Treatment Of Supracondylar Femoral Fractures Research Articles

[Translated article] Treatment of supracondylar femoral fractures by minimally invasive techniques vs. exposure of the fracture site: A retrospective cohort study

IntroductionFractures of the distal femoral third are an important cause of morbidity and mortality, and their treatment is currently controversial. ObjectivesTo compare the results between minimally invasive techniques versus exposure of the fracture site. Secondly, to evaluate the relationship between demographic factors, mechanism of injury and surgical delay with patient prognosis. MethodRetrospective cohort study carried out between 2015 and 2021 in a tertiary hospital. Data collection was performed by reviewing medical histories, measuring demographic and hospital parameters and definitive treatment strategy. One year of follow-up was completed in all patients, assessing the occurrence of surgical complications and mortality. A stratified analysis of the variables of interest was performed among patients over 65 years of age. Results128 fractures were recorded, with definitive osteosynthesis being performed in 117. Patients who underwent minimally invasive techniques required a shorter hospital stay (9 [7–12] vs. 12 [8.75–16] days) (p=0.007), with no differences in mortality or complications during follow-up. In those over 65 years of age, opening the fracture site was associated with an increased risk of infection compared to minimally invasive techniques (33.3% vs. 2%) (p=0.507). All the deceased were patients over 65 years of age (33.7% at one year). Surgical delay longer than 48h increased mortality by 10% among those older than 65 years (p=0.3). High-energy trauma had a higher proportion of pseudarthrosis (27.6% vs. 6.1%) (p=0.011). ConclusionsMinimally invasive techniques decreased hospital stay but not complications or long-term mortality.Level of evidence: IIb.

El uso del carbono en fracturas distales de fémur.

The surgical treatment of supracondylar femoral fractures in both poor-quality bone and high-energy fractures presents challenging task for the traumatologist. We present our experience with the use of carbon fiber reinforced plates and nails, along with other osteosyntheses, in the treatment of 9 patients with distal femur fractures. A group of patients, all women, with low-energy fractures, and another group of 3 male patients with a history of high-energy fractures (two nonunions). All patients consolidated, except for one infected nonunion whose osteosynthesis had to be changed. The. use of this method for the treatment of peri-implant femoral fractures and complex fractures we believe provides a successful and technically similar solution to other osteosyntheses

Treatment of Cats Distal Diaphyseal and Supracondylar Femur Fractures with Dynamic Intramedullary Cross Pinning Technique

This study was conducted on 12 cats with 11 supracondylar femur fractures and one distal diaphyseal femur fracture. Fracture properties, operation details, postoperative complications, and radiographic images of the cases were recorded. The supracondylar fractures in the study were classified according to Salter‐Harris, and they were determined as type I in 1, Type II in 7, and Type IV in 3 of them. Dynamic intramedullary cross pinning technique was applied to patients with Salter‐Harris type II, type I and distal diaphyseal femur fractures, dynamic intramedullary cross pinning, and intercondylar screw application, as for that, was applied to patients with Salter‐Harris type IV fractures. It was observed that 8 of the 12 patients who were operated on used their extremities after removing the bandage on the relevant extremity. In two patients with Salter‐Harris type IV fractures, lameness was observed due to fractures in other regions, but extremity movement returned to normal after healing the bone. A patient with a Salter‐Harris type IV fracture, due to the extent of the damage to the joint as a result of trauma, had narrowing and limping in the joint angle. In a patient with a Salter‐Harris type I fracture, pin migration occurred five days after the operation, and the cross‐pinning technique was applied in a second operation. In consequence of the findings, it was observed that the dynamic intramedullary cross pinning technique was influential in the treatment of supracondylar femur fractures in cats.

