Purpose: surgical fixation distal femoral fractures has been associated withnonunion and varus collapse. the soft tissue stripping esulted from this fracture and caused by the surgical approach have been factorassociated with delayed union and infection. the limited soft tissue exposure has been lauded as a solution to this fracture. however, it has occurred with new fixation as well (locked plate) this study is an attempt to look at the fixation from the surgical approach prospective. does the liss system improve the results of this difficult fracture? is there truly a difference in the outcome of this fracture utilizing the locked plate system or the percieved difference due to surgical mini invasive approach.

Method: one hundred and forty patientswere screened, and only 53 were randomized and treated in six academic centers over five years. all c3 fractures were excluded from the study as they were felt not to be treatable by the dcs device, but they were treated and fixed appropiately. thirty five females and 18 males were included and appropiately randomized.

Results: fifty three patients were randomized, 28 had the liss implant while 25 had the dcs utilized. there were three nonunions in the liss group, plus two patients required an early reoperation in the early post operative periods ( second – fifth post op. day) due to an early loss of reduction. further more, one patient developed a knee arthrofibrosis that required arthroscopic joint release with subsequent implant failure. that necessiated a reoperation. in the dcs group there was only one nonunion, that required reoperation. this translated into reoperation rate of 21%in the liss group compared to 4% with dcs.

Conclusion: this prospective multicenter randomized trial showeda significant difference when comparing the liss device to the dcs system in minimal invasive approach of distal femoral fractures fixation