Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Die LISS-platte bei distalen Oberschenkelfrakturen

LISS osteosynthesis of distal femoral fractures

Zusammenfassung

Grundlagen: In einer prospektiven, nicht randomisierten Studie wurden zwischen 2/97 und 9/98 29 frische distale Femurfrakturen mit dem winkelstabilen, minimal invasiv eingebrachten System LISS (Less Invasive Stabilization System) versorgt. Das Prinzip der LISS ist eine perkutan eingebrachtes Implantat, das anatomisch nach dem rechten und linken lateralen Femurkondylus geformt ist. Sie wird mit winkelstabilen, monokortikalen Schrauben verankert.

Methodik: In dieser Studie wurden 33 C3 und 33 C2 Frakturen mit intraartikulärer Dislokation über einen transartikulären Zugang mit lateraler parapatellarer Arthrotomie versorgt, während bei den 33 A Frakturen und 33 C2 und 32 B1 Frakturen ohne intraartikuläre Dislokation ein lateraler Zugang gewählt wurde. In die Nachuntersuchung wurden 29 Frakturen eingeschlossen. Das Durchschnittsalter der Patienten war 54 Jahre (20–92). Die durchschnittliche Nachuntersuchungszeit betrug 6 Monate (1,5–16). Der durchschnittliche ISS betrug 14,1 (9–27). 8 Frakturen waren offen (1mal Type I, 5mal Type II, 1mal Type IIIB).

Ergebnisse: Die durchschnittliche Operationszeit lag bei 131 (40–300) Minuten. Die durchschnittliche Bildwandlerzeit betrug 142 (31–402) Sekunden. Postoperativ kam es in einem Fall zu heterotopen Ossifikationen mit Einschränkung der Kniegelenksbeweglichkeit, in einem Fall zu einer tiefen Beinvenenthrombose mit Lungenembolie und in 3 Fällen zu tiefen Infekten, davon 2mal als Folge offener Frakturen. In 2 Fällen kam es zu Schraubenausrissen im proximalen LISS-Bereich innerhalb der ersten 2 Monate. In einem Fall war eine Rotationsdifferenz beider Femora von 32° zu sehen. Die Zeit bis zur knöchernen Durchbauung betrug durchschnittliche 3,1 (2,5–4,5) Monate. Die Zeit bis zur Vollbelastung betrug 3 (1.5–5) Monate. Die Kniegelenksbeweglichkeit betrug in 15 Fällen, mit einer Nachuntersuchungszeit von mehr als 3 Monaten, 121° (min 20° max. 140°). Der Lysholm-Score konnte für 9 Patienten ermittelt werden und ergab im Durchschnitt 67,5 Punkte (48–92) und der NEER-Score 69,8 (49–88) Punkte.

Schlußfolgerungen: Die Anwendung der LISS ermöglicht eine komplikationslose Ausheilung ohne Notwendigkeit der Knochentransplantation. Es muß besonderes Augenmerk auf eine achsengerechte Reposition gelegt werden, da diese am distalen Femur schwierig ist.

Summary

Background: In a prospective nonrandomized study conducted between February 1997 and September 1998, 29 displaced fractures of the distal femur were stabilized with an angular stable interlocking plate system (LessInvasiveStabilizationSystem, LISS) designed for minimally invasive placement. The LISS System consists of an anatomically configured plate contoured to fit onto the lateral femoral condyle and the shaft with monocortical screws which interlock into the plate and build an angular stable plate/screw construct. Using the AO fracture classification system, group 33 C3 group fractures and 33C2 fractures with intraarticular displacement were generally fixed via a transarticular approach with a lateral parapatellar arthrotomy of the knee joint and percutaneous placement of the shaft screws. While 33A type fractures and intraarticular nondisplaced group 33C2 and 32B1 fractures were treated via a lateral stab incision. The LISS was placed laterally on the femoral shaft under the vastus lateralis muscle.

Methods: 29 cases with an average age of 54 (range 20–92) years were included, the mean follow up was 6 months (1.5–16 months). The mean Injury Severity Score was 14.1 (range 9–27). 26 fractures were located at the distal segment of the femur (localization 33), further subdivided with 13 group C3, four group C2, eight type A fractures and one type B fracture. Additional three fractures were located at the distal shaft (localization 32) and classified as subgroup B13. Eight fractures were open (one Type I, five Type II, one Type IIIB (1)).

