The distal femur fracture is a difficult injury that affects young men andelderly women. The tissue stripping that occurs with the traditional approach has been a factor in the development of complications like infection and nonunion. This study addresses the issue of minimally invasive approach. Does the LISS system really improve the results of such fracture?

Fifty-two patients were included in the trial from six academic trauma centres. Twenty-eight fractures had been randomised to be fixed with the LISS device, while twenty-four had the DCS implant. Type C3 fractures were excluded as they were not amenable for fixation with DCS system. All procedures were performed via minimally invasive technique. The LISS system had the targeter that helped with plate insertion and distal diaphyseal screws placement. Radiography was utilised in the case of the DCS distal screws insertion.

All fractures went onto union, except two participants in LISS group who had to be revised due to loss of reduction, in the early post-operative peroid. There were three nonunions in the same group. These required a re-operation. Further more, a LISS participant who had re-injured his distal femur (unrelated to LISS plate), was fixed with different implant. There was a single nonunion with the DCS group that needed revision surgery. There was one participant from each group who had drifted into varus. Neither required a re-operation. This translated into a 21% re-operation rate in the LISS system compared to 4% with the DCS device.

Our data supports the use of the DCS system in the fixation of distal femur fractures (except Type C3} via a minimally invasive approach. The LISS implant seems to be technique dependent. In our centre, the LISS plate had been discontinued in favour of the DCP and LCP systems.

Introduction

Humeral non-union may present a challenging problem. The instability from the un-united fracture leads to pain, disability and significant morbidity. The incidence of humeral shaft non-union as a complication of both operative and non-operative treatment is approximately 8% to 12%. This retrospective study reviews the results of surgical treatment of humeral fracture non-union performed by a single surgeon with a consistent surgical protocol.

Introduction

The precise indications for tibial component metal backing and modularity remain controversial in routine primary total knee arthroplasty. This is particularly true in elderly patients where the perceived benefits of metal backing such as load redistribution and the reduction of polyethylene strain may be clinically less relevant. The cost implications for choosing a metal-backed design over an all-polyethylene design may exceed USD500 per primary knee arthroplasty case.