Indications for treatment of femoral trochanteric fractures with reversed less invasive stabilization system (LISS)

Abstract

Objective To discuss outcomes of and indications for treatment of femoral trochanteric fractures with reversed less invasive stabilization system (LISS).Methods A retrospective study was performed for 72 consecutive patients with femoral trochanteric fracture who had been treated with reversed LISS at our institution between June 2005 and June 2011.They were 33 men and 39 women,with a mean age of 73.4 years (range,45 to 87 years).The operation time,intraoperative blood loss,intra-hospital complications and internal fixation-related complications at the last follow-up were analyzed.The fracture union was assessed by follow-up radiographs and hip functional recovery by Harris hip scoring.Results The operation time averaged 141.4 minutes and the intraoperative blood loss averaged 138.1 mL.The intra-hospital complications included deep venous thrombosis in 3 cases,pneumonia in one,gastrointestinal bleeding in one,postoperative delirium in one,and a death resulting from multiple organ failure.Sixty-five patients (90.3％) obtained a mean follow-up of 22.1 months (range,18 to 46 months).The fracture union was achieved after an average of 4.2 months (range,3 to 8 months).The mean Harris score at the last follow-up was 73.7 points (range,20 to 100 points).Eight patients were excellent,19 good,25 fair and 13 poor,giving an excellent to good rate of 41.5％.The internal fixation-related complications at the last follow-up were observed in 10 out of the 65 patients (15.4％),including 6 cases of screw breakage,one of nonunion,one of plate breakage,one of screw loosening and one of malunion.Conclusions Reversed LISS should not be a routine treatment for femoral trochanteric fractures because of its high rate of complications.We recommend its indications include fractures more complex than AO type 31A2.2,those with a narrow medullary canal,those with a severely bowed or deformed femur,pathologic and periprosthetic ones and those with multiple traumas and a priority of immediate trauma control. Key words: Hip fractures; Fracture fixation, internal; Bone plates; Surgical procedures,minimally invasive; Indication