Successful results of minimally invasive surgery for comminuted supracondylar femoral fractures with LISS: comparative study of multiply injured and isolated femoral fractures

doi:10.1007/s00776-007-1156-8

Journal of Orthopaedic Science

Volume 12, Issue 5, September 2007, Pages 458-465

https://doi.org/10.1007/s00776-007-1156-8 Get rights and content

Abstract

Background

The aim of this prospective study was to compare the outcomes of distal femoral fractures treated by the Less Invasive Stabilization System (LISS) in multiply injured and isolated fracture cases.

Methods

This study comprised 26 patients (16 men, 10 women), who had 27 distal femoral fractures. Patients were divided into two groups; multiple injuries (group I) or isolated distal femoral fracture (group II). The average Injury Severity Score of group I was 26.7. Operations were performed according to biological fixation principles in a submuscular manner. No bone grafting was performed to enhance the healing. The cases were evaluated based on the criteria of Schatzker–Lambert and the modified Hospital for Special Surgery (HSS) scoring system.

Results

The mean follow-up period was 25.8 months. Union was achieved in all cases. Two patients in group I required débridement procedures due to deep infection. One of them healed completely but the other did not. The average range of knee motion of groups I and II at the last control were 112.8° and 121.8°, respectively. The mean modified HSS scores were 73.9 and 79.9, respectively. There was no significant difference in the HSS scores or the range of knee motion. The time to full weight bearing was longer in group I owing to the concomitant injuries.

Conclusions

We concluded that LISS is a useful method for comminuted supracondylar fractures with multiple trauma patients as the results showed no significant differences when compared with those of patients with isolated femoral fractures.

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The objective of this study was to report on the safety, efficacy and clinical outcomes of the Polyax™ Locked Plating System (Biomet, Warsaw, IN, USA) in the management of acute (non-implant related and periprosthetic) distal femoral fractures. We retrospectively reviewed 71 patients with 73 distal femoral fractures. Thirty-three of the included fractures occurred around previously placed implants. The average patients’ age was 67 years (range 18–98). There were 7 early postoperative complications (9.5%) including one deep surgical site infection, 2 pulmonary embolisms and 4 urinary or respiratory infections. At final follow-up (mean 12, range 9–55 months) all fractures progressed to clinical and radiological union. However, major revision surgery for healing problems was required in 5 cases (6.8%) and minor in 3 cases (4.1%). The average time to healing was 6 (range 3–23) months. Angulation less than 5 degrees in any plane was observed in 66 cases (89.7%), within 5–10 degrees in 5 cases (7.3%) and within 10–15 degrees in 2 cases (2.9%). The mean pre-injury and final follow-up values of Glasgow Outcome Scale were 1.5 (1–3) and 1.7 (1–3) respectively. Overall 61 patients (83.53%) retained their pre-injury activity status. The Polyax™ Locked Plating System offers a safe and efficient fixation in distal femoral fractures.
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Fractures of the distal femur are rare and severe. The estimated frequency is 0.4% with an epidemiology that varies: there is a classic bimodal distribution, with a frequency peak for men in their 30s and a peak for elderly women; however, at present it is found predominantly in women and in the elderly with more than 50% of patients who are over 65. The most common mechanism is an indirect trauma on a bent knee, and more rarely direct trauma by crushing. The anatomy of the distal femur explains the three major types of fracture. Because of the anatomy of the distal femur, only surgical treatment is indicated to stabilize the fracture. A non-surgical treatment is a rare option. The aim of this report was to provide an update on the existing surgical solutions for the management of these fractures and describe details of the surgical technique applicable to these injuries. Recent radiological, clinical and biomechanical data published in the literature are reported to compare different surgical options.
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Les fractures du fémur distal sont des fractures rares et graves. La fréquence est estimée à 0,4 % avec une épidémiologie qui évolue : la classique répartition bimodale persiste avec un pic de fréquence chez l’homme trentenaire et un pic chez la femme âgée, mais il apparaît une prédominance féminine et un vieillissement avec plus de 50 % des patients qui ont plus de 65 ans. Le mécanisme est le plus souvent un traumatisme indirect sur un genou en flexion, plus rarement un traumatisme direct par écrasement. L’anatomie du fémur distal explique les trois grands types de fracture. Compte tenu de ces considérations anatomiques, seul un traitement chirurgical est indiqué pour stabiliser la fracture. Le traitement orthopédique est exceptionnel. Le but de ce travail est de faire l’état de l’art actuel sur les différentes solutions chirurgicales pour la prise en charge de ces fractures en précisant les spécificités techniques. Les données radiocliniques et biomécaniques récentes de la littérature sont rapportées permettant la comparaison des montages.
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Mean length of hospitalisation was presented in 3 papers reporting a mean of 14.7 (5–61) days. Time to observable callus formation was assessed in 3 articles, with a mean duration of 7 weeks, ranging from 414 to 17 weeks.28 Table 3 illustrates post-operative complications.
The purpose of this systematic review was to assess the literature evaluating the clinical and radiological outcomes following less invasive surgical stabilisation system (LISS) fixation of distal femoral fractures (AO 32/33).
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Original articleSuccessful results of minimally invasive surgery for comminuted supracondylar femoral fractures with LISS: comparative study of multiply injured and isolated femoral fractures

Abstract

Background

Methods

Results

Conclusions

Injury

Injury

Injury

Op Tech Orthop

Injury

Injury

Injury

Injury Extra

Evolution of the internal fixation of long bone fractures: the scientific basis of biological internal fixation — choosing a new balance between stability and biology

J Bone Joint Surg Br

Changes in AO/ASIF principles and methods

Injury

The evolution of indirect reduction techniques for the treatment of fractures

Clin Orthop

The evolution of modern plate osteosynthesis

Injury

Preliminary stabilization of the Less Invazive Stabilization System

J Orthop Trauma

Original article
Successful results of minimally invasive surgery for comminuted supracondylar femoral fractures with LISS: comparative study of multiply injured and isolated femoral fractures