Reverse polyaxial less invasive stabilization systems for treatment of femoral intertrochanteric fractures of the distal femur.

INTRODUCTION: The reverse less invasive stabilization system (LISS) for the distal femur remains generally regarded as a safe and satisfactory option for the treatment of unstable proximal femoral fractures. The polyaxial LISS provides a reverse plating technique that leverages the advantages of proximal screws by allowing the adjustable locking screw to be better positioned and providing more reliable fixation on the proximal femur compared with the standard axial LISS. To assess this fixation method, a detailed evaluation of institutional outcomes of femoral intertrochanteric fractures treated with reverse polyaxial LISS was performed.

MATERIALS AND METHODS: A total of 29 patients presenting with femoral intertrochanteric fractures were treated with the reverse polyaxial LISS system between January 2010 and March 2011. Patients were classified into stable and unstable fracture groups according to the Orthopaedic Trauma Association's (OTA) classification. Clinical data, including operative time, blood loss, radiological records and complications, Harris Hip scores and Parker scores, were collected and analyzed.

RESULTS: There were no significant between-group differences in age, sex, or American Society of Anesthesiologists score. Operative time and blood loss were significantly higher in the unstable fracture group compared with the stable fracture group. Four cases of fixation failure, consisting of one case of A2.3, one case of A3.2 and two cases of A3.3, occurred 4-7 m postoperatively.

CONCLUSIONS: Treatment of femoral intertrochanteric fractures with unstable pattern using polyaxial reverse LISS results in high failure rates; therefore, it should not be recommended as a routine alternative method for the treatment of femoral intertrochanteric fractures with unstable pattern.