Background: There is no consensus on the best treatment of complex intraarticular fractures and high energy diaphyseal fractures of the long bones. The Locking Compression Plate (LCP) and the Less Invasive Stabilization System (LISS) are the new implants with angular stability developed by the AO/ASIF. The new screw-plate systems seem to offer an excellent alternative for the operative fixation in these cases.

Patients and methods: In a prospective study the new system was used to treat 20 patients (8 women, 12 men; average age 39.3 yrs) with 23 high – energy injuries (multifragmentary shaft fractures or complex intraarticular) from december 2001. During a mean period of 20 (13–30) months, complications, clinical and radiographic findings were followed prospectively. One patient was lost to follow-up. 19 patients underwent a standardized follow-up examination. According to the AO classification, 6 were proximal tibial fractures 41-C; 4 distal tibial 43-C; 6 distal femoral 33-C; 3 humerus 12-C and 4 distal radius 23-C. Ten of the fractures were open, 6 grade II, and 4 grade III. Because of severe concomitant injuries, 4 fractures were first treated with an external fixator and definitively stabilized more than two weeks after the injury. 2 patients were operated on after failure of others implants and non-union.

Results: The outcome correlated with the severity of the fracture, anatomic reduction, exact positioning of the plate and concomitant injuries. Despite the large number of open and comminuted fractures no serious complications as deep infections, vascular lesions, DVT or non-unions were presented.

Conclusions: We found the new internal fixator system to be a safe and reliable procedure. The new system offers numerous fixation possibilities and has proven its worth in complex fracture situations and in revision operation. A good knowledge of biomechanics is essential as well as precise preoperative planning.

Between 1972 and 1990, we performed 168 primary low-friction arthroplasties in 125 patients with acetabular protrusion. Twelve hips were lost to follow-up within eight years and eight which became infected were excluded from the final study. Of the 148 hips remaining, 62 with a mild protrusion were classified as group 1, 54 with moderate or severe protrusion as group 2 and, after 1985, 32 with moderate and severe protrusion which required bone grafts as group 3. The mean follow-up was 18.3 years (3 to 24) for group 1, 17.4 years (8 to 22) for group 2 and ten years (8 to 13) for group 3.

There were 31 revisions of the cup, 12 in group 1 and 19 in group 2. According to the Kaplan-Meier analysis the overall rates at 20 years were 21 ± 10.79% in group 1 and 37 ± 11.90% in group 2. There have been 43 radiological loosenings: 22 in group 1, 21 in group 2 and none so far in group 3, at ten years. The overall loosening rates at 20 years were 42 ± 14.76% in group 1 and 49 ± 19.50% in group 2. The grafts were well incorporated in all group-3 hips, and the bone structure appeared normal after one year.

The distance between the centre of the head of the femoral prosthesis and the approximate true centre of the femoral head was less in group 3 than in groups 1 and 2 (p < 0.01). According to the Cox proportional-hazards regression this was the single most important factor in loosening of the cup (odds ratio 1.11; 95% CI 1.05 to 1.18/mm). Better results were obtained in moderate and severe protrusions reconstructed with bone grafting than in hips with mild protrusion which were not grafted.