Treatment of complex juxta-articular fractures around the knee with less invasive stabilizing system (LISS) / 中华骨科杂志

ABSTRACT

Objective To evaluate the indications and clinical results of less invasive stabilizing system (LISS) in the treatment of complex fractures around the knee. Methods Screws in this system can be inserted through the aiming handle and can be locked into the plate-holes. Between Dec. 2003 and Jun. 2004, 41 cases(29 males, 12 females) of complex fractures around knee were treated with LISS. The mean age of the patients was 40.6 years (range 24 to 67 years). The proximal tibia was involved in 28 cases and distal femur in 13. In all 41 cases, there are 22 (53.7%) polytrauma, 6 (14.6%) delayed fractures and 1 revision surgery. All fresh fractures were operated in a minimal invasive way (only articualr surfaces need open reduction), fractures in metaphyseal area and tibial shaft were reduced indirectly and stabilized with minimal invasive percutaneous plate osteosynthesis(MIPPO). The delayed and revisional fractures were reduced with limited approach and stabilized with MIPPO. Results The mean operation time was 87.2 min. The follow-up averaged 16 months(range 13 to 21 months). 3 patients with bone deficit in distal femur underwent a bone graft which unioned eventually, the other patients had a mean healing time of 15.1 weeks(11 to 23 weeks) and a mean weight bearing time of 16.8 weeks (12 to 25 weeks). One pulling device broken and one screw lost in the tibial medullary cavity occured intraoperatively. Postoperatively, one loss of reduction occurred, no deep infection, loosening, breakage or failure of implants was noted. According to Rasmussen criteria of fracture reduction, excellent in 31 (75.6%) cases, good in 10 (24.4%). One year postoperatively, the mean ROM of the knees was 2.4? to 95.6?, the mean HSS knee score was 88.4 points(58 to 98 points)with 27 excellent, 10 good, 3 fair and 1 poor according to HSS scoring system. Conclusion LISS, with a novel operating concept and technique different to traditional methods, is an effective and alternative way for complex juxtaarticular fractures around the knee, especially for those difficult to deal with in traditional way. As a novel product further clinical studies are required to verify its effectiveness.