The Less Invasive Stabilisation System (LISS) was introduced with the aim to decrease the incidence of fracture nonunion and the need for primary bone grafting. We aim to describe the cases of nonunion of osteoporotic distal femoral fractures treated with the LISS at our institution and to review the cases of nonunion published in the literature.

Three cases of nonunion of osteoporotic distal femoral fractures treated with the LISS at our institution were identified. A thorough retrospective analysis of the available clinical information was performed. To identify all published papers on LISS, an exhaustive literature search was performed. The Medline and PubMed databases were searched for the following keywords: femoral fractures, distal femoral fractures, supracondylar, LISS, less invasive stabilization system and femoral no nunions. The search period was 1996 to 2008. All relevant studies were analysed.

Low energy trauma was responsible for the closed fractures encountered in our patients. Two patients sustained fractures around a joint arthroplasty: one fracture above a total knee arthroplasty and one fracture below a total hip arthroplasty. The operative technique consisted of indirect reduction on the traction table and minimally invasive percutaneous osteosynthesis. The postoperative radiographic alignment was satisfactory for all fractures. Aseptic nonunion was diagnosed in all patients. Implant failure occurred in two patients with fracture of the proximal screws in one case and fracture of the distal screws in the second case. No case s of failure of distal locking screws have previously been described in the literature. No other complications were identified. The literature search identified 21 cases of fracture nonunion. Six of these fractures occurred in osteoporotic bones as a result of low energy trauma. All 6 fractures were above a total knee arthroplasty.

The LISS is a new implant who has shown good results in the management of difficult distal femoral fractures. Its use is however not without problems: concerns with regards to inadequate or excessive rigidity and a demanding surgical technique are just some of the issues.

Surgical treatment is considered for treatment of plantar fasciitis in the 10% of patients who do not improve with large range of non-operative measures. The aim of this study is to describe a surgical technique that maintains normal foot mechanics by preserving the integrity of plantar fascia and to demonstrate its effectiveness in the treatment of severe plantar fasciitis unresponsive to no-operative treatment.

The study is a retrospective-prospective analysis of patients who underwent surgery for plantar fasciitis unresponsive to at least 6 month of non-operative measures. The surgical technique involves excision of the heel spur if present, drilling of the calcaneus and a split of the plantar fascia in line with its fibres taking great care not to detach it from its calcaneal attachment. The clinical outcome was assessed prospectively using the Foot and Ankle Ability Measure which is a self-reported questionnaire used to assess the effectiveness of treatment in ankle and foot disorders.

Between 1993 and 2007, 52 patients (56 feet) had surgery for plantar fasciitis. There were 35 females and 17 males and the average age at surgery was 51. Retrospective data was available on all patients. No patients had prior surgery for their symptoms. Of 52 patients treated, 34 were able to be contacted at an average of 46 months after surgery. The average FAAM score was 93 (maximum of 100, 95%CI, 89, 97) and 80% of patients reported a normal or nearly normal overall level of function with no reports of a severely abnormal level of function. Two patients reported no change in symptoms after the surgery. All other patients reported they were satisfied with the outcome of surgery. No patient reported recurrence of symptoms or further surgery for plantar fasciitis. The early postoperative complications were superficial cellulitis (2 patients), wound breakdown (3 patients) and deep vein thrombosis (1 patient). The only long term complication was hypoaesthesia around the surgical scar (8 patients) with no adverse impact on the final outcome.

Plantar fascia release or division has been associated with altered foot biomechanics which may be responsible for forefoot fractures and medial and lateral column foot pain sometimes described after this procedure. Our surgical technique avoids these problems by preserving the integrity of plantar fascia and at the same time is very effective in relieving the symptoms of chronic and severe plantar fasciitis.