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Erschienen in:
01.09.2015 | Original Article
Severely comminuted proximal femoral fractures: one implant may not solve the problem
Erschienen in: European Orthopaedics and Traumatology | Ausgabe 3/2015
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Background
Severely comminuted proximal femoral fractures present a complex problem with anatomical, biological, and functional dimensions. The objective of this study is to evaluate the concept of primary protected fixation using the reverse less invasive stabilization system (LISS) plate augmented by anterior plate ± bone grafting.
Material and methods
From August 2007 to August 2012, 19 patients, 13 males, and 6 females suffering from comminuted proximal femur fractures, types IV and V as per the Seinsheimer classification, were managed. Full active range of motion of the hip and knee joints and nonweight bearing (wt-b) ambulation were allowed from the second postoperative day.
Results
Only 19 patients were available for complete follow-up for a mean period of 18 ± 9.66 months. Full wt-b was achieved in a mean time 6.8 ± 3.1 weeks. All the fractures achieved union without further intervention. Only one case had delayed union to 7 months. The mean time to radiological union was 3.8 ± 1.56 months (range 3–7 months). None of the cases had nonunion, varus collapse, screw cutting through the femoral head, implant related problems, or limb shortening. Two cases got superficial infection. All patients except two regain their original job. Sports practice was regained in 15 patients (78.9 %) in a mean time of 7.6 months.
Conclusions
Sometimes, one implant may not satisfy the surgeon, offer a stable fixation, or solve the patient’s problem. This protected fixation represents a frequent option in revision surgery. But, in primary fixation, it has to be reserved to special types of fractures, with them high failure is suspected. It offers a protected stable fixation that can withstand the stresses.