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BACKGROUND: The traditional surgical treatment of proximal tibial fractures has extensive dissection of the fracture site, and affects local blood circulation, increases the incidence of delayed union and nonunion. In recent years, the rising minimally invasive internal fixation system can protect the local soft tissue and blood circulation to the maximum extent, and provide better conditions for fracture healing. The application of new spreader also solves the problems of stability and durability of traditional manual traction reduction, and the combination of the two is gradually concerned. OBJECTIVE: To explore the effect of a new minimally invasive spreader assisted reduction and less invasive stabilization system for the treatment of proximal tibial fractures. METHODS: Twenty-two patients with proximal tibial fractures treated from May 2016 to October 2019 were studied and randomly assigned to control group and observation group (n=11 per group). Patients in the control group were treated with conventional manipulative reduction and conventional incision plate internal fixation. Patients in the observation group were treated with a new minimally invasive spreader assisted reduction and less invasive stabilization system. This study was approved by the Ethics Committee of Fifth Hospital, Guangzhou Medical University. RESULTS AND CONCLUSION: Compared with the control group, Rasmussen knee function score was better in the observation group at the last follow-up. Intraoperative blood loss, operation time, length of hospital stay, and weight-bearing time in the observation group were better than those in the control group. Postoperative complications such as joint limitation and delayed fracture healing were less in the observation group than in the control group. However, the healing time was not statistically significant between the two groups. Moreover, infection of the incision and loosening and fracture of the internal fixator were not statistically significant between the two groups. These indicated that the application of a new minimally invasive spreader combined with less invasive stabilization system for proximal tibial fractures can reduce surgical reduction time and local soft tissue damage, which is beneficial to early functional exercise and can reduce postoperative complications.
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Objective: To explore the early effectiveness and advantages of mini-Swashbuckler approach in treatment of distal femoral type C fractures by comparing with Swashbuckler approach. Methods: A retrospective analysis was made on 43 patients with distal femoral type C fractures between January 2014 and June 2018. Twenty-two patients were treated with open reduction via mini-Swashbuckler approach and internal fixation with less invasive stabilization system (LISS) plate in modified group; and 21 patients were treated with open reduction via Swashbuckler approach and internal fixation with LISS plate in traditional group. There was no significant difference in age, gender, cause of trauma, fracture classification, fracture side, interval between injury and operation, and complications between the two groups ( P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy times, hospitalization time, fracture healing time, Hospital for Special Surgery (HSS) scores of the knee, and postoperative complications were recorded and compared between the two groups. Results: The operation successfully completed in both groups. The operation time of the modified group was significantly longer than that of the traditional group, the fluoroscopy times was increased and the blood loss was reduced, the differences were significant ( P0.05). Conclusion: Compared with Swashbuckler approach, mini-Swashbuckler approach has limited visual field exposure, which leads to prolonged operation time and increased fluoroscopy times, but the risks of complications do not increase. Because of its small soft tissue injury and less blood loss, it is conducive to the recovery of knee joint function after operation.
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Objective To evaluate the feasibility of a new reduction technique by comparing 2 reduction strategies in the treatment of distal femoral fractures with less invasive stabilization system (LISS).Methods A retrospective study was performed on the clinical data of 31 patients with distal femoral fracture who had been treated with LISS at Department of Orthopedics,Huadong Hospital Affiliated to Fudan University from January 2014 to December 2016.They were 11 males and 21 females.In 21 of them reduction of the fracture ends was conducted before fixation of the distal femur (strategy one),involving 9 males and 12 females with an age of 73.2 ± 16.2 years;in the other 10 of them reduction of the fracture ends was conducted after fixation of the distal femur (strategy two),involving 2 males and 8 females with an age of 70.8 ± 20.4 years.The 2 groups were compared in terms of perioperative blood loss,operation time,postoperative complications and the modified Hospital for Special Surgery (HSS) score of the affected knee joint.The enumeration data were compared with Fisher exact test and the measurement data with t-test.Results The 2 groups were compatible due to the insignificant differences in their preoperative general data (P ＞ 0.05).There were no significant differences between the 2 groups in terms of perioperative blood loss (593.3 ± 99.1 mL versus 494.7 ± 94.4 mL),operation time (121.7 ± 8.1 min versus 106.4 ± 8.5 min),rate of postoperative complications (0 versus 10％) and modified HSS score of the affected knee joint (83.8 ± 1.4 versus 84.2 ± 3.1) (P ＞ 0.05).Conclusions The 2 reduction strategies can lead to similar surgical effects in the treatment of distal femoral fractures with LISS.Strategy two can be a feasible alternative for surgeons with its theoretical advantage of simplicity.
