Less Invasive Stabilization System (LISS) Versus Proximal Femoral Nail Anti-rotation (PFNA) in Treating Proximal Femoral Fractures

Abstract

Therapeutic Level II. See page 128 for a complete description of levels of evidence.

Proximal femoral nails compared with reverse distal femoral locking plates in intertrochanteric fractures with a compromised lateral wall; a randomised controlled trial

“…They can be done by minimally invasive methods. Clinical studies have also shown good or equivalent results of reverse-DFLCP compared to intramedullary devices [15][16][17]26].…”

“…But they are associated with a higher number of varus collapse and implant failure [13,14]. To overcome this problem the reverse-DFLCP of the contralateral side has been advocated by some authors, as it provides an added number of screw options for proximal femoral fracture fragment, resulting in a more stable construct [15][16][17]. They are anatomically suitable for proximal femoral fractures because the shape of the lateral condyle of the femur is similar to the greater trochanter, and the plate of the contralateral side follows the physical curve of the femoral shaft.…”

“…Due to higher failure rates of proximal femoral locking compression plate [13,14], some authors advocated the use of reverse distal femoral locking compression plate (reverse-DFLCP) of the contralateral side for intertrochanteric fractures, as it provided an added number of screw options for proximal femoral fracture fragments, thus resulting in a more stable construct with higher pull out resistance [15][16][17]. Clinical studies have also showed good results of reverse-DFLCP when compared to intramedullary devices [15][16][17].…”

Combination of modified free vascularized fibular grafting and reverse Less Invasive Stabilization System (LISS) for the management of femoral neck nonunion in patients thirty years of age or younger

“…Atrophic nonunion was observed in all cases. An appropriate-length distal femoral LISS plate was chosen using a right-sided plate for the left femur and vice versa, and placed as previously described after the reduction of the nonunion was confirmed using an image intensifier, with minor modifications [20]. In brief, the plate was placed close to the proximal and the posterior of the femur in order to fix the proximal of the nonunion and the vastus lateralis was split for it is convenient to place plate under direct version.…”

“…The Less Invasive Stabilization System for the treatment of distal femurs (LISS-DF, Synthes USA, Paoli, PA) was designed as an optimized fixation for fractures of the knee [17][18][19]. 'upside-down' LISS, so-called reverse LISS, has been successfully employed to treat complex proximal femur fractures [20][21][22][23][24][25]. However, combined procedure of modified FVFG and reverse LISS in the treatment of femoral neck nonunion has not been described so far.…”