The effect of surgeon-controlled variables on construct stiffness in lateral locked plating of distal femoral fractures

BackgroundNonunion following treatment of supracondylar femur fractures with lateral locked plates (LLP) has been reported to be as high as 21 %. Implant related and surgeon-controlled variables have been postulated to contribute to nonunion by modulating fracture-fixation construct stiffness. The purpose of this study is to evaluate the effect of surgeon-controlled factors on stiffness when treating supracondylar femur fractures with LLPs:Does plate length affect construct stiffness given the same plate material, fracture working length and type of screws?Does screw type (bicortical locking versus bicortical nonlocking or unicortical locking) and number of screws affect construct stiffness given the same material, fracture working length, and plate length?Does fracture working length affect construct stiffness given the same plate material, length and type of screws?Does plate material (titanium versus stainless steel) affect construct stiffness given the same fracture working length, plate length, type and number of screws?MethodsMechanical study of simulated supracondylar femur fractures treated with LLPs of varying lengths, screw types, fractureworking lenghts, and plate/screw material. Overall construct stiffness was evaluated using an Instron hydraulic testing apparatus.ResultsStiffness was 15 % higher comparing 13-hole to the 5-hole plates (995 N/mm849N vs. /mm, p = 0.003). The use of bicortical nonlocking screws decreased overall construct stiffness by 18 % compared to bicortical locking screws (808 N/mm vs. 995 N/mm, p = 0.0001). The type of screw (unicortical locking vs. bicortical locking) and the number of screws in the diaphysis (3 vs. 10) did not appear to significantly influence construct stiffness (p = 0.76, p = 0.24). Similarly, fracture working length (5.4 cm vs. 9.4 cm, p = 0.24), and implant type (titanium vs. stainless steel, p = 0.12) did also not appear to effect stiffness.DiscussionUsing shorter plates and using bicortical nonlocking screws (vs. bicortical locking screws) reduced overall construct stiffness. Using more screws, using unicortical locking screws, increasing fracture working length and varying plate material (titanium vs. stainless steel) does not appear to significantly alter construct stiffness. Surgeons can adjust plate length and screw types to affect overall fracture-fixation construct stiffness; however, the optimal stiffness to promote healing remains unknown.

Use of carbon plates for the treatment of supracondylar femoral fractures: preliminary experience

INTRODUCTION
 Distal femur fractures in adults have an estimated annual incidence of 6% of all femur fracture. Choice of the type of fixation depends on the characteristics of the fracture and the general condition of the fractures Carbon fiber reinforced—polyetheretherketone (CFRPEEK) offer several potential benefits when compared with metal alloy implants, including a modulus of elasticity approaching cortical bone and fatigue strengths greater than most metals.
 MATERIAL AND METHODS
 We retrospectively identified treat 17 patients, treated with minimally invasive plate osteosynthesis (MIPO) with carbon plates (Piccolo Composite ®). The patients were evaluated with clinical and radiographic follow-up at 1 month, 3 month, 6 month e 1 year. The clinical evaluation was performed using knee society score (KSS) and the CAS score.
 RESULTS
 Clinically 15 of 17 patients examined healed (88,2 %), 1 patient (5,8 %)went to delay of consolidation healed in 11 month), 1 (5,8 %) patients went to non-union and we perform a revision arthroplasty. The mean healing time was 92,88 days (st. dev 28,63, min. 56 d – max 140). The mean CAS score at 1 year was 4,47 (st. dev 1,46, min 2 – max 6). The mean KSS at 1 year was 73,11
 DISCUSSION
 Titanium has good osseointegrative properties and an elastic modulus more similar to bone. Carbon plates with a stiffness closer to the 159 modulus of elasticity of bone, and exhibiting better fatigue properties, could be a good alternative to existing metallic plates. Our group of patients showed average healing time of about three months, but the formation of callus is evident as early as 1 month after surgery. For this reason a partial weight bearing was early allowed in 15 patients. Which guarantees a recovery of daily activities from 5 months after surgery, reducing the risk of mortality.
 CONCLUSION
 The new carbon plates guarantee the possibility of performing a more elastic synthesis that is closer to the biological characteristics of the bone.

