma, even if their final results seem to be lower in comparison to isolated femur fractures.