Less invasive stabilising system plate versus retrograde intramedullary nail for osteoporotic distal femoral fracture
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Distal femoral fractures are not as common as proximal femoral fracture in elderly, but they can lead to significant post-injury morbidity and mortality. These types of fractures have been treated mainly operatively over the last few decades. Elderly patients have poor bone quality and they do not tolerate a major open surgery. A less invasive stabilising system (LISS) plate overcomes many of these problems. We looked into the results of treatment with LISS plates and retrograde intramedullary (IM) femoral nail in osteoporotic distal femoral fracture treated in our hospital.
Retrospective review of case notes and X-rays of patients who are at least 60 years of age at the time of injury, over a period of 7 years. We recorded the type of injury, type of procedure, complications, follow-up period, time to bony union, knee range of movement, need for further surgery and weight-bearing status at last follow-up.
A total of 40 patients were identified with distal femoral fracture treated by either LISS plate or retrograde femoral IM nail, out of which 33 case-notes were available till discharge. Out of 33 cases, 24 were treated with LISS plate and the rest 9 were treated with a retrograde femoral IM nail. In our series, patients treated with the LISS plate appeared to have better outcome when compared with patients treated with IM nail. The LISS plate group has higher mean age (82 years vs. 76 years), had better knee range of movement at discharge, had fewer complications (4% vs. 67%), needed fewer second surgery (4% vs. 33%), and had lower mean follow-up period (5 months vs. 7 months) when compared to patient group treated with distal femoral retrograde IM nail.
Previous studies have shown the LISS plate to be an effective device in treating complex distal femoral fractures including periprosthetic fractures. Our study looked into a unique group of patients who are physiologically high risk and have poor tolerance for a major surgery. The LISS plate appears to be a good implant to treat osteoporotic distal femoral fractures.
KeywordsLISS plate Osteoporotic fracture Distal femoral fracture Intra-medullary nail Non-union Mal-union Peri-prosthetic fracture
None of the authors have received any external fund for the study.
Conflict of interest statement
No funds were received in support of this study. No benefits of any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.
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