Clinical study on the use of supracondylar femur plate (J plate/ hockey stick plate) for repair of supracondylar femur fractures in cats

The current study was undertaken to evaluate the clinical efficacy of Supracondylar femur plate for repair of supracondylar femur fractures in cats. Out of the clinical cases presented, 1% of cases in cats correspond to fractures, in which 25% correspond to supracondylar femur fractures. This study was conducted on six cats with age ranging from 4-11months, in 5 female and 1 male cat presented to the Department of Veterinary Surgery and Radiology at the College of Veterinary Science, Hyderabad with the chief complaint of falling from an height. These six cases of fractures were diagnosed by clinical signs, orthopaedic examination and survey radiography. The symptoms observed in the cats presented for treatment were pain on manipulation, abnormal angulation and lameness immediately after trauma, swelling, non-weight bearing, dangling of the limb and crepitation at the fracture site. Pre-operative radiographic examination in plain orthogonal views, i.e., cranio-caudal and medio-lateral radiographs revealed supracondylar fractures in all cats. These fractures were stabilized with 2.0 mm supracondylar femur plate 1 in right femur and 5 in left femur. Good implant stability throughout the treatment period without any complications was achieved all cats. In all six cats in the present study showed partial weight bearing on the 1st post- operative day. All cats showed normal weight bearing at rest, the weight bearing of the affected limb while walking from 2nd Post-operative day. All cats achieved complete weight bearing by 15th post-operative day. i.e. from Grade V to Grade I. The radiographs obtained on 30th day Post-operative day revealed proper apposition, decreased fracture gap, appearance of progressive bridging callus with adequate radio-density in all 6 cats, and on 60th day revealed continuity of complete corticomedullary cavity and compete bone formation without any complications with fast healing. Based on present study, it was concluded that supracondylar femur plate was successful in the treatment of supracondylar femur fractures in cats.

More than a reposition tool: additional wire cerclage leads to increased load to failure in plate osteosynthesis for supracondylar femoral shaft fractures

IntroductionSurgical treatment of supracondylar femoral fractures can be challenging. An additional wire cerclage is a suggested way to facilitate fracture reduction prior to plate osteosynthesis. Denudation to the periosteum remains a problematic disadvantage of this procedure.This study analyzed the effect of an additional wire cerclage on the load to failure in plate osteosynthesis of oblique supracondylar femoral shaft fractures.Materials and methodsOn eight pairs of non-osteoporotic human femora (mean age 74 years; range 57–95 years), an unstable AO/OTA 32-A2.3 fracture was established. All specimens were treated with a polyaxially locking plate. One femur of each pair was randomly selected to receive an additional fracture fixation with a wire cerclage. A servohydraulic testing machine was used to perform an incremental cyclic axial load with a load to the failure mode.ResultsSpecimens stabilized with solely plate osteosynthesis failed at a mean load of 2450 N (95% CI: 1996–2904 N). In the group with an additional wire cerclage, load to failure was at a mean of 3100 N (95% CI: 2662–3538 N) (p = 0.018).Compression deformation with shearing of the condyle region through cutting of screws out of the condylar bone was the most common reason for failure in both groups of specimens. Whereas axial stiffness was comparable between both groups (p = 0.208), plastic deformation of the osteosynthesis constructs differed significantly (p = 0.035).ConclusionsAn additional wire cerclage significantly increased the load to failure. Therefore, an additional cerclage represents more than just a repositioning aid. With appropriate fracture morphology, a cerclage can significantly improve the strength of the osteosynthesis.

Closed reduction combined with Taylor three-dimensional space stent fixation for supracondylar femoral fracture in children

