Distal femoral fractures and LISS stabilization

In recent years, the technique of surgical stabilization in the distal femu r has changed. This change decreased the number of non unions and the need for bone grafting. Minimally invasive surgical techniques with a submuscula r plate placement have replaced the emphasis on anatomical reduction in the shaft area. Reconstruction of complex articular injuries has been simplifi ed by more direct visualization of the articular surface with the lateral p eripatellar approach. Problems remaining are surgical technique and implant considerations. The Less Invasive Stabilization System (LISS) simplifies t he surgical technique for percutaneous plate osteosynthesis. An insertion g uide is used to insert monocortical, self-tapping screws through a stab inc ision. A thread in the plate provides the angular stability for the anchori ng of these screws. In extra-articular fractures and simple intra-articular fractures, the distal femoral nail permits intramedullary stabilization. A spiral blade improves fixation of the distal femoral condylar block. Despi te the enhanced surgical technique and implant possibilities, a great numbe r of patients show a functional deficiency. These are particularly patients with complex intra-articular fractures. The 'fatigue failure' of the osteo porotic implant-bone construct is a problem in elderly patients. The LISS r epresents a good option to avoid the addition of bone cement to an osteosyn thesis.