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ANTECEDENTES: La fractura periprótesica de fémur en artroplastia total de rodilla supone uno de los mayores retos quirúrgicos. La tasa de complicaciones generales supera el 30% tanto con tratamiento conservador como con el quirúrgico. Parece que la técnica de osteosíntesis con placas bloqueadas de manera mínimamente invasiva ofrece buenos resultados para el tratamiento de las fracturas en las que no existe movilización del componente femoral. MÉTODOS: Se estudian retrospectivamente, desde enero de 2005 hasta diciembre del 2011, 32 pacientes, evaluando el tiempo de consolidación, el rango de movilidad, la deambulación y el alineamiento final mediante la realización de telemetrías en carga. El seguimiento medio fue de 56,5 meses (25-144). RESULTADOS: Se siguieron 32 pacientes (31 mujeres; un hombre) de los cuales el rango medio de edad fue de 77 años (70-89). Tres pacientes fallecieron (9%) y 4 pacientes (12%) se perdieron en la evolución final. La tasa media de consolidación fue de 16,5 semanas (8-24); no se produjeron infecciones, presentaron 3 seudoartrosis y solo se produjo un alineamiento en excesivo valgo (15°). El balance articular fue similar al previo a la fractura. La deambulación final fue igual a la previa en 24 de los 25 casos. CONCLUSIONES: Es una técnica adecuada para conseguir la consolidación en este tipo de fracturas y restablecer tanto la movilidad previa como un alineamiento correcto de la extremidad.
BACKGROUND: Peri-prosthetic fracture of the distal femur above total knee arthroplasty presents a challenging surgical problem for orthopaedic surgeons, as complication rates for both surgical and non-surgical treatment have been reported to be as high as 30%. The minimally invasive plate osteosynthesis (MIPO) technique seems to have better results than other techniques in this type of fracture when there is no loosening of the femoral implant. METHODS: A total of 32 patients with this fracture were treated from January 2005 to December 2011. A retrospective review was conducted on the weeks of consolidation, range of motion, final alignment, and the ability to walk. The mean follow up was 56.5 months (25-144). RESULTS: A total of 32 (31 female, 1 male) patients, with a mean age 77 (70-89) years old were treated, of whom 3 (9%) died and 4 were lost to follow-up. The mean time of consolidation was 16.5 weeks (8-24). There were no infections, although there were 3 non-unions and 1 malalignment (15° of valgus). We were able to restore the range of motion in every patient as it was before the fracture, as well as the ability to walk outdoors in 24 patients. CONCLUSION: The MIPO technique is a great technique in order to achieve a good range of motion and alignment of these fractures.
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Humans , Male , Female , Aged , Aged, 80 and over , Arthroplasty, Replacement, Knee/adverse effects , Periprosthetic Fractures/surgery , Periprosthetic Fractures/etiology , Femoral Fractures/surgery , Femoral Fractures/etiology , Prosthesis Failure , Retrospective Studies , Risk Factors , Follow-Up Studies , Minimally Invasive Surgical Procedures , Fracture Fixation, Internal/methodsABSTRACT
Objective:To analyze Comparison of less invasive stabilization system and anatomical steel plate on patients with shin middle lower fracture.Methods: To choose shin middle lower fracture patients in our hospital as research object, randomly divided into control group with anatomical steel plate and observation group with LISS, compared with surgery related indicators, function of knee joint, knee joint mobility.Results: 1)observation group patients’ internal fixation time, fracture healing time and full load time were significantly shorter than control group patients, intraoperative blood loss was less than control group; 2)observation group patients’ various periods of knee joint function indexes were higher than control group patients; 3)observation group patients’ knee, knees maximum Angle were significantly greater than control group (t=4.395,t=4.968,t=5.382,t=5.049;P<0.05).Conclusion: LISS can reduce the complexity of minimally invasive internal fixation tibial middle period of fracture of surgical trauma, postoperative healing, at the same time in the enhancement of long-term knee joint function after surgery for ensure that its activity.
