Die operative Versorgung suprakondyl�rer Femurfrakturen bei liegender Knieendoprothese?"less invasive stabilization system" (LISS) oder retrograder Marknagel?

Abstract

Retrograde intramedullary locking nailing as well as the LIS system are propagated as minimally invasive treatment options for distal femoral fractures following total knee arthroplasty. In a retrospective study, we reviewed the clinical results after operative treatment of 18 periprosthetic supracondylar femoral fractures. The fracture was stabilized with the less invasive stabilization system (LISS) in nine patients (average age: 80.3 years) and with a retrograde intramedullary locking nail in the remaining nine patients (average age: 76.8 years). The mean follow-up was 18.2 months (6-35 months). We did not find significant differences concerning the operation time (nailing 99.8 min vs 102.3 min with the LISS) or the length of stay in the hospital (nailing 10.6 days vs 12.7 days with the LISS). In one patient of the nailing group we found a valgus malalignment of 18 degrees. Seven patients in each group were satisfied with the clinical results. In one patient of the LISS group a revision due to an infection was necessary. In one patient of the nailing group a reosteosynthesis had to be performed. To sum up, both systems are useful tools in the treatment of dislocated periprosthetic fractures and both systems are not without any problems. However, under special consideration of the complications we found in our study, the LISS seems to be a better alternative in osteoporotic bone with a small distal fragment. The choice of the optimal implant should therefore depend on the type of fracture and knee arthroplasty, the type of bone, and the experience of the surgeon.

Results of titanium locking plate and stainless steel cerclage wire combination in femoral fractures

“…Comparing this data to results of monoaxial locking titanium alloy plates (LISS or LCP), there was no negative influence of accompanying stainless steel cerclage wiring and comparable or lower complication and revision rates were reported 21222324…”

Treatment of Distal Femoral Fractures with the Less Invasive Stabilization System (LISS) in Paraplegics

“…Biomechanical studies have demonstrated that the LISS provides a stable fixation of the distal fragment especially in osteoporotic bone [4,11]. Recent studies showed, that also in periprosthetic supracondylar fractures the LISS seems to be a good surgical treatment option because of the highly secure fixation of the distal femur [1,4,10]. In cases of preexisting implants a combination of angle-stable screws with conventional bicortical screws might be useful to improve the proximal implant fixation.…”

Periprosthetic Femoral Fracture

“…The time from surgical treatment with lower extremity arthroplasty until the occurrence of a corresponding PPFF is reported as 20-63.6 months in the literature (5,11,13,14). Mortality after PPFF and its treatment varies with patient age and concomitant diseases between 4.5% and 22% (13,(15)(16)(17)(18)(19).…”

“…Subject to the patient's general condition and operability, conservative treatment may be indicated with non-dislocated PPFF and adequate implant bed. In the literature, consensus has developed that, due to the high rate of concomitant complications (non-union rates of up to 20%; secondary dislocation with increased weight-bearing; postoperative impairment of movement), conservative treatment should only be attempted in selected cases (10,11,21,24,31,32). Likewise, stabilization by means of an external fixator is only Type I Type II Type III recommended in special cases and as a temporary measure due to the increased risk of infection and the additional discrimination of the bone bed by the boreholes required for the pins (9-11).…”