Results: Mean operative time was 131 (range 40–300) minutes. Mean image intensifier time was 142 (range 31–402) seconds. Postoperative complications included one case with heterotopic ossification (HO) limiting knee motion, deep thrombosis with pulmonary embolism in one and 3 cases of deep infection (one Type IIIB open, one arterial injury, one Type II open). Implant and technique related complications included two cases of proximal screw pull out in the first two month postinjury. These cases were treated by proximal screw exchange. In a 37 year old female with an increased antetorsion angle of 32° (internal rotation deformity) postoperatively a rotational correction was performed.

Time to fracture healing averaged 3.1 (range 2.5–4.5) months in 23 cases. Time to full weight bearing averaged 3 (range 1.5–5) months. At the latest follow up of 15 cases with ore than three months follow up the knee flexion averaged 121° (min 20° max 140°). 13 cases had a knee flexion of less than 120° with 3 of them less than 90°. In two cases at the follow-up an extension lag of 10° was noted. The Lysholm score was available for 9 patients and showed a mean of 67,5 points (range 48–92) points and theNeer score for nine patients with follow-up of more than 1 year averaged 69,8 (range 49–88) points (1 failure, 3 unsatisfactory, 4 satisfactory, 1 excellent result). The other cases were still under follow-up with ongoing evaluations.

Conclusions: The use of the LISS for distal femoral fractures with correct technique lead to uneventful bony healing without the additional morbidity of a bone graft. However, the surgical technique is demanding and care must be taken to restore axial alignment.

This is a preview of subscription content, log in to check access.

Literatur

  1. (1)

    Gustilo RB, Anderson JP: Prevention of infection in the treatment of one thousand and twenty five open fractures of long bones. J Bone Joint Surg Am 1976; 58: 453–458.

  2. (2)

    Johnson EE: Combined direct and indirect reduction of comminuted four-part intraarticular T-type fractures of the distal femur. Clin Orthop 1988; 231: 154–162.

  3. (3)

    Koval KJ, Hoehl JJ, Kummer FJ, et al: Distal femoral fixation: a biomechanical comparison of the standard condylar buttress plate, a locked buttress plate, and the 95-degree blade plate. J Orthop Trauma 1997; 11: 521–524.

  4. (4)

    Krettek C, Schandelmaier P, Miclau T, et al: Transarticular joint reconstruction and indirect plate osteosynthesis for severe distal intercondylar C2/C3 type femoral fractures. Injury Supplement 1997; 28: 31–41.

  5. (5)

    Krettek C, Schandelmaier P, Miclau T, et al: Minimally invasive percutaneous plate osteosynthesis (MIPPO) using the DCS in proximal and distal femoral fractures. Injury Supplement 1997; 28: 20–30.

  6. (6)

    Mize RD, Bucholz RW, Grogan DP: Surgical Treatment of Displaced, Comminuted Fractures of the Distal End of the Femur. J Bone Joint Surg Am 1982; 64: 871–878.

  7. (7)

    Ostrum RF, Geel C: Indirect reduction and internal fixation of supracondylar femur fractures without bone graft. J Orthop Trauma 1995; 9: 278–284.

  8. (8)

    Schavan R, Frigg R: Selbstbohrende Schanz’sche Schrauben. Swiss Surgery Supplement 1998; 2: 83–83.

  9. (9)

    Siliski JM, Mahring M, Hofer HP: Supracondylar-intercondylar fractures of the femur. Treatment by internal fixation. J Bone Joint Surg Am 1989; 71: 95–104.

  10. (10)

    Zehntner MK, Petropoulos P, Burch H: Factors Determining Outcome in Fractures of the Extremities Associated with Arterial Injuries. J Orthop Trauma 1991; 5: 29–33.

Download references

Author information

Correspondence to P. Schandelmaier.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Schandelmaier, P., Stephan, C., Krettek, C. et al. Die LISS-platte bei distalen Oberschenkelfrakturen. Acta Chir. Austriaca 32, 75 (2000). https://doi.org/10.1007/BF02949871

Download citation

Schlüsselwörter

  • LISS
  • distale Femurfraktur
  • Plattenosteosynthese
  • Nachuntersuchung

Keywords

  • LISS
  • distal femur fracture
  • osteosynthesis