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Objective To summarize complications and early clinical effect of less invasive stabilization system and the femoral condylar support plates in treatment of AO type C distal femoral fractures. Methods We reviewed 46 patients who had internal fixation of AO type C distal femoral fractures. Of all 46 patients, 25 were with less invasive stabilization sys-tem and 21 were with femoral condylar support plates fixation. Comparative analysis was performed using intraoperative in-dex, postoperative complications and the Evanich score at follow-up. Results All 46 patients were followed up with a mean time of 19.6 months after surgery. The difference in incision length, blood loss, fracture healing time was significant between the 2 groups(P＜0.05)but not in the duration of operations and hospital stays(P>0.05). The statistical signifi-cance was also found in the total incidence of postoperative complications and the Evanich score at the last follow-up(P＜0.05). Conclusion Patients with less invasive stabilization system fixation had the characteristics of less trauma, shorter fracture healing time, less postoperative complications and better functional recovery compared with femoral condylar sup-port plates. Less invasive stabilization system had became an ideal internal fixation in treatment of AO type C distal femoral fractures.
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Objective To evaluate the therapeutic effect of modified dual plating and less invasive stabilization system(LISS) in the complex fractures of tibial plateau.Methods One hundred and sixty-eight patients with complex fractures of tibial plateau were divided into two groups by the therapeutic methods,89 patients were in modified dual plating group while 79 patients were in LISS group.The advantages and curative effect of two groups were retrospectively analyzed.Results The excellent and good rate in modified dual plating group was slightly higher than that in LISS group [89.9％ (80/89) vs.86.1％ (68/79)],and there was no significant difference (P ＞ 0.05).No patient occurred deep site infection,severe nerve damage,phlebothrombosis in two groups.In modified dual plating group,the operation time and bleeding volume was (89.2 ± 13.6) min and (188.4 ± 45.6) ml,the hospital stay and healing time was (16.5 ± 1.8) d and (13.3 ±2.1) months.In LISS group,the operation time and bleeding volume was (74.3 ± 12.5) min and (236.5 ±65.5) ml,the hospital stay and healing time was (16.7 ± 2.1) d and (11.4 ± 1.5) months.There was no significant difference (P ＞ 0.05).Conclusion The therapeutic effect of modified dual plating and LISS have no significant difference for complex tibial plateau fractures.
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Objective To discuss the method and efficiency of less invasive stabilization system (LISS) in treatment of comminuted tibia[ fractures. Methods A total of 14 patients with comminuted tibial fractures were treated with LISS between January 2005 and July 2006. There were 10 males and four females, at age range of 19-61 years (mean 34 years). Of all, 11 patients were with proximal fractures of tibia and three with distal ones, including six with open fractures and eight with closed ones. The period from injury to operation was 2-13 days. An observation was done on postoperative soft tissue recovery and fracture healing. Results The average period of follow-up was 9.4 months (4-16 mouths). All frac-tures were healed up after average 7.8 months (4-12 months). All incisions were healed up at one stage, with no complications on nerves, blood vessels or soft tissues. The axes of tibia were good, with sound function of knee and ankle joints. Conclusion LISS is characterized by easy operation, minor trauma, high healing rate and low complications in treatment of comminuted tibial fractures.
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[Objective]To explore the technique and results of reverse less invasive stabilization system(LISS) plating for subtrochanteric femur fractures.[Method]From October 2007 to May 2009,31 cases of fresh subtrochanteric femur fractures were treated with reverse LISS. There were 23 males and 8 females,with an average age of 48.6 years (range 27 to 83 years). Twelve injuries were the result of a traffic accident,six,a fall from a greater height,four,a crush injury and nine,a fall from a standing height. According to Seinsheimer classification,four fractures were type ⅡC,twelve ⅢA,six ⅢB,six Ⅳ and three Ⅴ. After anesthesia was effectively administered,subtrochanteric fracture was reduced indirectly with patient on a fracture table. Then,the reverse LISS plate was inserted through a lateral incision of the greater trochanter between the lateral vastus muscle and the periosteum. Guided by the aiming arm,4 to 5 screws were inserted through stab incisions into the proximal and distal fragments,respectively. [Result]Operative time averaged 50 minutes (range,35-80 minutes) and estimated blood loss averaged 90 ml(range,60-150 ml). Thirty-one patients were available for evaluation with an average follow-up of 15.6 months. All fractures healed at a mean of 18.2 weeks (range 13 to 32 weeks). There was no failed fixation,or deep infection. Average range of motion of the hip joint was recorded as follows:flexion 115?,external rotation 35?,internal rotation 15?,adduction 15?,and abduction 36?. According to the modified Harris hip score,scores ranged from 82 to 100 (average,92.6),and there were 24 excellent and 7 good results.[Conclusion]Reverse LISS plating yields good results in subtrochanteric femur fractures,with stable fixation and minimal invasive procedure.
