LISS-Tractor. Combination of the less invasive stabilization system (LISS)with the AO distractor for fractures of the distal femur and proximal tibia

Minimally invasive plate osteosynthesis (MIPO) in conjunction with the less invasive stabilization system (LISS) first requires reduction and retentio n of the fracture using such a ids as externa I fixation, distractors, and percutaneous reduction clamps before the plate can be applied. Based on the open indirect "biological" technique of osteosynthesis, the LISS was combi ned with an AO distracter (IISS tractor) integrated into the LISS plate. Th is made reduction possible against the plate before final fixation of the L ISS plate. The LISS tractor concept was validated in three patients and we present the technique here. No malalignments > 5 degrees occurred, Fluoroscopy lasted 3.0 min (range: 2.1-4.5) and the operation 125 min (range: 90-150). Modific ation of the well-known LISS technique by integrating the distracter into t he LISS plate to simplify reduction and to provide temporary retention of t h e fracture has the potential to reduce the fluoroscopy time, the operatio n time,the rate of malalignments, and the learning cu rye for this MIPO tec hnique.