To explore the effectiveness and safety of closed reduction combined with Taylor three-dimensional space stent fixation in treatment of supracondylar femoral fractures in children. Between July 2008 and July 2016, 20 patients with supracondylar femoral fractures were treated with closed reduction combined with Taylor three-dimensional space stent fixation. There were 14 males and 6 females, with an average age of 10.3 years (range, 6-14 years). The cause of injury was traffic accident in 5 cases, falling from high place in 6 cases, and falling in 9 cases. All fractures were closed fractures. Among them, 12 cases were flexion type and 8 cases were straight type. According to AO classification, 12 cases were rated as type A1 and 8 cases as type A2. The fractures were over 0.5-5.0 cm (mean, 2.5 cm) of the epiphysis line. The time from injury to surgery was 2-8 days (mean, 3.5 days). Postoperative knee joint function was evaluated based on the Kolment evaluation criteria. All children were followed up 6-24 months (mean, 18.1 months). There was no complication such as nail infection, vascular nerve injury, external fixation looseing, fracture displacement, or re-fracture. All fractures healed and the fracture healing time was 4-6 weeks with an average of 4.5 weeks. The stent removal time was 8-12 weeks (mean, 9.5 weeks). The gait and knee function recovered, and there was no abnormality of the epiphysis. At last follow-up, the knee joint function were excellent in 18 cases and good in 2 cases according to the Kolment evaluation criteria, and the excellent and good rate was 100%. Closed reduction combined with Taylor three-dimensional space stent fixation is an effective treatment for the children with supracondylar femoral fractures, with small trauma and rapid recovery. It can avoid damaging the tarsal plate, be high fracture healing rate, and promote the recovery of limb function.

A double-plating approach to distal femur fracture: A clinical study

BackgroundLocked plating is one of the latest innovative options for treating supracondylar femur fractures with relatively low failure rates. Single lateral plating was often found to have a relative higher failure rate. No clinical studies of double-plating distal femur fixation have thus far been reported. The aim of this study is to present our clinical experience with this surgical approach. Patients and methodsThirty-two patients (26 females and 6 males, mean age 76 years, range 44–101) were included in the study. Eight of them patients had a periprosthetic stable implant fracture and two patients were treated for a nonunion. ResultsAll fractures, excluding one that needed bone grafting and one refracture, healed within 12 weeks. One patient needed bone grafting for delayed union and one patient needed fixation exchange due to femur re-fracture at the site of the most proximal screw. Two patients developed superficial wound infection and one patient required medial plate removal after union due to deep infection. ConclusionsBased on these promising results, we propose that the double-plating technique should be considered in the surgeon’s armamentarium for the treatment of supracondylar femur fractures, particularly in patients with poor bone quality, comminuted fractures and very low periprosthetic fractures.

Analysis of risk factors for failure of locked plate fixation of distal femur fracture

Background: It is quite rare as well as severe to seen commonly distal femur fractures. 0.4% and 3% is the estimated frequency of all fractures and femoral fractures. The gender ratio has changed and today there is a majority of women, and the population is also increasingly older; mean 61 years old at fracture and over 65 in more than half the cases. Hence; we planned this study to examine patients with distal femoral fractures which were treated with locked plates, to assess the various risk factors responsible for complications. Materials & Methods: The present study was carried out in department of orthopaedics and included 400 patients who were treated with open reduction internal fixation (OIF) using a lateral distal femoral locked plate construction. Prospective institutional databases were used to gather information on the fixation which included locked screws in the distal fragment and non-locked, locked, or a combination of locked and non-locked screws in the proximal fragment of the bone. Only the patients with unilateral fracture were included for the present study. All the patients were divided into three predominant groups for the sake of convenience of description, namely; the entire cohort group, group with closed fractures, and group with open fractures. Primary outcome measures included reoperation to promote union, deep infection, and construction failure. These dependent variables were used in statistical analyses. For the identification of the risk factors, the 3 separate groups (entire cohort, closed fractures, and open fractures) were used for each of these populations. Results: A little of 20% of the total fractures required re-operation. Diabetes and open fractures were found to be the independent risk factors for reoperation to promote union and deep infection. For implant failure, risk factors included open fracture, smoking and shorter plate length. Conclusion: It is more advantageous to use relatively long constructs for the treatment of supracondylar femur fractures

Role of retrograde short nail in the treatment of supracondylar femoral fractures (extra-articular type A)