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[Objective]To analize the complications in the treatment of the fractures around the knee joint with less invasive stabilization system(LISS).[Method]From July 2005 to October 2007,89 patients with 91 fractures around knee joint were treated with the LISS,including 45 fractures of distal femur and 46 fractures of proximal tibia.[Result]All patients were followed up for 13 to 29 months.The average time to union was 16 weeks(ranged,11-25 weeks).The functional outcome: 45 had an excellent result,35 had a good result and 11 had a fair result,with 87.9% excellent to good results.There were 10 patients(11%) with symptomatic hardware irritation,2 of them had soft-tissue disruption.Seven cases(8%) had malalignment,2(2%) loss of reduction,1(1%) delayed union,1(1%) failed fixation,1 superficial peroneal nerve injury and 1 profound peroneal nerve injury.Cold-welding occurred in 9 cases(10%) which resulted in difficult removal.[Conclusion]LISS is one of the reliable and effective methods in fixation of the fractures around the knee joint.However,its operation indications and operating instructions should be strictly followed.
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[Objective]To summarize results of treating complex proximal tibia fractures with less invasive stabilization system(LISS),and to explore the concept and technology of LISS.[Method]From January 2004 to March 2006,39 cases of complex proximal tibia fractures were treated with less invasive stabilization system,including 26 male and 13 female.The mean age of the patients was 34.8 years(range 22 to 54 years).According to the AO/OTA fracture classification,there were 19 cases in type 41-A3,12 cases in type 41-C2,4 cases in type 41-C3,4 cases in proximal type 42.Seven cases were open fractures and were classified as 3 grade Ⅰ,4 grade Ⅱ open fracture according to the system of Gustilo.Eleven patients were multitraumatic patients.[Result]All the cases were followed up for averaging 15.6 months(10～21 months).The mean operation time was 75 min(60～130 min).All fractures healed,the averaging healing time was 13 weeks(11～16weeks).The averaging blood lost was 300 ml(170～500 ml).The postoperative alignment of 33 fractures was satisfactory,5 cases had 6?～ 8 ?valgus auglation,one case had 5?varus auglation in coronal plane.The mean time of weight bearing was 14.2 weeks(11～18 weeks).The range of movement was 100?～120?.All the cases had no infection,breakage of screws and plates,failed fixation and so on.According to HSS scores system,there were 26 excellent cases,7 good cases,5 fair cases,1 poor case,the excellent and good rate was 84.6%.[Conclusion]Less invasive stabilization system,providing stable fixation and optimizing early bone union and functional rehabilitation,is a realistic therapy in treatment of complex proximal tibia fractures.Exact comprehension of LISS concept and procedure,adjustment according to cases,are very important to assure satisfactory results.
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Objective To discuss curative effects of the AO Less Invasive Stabilization System(LISS) in the treatment of complex fractures around the knee joint.Methods The internal fixation at distal femur or proximal tibia was performed in 15 cases of closed complex fractures at the metaphysic area near the knee joint by using the LISS(left-sided in 9 cases and right-sided in 6 cases) from April 2004 to June 2005. Results All the 15 cases were followed for 5~26 months(mean,13.2 months).The time to full weight bearing was 12~26 weeks,and the time to bone union under X-ray was 11~24 weeks.No delayed union or disunion was observed.There were 1 case of superficial infection and 2 cases of skin blister,all of which were cured with dressing changes.No deep infection,skin necrosis,or osteofascial compartment syndrome occurred.Functional evaluation according to the Johner-Wruhs system revealed "excellent" results in 11 cases,"good" results in 3,and "fair" in 1,the total satisfactory rate being 93.3%(14/15).Palpable shift and separation inside tibia had occurred in 1 case of tibial plateau fracture(type C3) 2 weeks after operation,and a steel bar was inserted to fix the tibial plateau in a second operation.Bone union was achieved in this case 20 weeks after operation,with "good" evaluation results.Genu varum(tibial plateau angle,82?) had occurred in 1 case of tibial plateau fracture(type C3) 8 weeks after operation,and bone union was noted 20 weeks after operation,with "fair" evaluation results.Conclusions The LISS is indicated for fractures at distal femur or proximal tibia,or osteoporotic fractures of distal femoral shaft.For type C3 complex tibial plateau fracture,fixation with a steel bar on the entocondyle should be employed,rather than relying on the LISS.
