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Use of the Less Invasive Stabilization System (LISS) in patients with distal femoral (AO33) fractures: a prospective multicenter study

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Abstract

Introduction

The Less Invasive Stabilization System (LISS) is an internal fixator that can be inserted percutaneously by means of a minimally invasive surgical approach. This paper presents the use of this system exclusively in patients with AO33 distal femoral fractures, a group in which fracture management is often complicated by multiple trauma and soft-tissue damage.

Materials and methods

A series of 62 patients (mean age 52 years) with 66 AO33A or C fractures received the LISS implant and were followed prospectively for 12 months. Assessments included the radiographic evaluation of implant placement and healing, measurement of valgus/varus and sagittal joint malalignment, and the assessment of weight-bearing capacity and range of motion.

Results

The mean duration of surgery was 85 min (range 40–135 min) for 33A fractures and 149 min (range 50–300 min) for 33C fractures. Postoperative radiographic assessments showed that the LISS implant was positioned correctly in 59 cases (89%). Assessment of valgus/varus alignment showed correct axial alignment in 49 cases (74%), a deviation of 5–10° in 13 cases, and a 10–20° deviation in 1 case. Correct sagittal alignment was observed in 56 cases (85%), 5–10° malalignment in 5 cases, and 10–20° in 2 cases. During the course of the 1-year follow-up, 8 patients (9 fractures) died; 2 other patients were not available for follow-up. Complete fracture healing was achieved in 85% of the followed-up patients. Forty-eight patients were capable of full weight-bearing. After fracture healing, maximum flexion of the injured limb was on average 80% of the range of the uninjured limb. An extension deficit of more than 5° was measured in 3 cases. Of the 62 patients, 14 underwent further operations during the course of follow-up. Of these, 6 required bone grafting and 3 refixation of the implant due to implant loosening. Deep infections requiring several debridements occurred in 2 patients. No complications relating solely to the implant were observed.

Conclusion

The LISS showed good overall results in the treatment of these difficult fractures. It is a good alternative to conventional extramedullary and intramedullary stabilizing techniques, especially in more complex fracture situations.

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Acknowledgements

We would like to acknowledge the following centres for their contribution: Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum der Charité, Humboldt Universität zu Berlin; Medizinische Hochschule Hannover; BG Unfallklinik Tübingen; Universitätsklinikum Benjamin Franklin Berlin; Inselspital Bern; Kantonsspital Basel; Kantonsspital Fribourg; Spital Davos; Academisch Ziekenhuis Utrecht.

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Authors and Affiliations

  1. Klinik für Unfall- u. Wiederherstellungschirurgie Universitätsklinikum Charité Campus, Virchow-Klinikum Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Michael Schütz & Norbert Haas

  2. AO Clinical Investigation and Documentation, Stettbachstr. 10, 8600, Dübendorf, Switzerland

    Mathias Müller

  3. Kantonsspital Basel, Spitalstrasse 21, 4031, Basel, Switzerland

    Pietro Regazzoni

  4. BG-Unfallklinik, Schnarrenbergstrasse 95, 72076, Tübingen, Germany

    Dankward Höntzsch

  5. Trauma Department Hannover, Medizinische Hochschule, Carl Neuberg Str. 1, 30625, Hannover, Germany

    Christian Krettek

  6. Academisch Ziekenhuis Utrecht, Postbus 85500, 3508 GA , Utrecht, The Netherlands

    Christian Van der Werken

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  1. Michael Schütz
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  2. Mathias Müller
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  3. Pietro Regazzoni
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  4. Dankward Höntzsch
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  5. Christian Krettek
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  6. Christian Van der Werken
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  7. Norbert Haas
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Correspondence to Mathias Müller.

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Schütz, M., Müller, M., Regazzoni, P. et al. Use of the Less Invasive Stabilization System (LISS) in patients with distal femoral (AO33) fractures: a prospective multicenter study. Arch Orthop Trauma Surg 125, 102–108 (2005). https://doi.org/10.1007/s00402-004-0779-x

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