ObjectivesThe aim of the study was to evaluate the results of retrograde short nailing in the treatment of supracondylar femoral fractures (type A, extra-articular fracture).BackgroundThe incidence of distal femur fractures is increasing in our country as traffic accidents increase. Problems with distal femur fractures may not be limited to the femur itself, but may extend to internal knee structures.Patients and methodsThis work was a prospective study of 30 patients with supracondylar femoral fractures (extra-articular type A) treated with a short retrograde femoral nail. All patients were evaluated both clinically and radiologically through routine follow-up visits and all information concerning each patient was collected and recorded using the patient information sheet and data were tabulated and evaluated.ResultsIn our study of 30 patients with type A supracondylar fractures treated with a retrograde nail, we found excellent results in eight patients, good results in 16 patients, fair results in four patients, and poor results in two patients (P > 0.040).ConclusionTreatment of supracondylar femoral fractures (type A, extra-articular fracture) with a retrograde short nail yields satisfactory results in adults.

Selfdynamisable internal fixator Mitkovic in treatment of periprosthetic supracondylar femoral fracture after total knee arthroplasty

Supracondylar periprosthetic femoral fractures after total knee arthroplasty are very rare, but very difficult to treat. They occur most often as a result of low energy trauma (slips and fall) in older patients with present osteoporosis and periprosthetic osteolysis. The treatment of these fractures is very difficult due to reduced biological capacity for healing in most cases. Surgical treatment of these fractures is accompanied by severe complications (prolonged healing, nonunion and disintegration osteosintets material) in 25 to 70% of the cases. The aim of this paper is to present the treatment of supracondylar femur fractures after total knee arthroplasty in men aged 72 with selfdynamisable internal fixator Mitkovic. Surgical treatment of fracture performed on the six day after the injury with minimally invasive surgical technique through two incisions. Verticalization and walking with crutches with non-weight-bearing started the first postoperative day. Patient discharged from hospital fifth postoperative day. Full weight-bearing on the operated leg is allowed after 6 weeks. The patient started a stationary physical therapy 6 weeks after surgery. Postoperative follow-up was 10 months. The fractures healed with an excellent functional result. Application of selfdynamisable internal fixator Mitkovic with minimally invasive technique in the treatment of these complex fractures provides excellent biomechanical conditions for healing.

Retrograde intramedullary nails with distal screws locked to the nail have higher fatigue strength than locking plates in the treatment of supracondylar femoral fractures

We investigated a new intramedullary locking nail that allows the distal interlocking screws to be locked to the nail. We compared fixation using this new implant with fixation using either a conventional nail or a locking plate in a laboratory simulation of an osteoporotic fracture of the distal femur. A total of 15 human cadaver femora were used to simulate an AO 33-A3 fracture pattern. Paired specimens compared fixation using either a locking or non-locking retrograde nail, and using either a locking retrograde nail or a locking plate. The constructs underwent cyclical loading to simulate single-leg stance up to 125,000 cycles. Axial and torsional stiffness and displacement, cycles to failure and modes of failure were recorded for each specimen. When compared with locking plate constructs, locking nail constructs had significantly longer mean fatigue life (75,800 cycles (SD 33,900) vs 12,800 cycles (SD 6100); p = 0.007) and mean axial stiffness (220 N/mm (SD 80) vs 70 N/mm (SD 18); p = 0.005), but lower mean torsional stiffness (2.5 Nm/° (SD 0.9) vs 5.1 Nm/° (SD 1.5); p = 0.008). In addition, in the nail group the mode of failure was either cut-out of the distal screws or breakage of nails, and in the locking plate group breakage of the plate was always the mode of failure. Locking nail constructs had significantly longer mean fatigue life than non-locking nail constructs (78,900 cycles (SD 25,600) vs 52,400 cycles (SD 22,500); p = 0.04). The new locking retrograde femoral nail showed better stiffness and fatigue life than locking plates, and superior fatigue life to non-locking nails, which may be advantageous in elderly patients.

Supracondylar femoral fracture treatment in an obese population

Supracondylar femur fracture care in the morbidly obese population is challenging. Historically, Lambotte's seven steps of fracture treatment have been helpful in clarifying the surgical process. This article reviews these classic steps, modifies them slightly, and applies them to the treatment of supracondylar femur fractures in the morbidly obese population.