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Objective To report the preliminary results of Less Invasive Stabilization System (LISS) applied in treatment of proximal tibial fractures. Methods 22 patients with acute fractures of proximal tibia were treated with LISS plates from November, 2003 to June, 2004. There were 6 females and 16 males, with a mean age of 41.8 years (ranging from 22 to 69 years). According to AO classification, 7 cases were type 41- A, and 15 cases were type 41- C (9 combined with other fractures). 5 of these were open fractures (3 cases of Gustilo- Anderson type Ⅲ A and 2 cases of type Ⅲ B). Results All fractures were eventually healed. There were 2 cases of superficial infection. No deep infection, failure of fixation or malalignment was found in this group. However, 1 case showed displacement of articular surface 6 months postoperatively. The range of motion was from 2? to 98.6? . The mean time of radiographic healing was 14.5 weeks (ranging from 11 to 17 weeks) and the mean time of full weight bearing was 15.2 weeks (ranging from 12 to 18 weeks). By Johner - Wruhs' evaluation, 13 cases were rated as excellent, 7 as good, 2 as fair 1 year postoperatively. Conclusions LISS is a safe and effective fixation device for proximal tibial fractures, especially for those caused by high- energy injuries. The benefits of this system include less intervention of blood supply, less soft tissue complications and a high union ratio of fractures.
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Objective To report the preliminary results of treatment of fracture nonunion at the distal femur and the proximal tibia with Less Invasive Stabilization System (LISS). Methods From February 2003 to August 2004, LISS fixation and bone grafting were employed to treat 5 cases of fracture nonunion at the distal femur and 4 cases of fracture nonunion at the proximal tibia. The nonunion had resulted from failure of internal fixation in 7 cases, failure of external fixation in 1 and infection in 1. The history of nonunion lasted from 10 to 111 months (mean 29m). Results All the 9 patients were followed up for an average of 8 (6 to 16) months only to reveal solid bone union in all the fractures, with a mean healing time of 4.7 months (ranging from 4 to 6 months). No loosening or breakage of the implants occurred in this series. Conclusion Due to its advanced design, LISS can be used to treat effectively fracture nonunion at the distal femur and the proximal tibia.
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Objective To compare the functional and radiographic outcomes of modified dual plating and less invasive stabilization system(LISS)in treatment of patients with complex tibial plateau fractures.Methods From November 2003 to November 2004,84 patients with complex tibial plateau fracture were treated with modified dual plating or LISS fixation.Their functional and radiographic outcomes were reviewed to compare the differences in bone union time,full weight-bearing time,knee joint's HSS(The Hospital for Special Surgery)scores,complications, tibia plateau angle(TPA)and posterior slope angle(PA).Results The 84 cases had complete follow-up records and a mean tollow-up of 16.2 months(range,12 to 23 months).Nine complications occurred in the modified dual plating group.The mean full weight-bearing time and radiographic bone union time were 16.8 and 15.1 weeks respectively for this group which had a mean HSS score of 87.4 points.Six complications were found in the LISS group.The mean full weight-bearing time and radiographic bone union time were 14.1 and 13.8 weeks respectively for this group which had a mean HSS score of 89.6 points.There were no significant differences between the two groups in changes of TPA and PA.Conclusion LISS can provide as good fixation as modified dual plating can for most complex tibial plateau fractures,but additional medial plate fixation may be necessary for some special cases.
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Objective To explore diagnosis of nonunion following intramedullary nailing of femoral and tibial fractures and the treatment of nonunion of femoral and tibial fractures with Less Invasive Stabilization System (LISS) or locking compression plate (LCP). Methods From February 2003 to December 2004, 7 cases of nonunion after intramedullary nailing of femoral and tibial fractures were diagnosed by X-ray or CT scanning or CT-3D. LISS or LCP fixation and bone grafting were employed to treat the 7 cases of nonunion in the femur and tibia. Their case histories ranged from 10 to 49 (mean 23.3) months. Results All the 7 patients were followed up for a mean of 9.1 (4 to 16) months. The bone union time for all the fractures averaged 4.7 months (ranging from 4 to 6 months). No loosening or breakage of the implants occurred in this series. Conclusions The operation should be done for the patients who feel pain in the lower extremities or the fracture line still exists at the fracture ends long time after intramedullary nailing. In order to improve the healing of bone fractures, micromovement and bone defects at the fracture site should be eliminated. Because of its merits in design, the LISS can be used to effectively treat nonunion at the distal femur or the proximal tibia.
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Many techniques of the internal fixation have resulted in these years from the new concept of biomechanical osteosynthesis (BO). LISS (less invasive stabilization system) is a typical representative of BO in minimally invasive surgery. The clinical results have been greatly improved by LISS in the operative treatment of distal humerus fractures, the proximal tibia fractures, periprosthetic supracondylar fractures and osteoporotic fracture, but skills of using LISS should be improved, indications of using LISS explored, and the mechanism that LISS improves the healing of fracture studied further.