Biomechanical Evaluation of Peri- and Interprosthetic Fractures of the Femur

Because of an increasing life expectancy of patients and the rising number of joint replacements, peri- and interprosthetic femoral fractures are a common occurrence in most trauma centers. This study was designed to answer two primary questions. First, whether the fracture risk increases with two intramedullary implants in one femur; and second, whether a compression plate osteosynthesis is sufficient for stabilizing an interprosthetic fracture. Twenty-four human cadaveric femurs were harvested and four groups were matched based on the basis of bone density using a peripher quantitative computer tomography (pQCT). All groups-(I) hip prosthesis with a cemented femoral stem; (II) hip prosthesis and retrograde femoral nail; (III) hip prosthesis, retrograde femoral nail, and lateral compression plate; (IV) all three implants with an additional simulated interprosthetic fracture-were biomechanically tested in a four-point bending in lateral-medial direction. The second group with two intramedullary implants exhibited 20% lower fracture strength in comparison with group 1 with proximal femoral stem only. The stabilization of an interprosthetic fracture with a lateral compression plate (group IV) resulted in a fracture strength similar to femur with prosthesis only. Two intramedullary implants reduce the fracture strength significantly. If an interprosthetic fracture occurs, sufficient stability can be achieved by a lateral compression plate. Because two intramedullary implants in the femur may decrease the fracture strength, the treatment of supracondylar femoral fractures with a retrograde nail in cases with preexisting ipsilateral hip prosthesis should be reconsidered.

Operative Versus Nonoperative Management of Distal Femur Fracture in Myelopathic, Nonambulatory Patients

Treatment of supracondylar femur fractures in myelopathic, nonambulatory patients has traditionally been nonoperative, emphasizing careful skin protection, limited mobilization, and acceptance of malunion. This study compares the results of surgical treatment with nonsurgical treatment in this patient population. The records of all myelopathic, nonambulatory patients treated for supracondylar femur fractures (OTA code 33) between 2001 and 2006 were reviewed: 25 patients (29 fractures) were discovered (11 women, 14 men; average age, 51 years). Surgical treatment was performed in 17 fractures (13 retrograde intramedullary rods and 4 plates) and nonsurgical treatment in 12 fractures. Union was obtained in all operatively treated fractures and in 90% of nonsurgically treated fractures. Average follow-up was 16 months. One patient treated with a retrograde nail sustained a nondisplaced intertrochanteric hip fracture treated nonoperatively. One patient treated operatively developed a late deep infection. There were no other surgical-related complications. Skin or wound complications developed in no patients treated surgically and in 4 patients treated nonsurgically (P=.0208). Three patients with nonoperatively treated fractures required eventual surgery (3 above-knee amputations). Operative treatment of femoral fractures in nonambulatory patients with myelopathy is safe and effective. There were fewer skin and wound complications in the surgically treated supracondylar femur fractures.

RETROGRADE NAILING VERSUS FIXED‐ANGLE BLADE PLATING FOR SUPRACONDYLAR FEMORAL FRACTURES: A RANDOMIZED CONTROLLED TRIAL

A variety of devices have been used in the treatment of supracondylar femoral fractures. The condylar blade plate relies on the principles of open reduction, absolute stability and interfragmentary compression to achieve union. The technique of retrograde nailing uses indirect reduction of the metaphyseal fracture component, offering relative stability and a less invasive approach. Randomized comparison of these common methods of fixation has not been reported. Twenty-two patients with 23 supracondylar femur fractures were recruited from two regional trauma centres over a 26-month period and randomized to receive either a retrograde intramedullary nail fixation (IM group, 12 fractures) or a fixed-angle blade plate fixation (BP group, 11 fractures). The groups were followed for 12-36 months. The primary outcome measures were revision surgery and general health. Three patients in the IM group required revision surgery for the removal of implant components. No reoperations occurred in the BP group. There was a trend towards greater pain in the IM group, although there was no statistically significant difference in the scores for any of the SF-36 domains. Both distal femoral nailing and blade plating give good outcomes. There is a trend for patients undergoing retrograde nailing to complain of more pain and to require revision surgery for removal of implants.

Locked Plates Combined With Minimally Invasive Insertion Technique for the Treatment of Periprosthetic Supracondylar Femur Fractures Above a Total Knee Arthroplasty

New locked plate devices offer theoretical advantages for the treatment of supracondylar femur fractures associated with a total knee arthroplasty (TKA). These devices also can be inserted with relative ease by using minimally invasive techniques, provide a fixed angle construct, and improve fixation in osteoporotic bone. The purpose of this study was to evaluate the results and complications of treating periprosthetic supracondylar femur fractures above a TKA with a locked plate designed for the distal femur. Prospective, consecutive case series. Level I trauma center. Twenty-two consecutive adult patients with 24 (2 bilateral) supracondylar femur fractures (OTA 33A) above a well-fixed non-stemmed TKA were treated with the Locking Condylar Plate. One patient who died before fracture healing and 1 who was lost to follow-up were excluded from analysis. All remaining patients (5 males, 15 females, average age, 73 (range, 50-95) years) were available for follow-up at an average of 15 (range, 6-45) months. According to the OTA classification, there were three 33A1, eight 33A2, and eleven 33A3 fractures. All fractures were closed. Indirect reduction methods without bone graft were used in all cases. Nineteen of 22 fractures healed after the index procedure (86%). All 3 patients with healing complications were insulin-dependent patients with diabetes who also were obese (body mass index >30). Two developed infected nonunions and 1 an aseptic nonunion. Postoperative alignment was satisfactory (within 5 degrees ) for 20 of 22 fractures. Fracture of screws in the proximal fragment occurred in 4 patients. In 3 of these cases, there was progressive coronal plane deformity. There was no change in alignment in any other patient. Fifteen of 17 patients who healed returned to their baseline ambulatory status, with 5 requiring additional ambulatory support compared with baseline. Fixation of periprosthetic supracondylar femur fractures with a locking plate provided satisfactory results in nondiabetic patients. Diabetic patients seem to be at high risk for healing complications and infection.

Distal femoral fracture fixation utilizing the Less Invasive Stabilization System (L.I.S.S.): The technique and early results

The treatment of supracondylar femoral fractures in the past three decades has evolved from non-operative to operative treatment. While operative fixation utilizing either plate fixation or rigid intramedullary nail fixation has improved patient outcomes, the problems of malunion, nonunion, need for bone grafting, joint stiffness, and infection persist. An emphasis on maintenance of the soft tissue envelope around fractures has improved efficacy in increasing osseous healing and decreasing infection. Out of this movement grew the concept of submuscular plating for distal femoral fractures, and sub-sequently L.I.S.S. fixation (Less Invasive Stabilization System) for distal femoral fractures. The technique and early results utilizing the L.I.S.S. for distal femoral fractures is described. The technique of L.I.S.S. fixation first begins with traditional direct visualization and internal fixation of the articular surface. Closed reduction is then performed on the metaphyseal / diaphyseal component of the fracture, followed by submuscular fixation utilizing the L.I.S.S. fixation. The L.I.S.S. can best be thought as an “internal” external fixator.

Fixation of distal femoral fractures above total knee arthroplasty utilizing the Less Invasive Stabilization System (L.I.S.S.)

Supracondylar femoral fractures above total knee arthroplasty remain a treatment challenge. Complication rates as high as 30% are associated with both non-operative and operative treatment. Conventional plate fixation and rigid intramedullary nail fixation has improved the treatment of these fractures. However, problems still exist in the setting of a short distal femoral block and/or significant osteoporosis. Less Invasive Stabilization System (L.I.S.S.) fixation has been utilized for the treatment of supracondylar femoral fractures above total knee arthroplasty. Multiple fixed angle screws give optimal fixation around the femoral component. Advantages appear to include maintenance of distal femoral fixation, low infection, and low need for bone grafting.