Minimally invasive fracture stabilization of distal femoral fractures with the LISS: A prospective multicenter study results of a clinical study with special emphasis on difficult cases

Introduction Distal femoral fractures are a challenging medical and social problem as they may occur at any age. All the available osteosynthesis types can be used to treat such injuries. However, despite the disadvantages, fixation with plates has been the most common and developed. Aim of study was to analyze the world literature and summarize the information regarding the use of plate fixation in the treatment of distal femoral fractures, identifying unresolved issues and promising directions. Materials and methods The following sources were used for collecting the information: Pubmed and E-library databases, publications of Elsevier, Springer and other publishing companies, materials of the Russian National Library, AO Surgery Reference on line. Results A review of global literature demonstrated that a minimally invasive approach which allows for bone fragment blood flow and stable fixation with a locking compression plate (LCP) are the most important factors that can improve the quality of treatment with plating. Discussion Plate fixation is still the most preferred method in the treatment of distal femoral fractures. In most severe injuries, accompanied by the medial support loss (33–A3, 33–C2 and 33–C3 fracture types according to AO classification), the use of not only the lateral but also the medial plate to achieve stable osteosynthesis has been discussed. Conclusion Further advance of the technology for treating these injures may be associated with designing an “anatomical” medial plate and a method for its minimally invasive implantation. Development of a lateral plate which could provide the stability similar to bilateral osteosynthesis seems even more prospective. Undoubtedly, such a plate would be useful in limb reconstruction surgery as well, for changing the external fixation to internal one after deformity correction and limb lengthening.

Download Full-text

Minimally invasive percutaneous plate osteosynthesis (MIPPO) using the DCS in proximal and distal femoral fractures

Injury ◽

10.1016/s0020-1383(97)00075-2 ◽

1997 ◽

Vol 28 ◽

pp. S ◽

Cited By ~ 7

Author(s):

C Krettek

Keyword(s):

Minimally Invasive ◽

Plate Osteosynthesis ◽

Femoral Fractures ◽

Distal Femoral Fractures

Download Full-text

Prospective multicenter study of minimally invasive surgery for the treatment of adult spinal deformity

Journal of Neurosurgery Spine ◽

10.3171/2021.8.spine21369 ◽

2021 ◽

pp. 1-8

Author(s):

Gregory M. Mundis ◽

Jakub Godzik ◽

Paul Park ◽

Kai-Ming Fu ◽

Stacie Tran ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Multicenter Study ◽

Interbody Fusion ◽

Adult Spinal Deformity ◽

Lumbar Interbody Fusion ◽

Inclusion Criteria ◽

Prospective Multicenter Study ◽

The Mean

OBJECTIVE Traditional surgery for adult spinal deformity (ASD) is effective but may result in exposure-related morbidity. Minimally invasive surgery (MIS) can potentially minimize this morbidity; however, high-level evidence is lacking. This study presents the first prospective multicenter investigation of MIS approaches for ASD. METHODS A prospective multicenter study was conducted. Inclusion criteria were age ≥ 18 years, with at least one of the following radiographic criteria: coronal Cobb (CC) angle ≥ 20°, sagittal vertical axis (SVA) > 5 cm, pelvic tilt (PT) > 25°, and thoracic kyphosis > 60°. Additional inclusion criteria were circumferential MIS, including interbody fusion (transforaminal lumbar interbody fusion [TLIF], lateral lumbar interbody fusion [LLIF], or anterior lumbar interbody fusion [ALIF]) with percutaneous posterior fixation on a minimum of 4 intervertebral levels. Radiographic and clinical outcomes (visual analog scale [VAS], Oswestry Disability Index [ODI], and Scoliosis Research Society–22 [SRS-22]) were collected preoperatively and at 12 months postoperatively; preoperative and postoperative values were compared using paired Student t-tests. RESULTS Seventy-five patients with a minimum 1-year follow-up were identified (75 of 111; 67.6%). The mean ± SD age was 68.8 ± 9.0 years, and 48 patients (64%) were female. Patients underwent a mean of 6.7 ± 2.9 levels of fusion with LLIF (85%), ALIF (55%), and TLIF (9%); the mean estimated blood loss was 547.6 ± 567.2 mL, and the mean length of stay was 7.0 ± 3.7 days. Significant improvements were observed in ODI (−19 ± 12.9, p < 0.001), SRS-22 (0.8 ± 0.66, p < 0.001), VAS back (−4.3 ± 2.8, p < 0.001), and VAS leg (−3.0 ± 3.2, p < 0.001) scores. Significant decreases in SVA (−26.4 ± 53.6 mm; p < 0.001), pelvic incidence–lumbar lordosis (−11.3° ± 14.9°, p < 0.001), and CC angle (−12.1° ± 11.8°, p < 0.001) were also observed. Complications occurred in 39 patients (52%); 11 patients (15%) experienced major complications, and 16 patients (21%) required reoperation. CONCLUSIONS MIS approaches for ASD resulted in meaningful symptomatic improvement. The complication rates were similar to historic norms, with a fairly high reoperation rate at 1 year. Longer follow-up will be necessary to evaluate the durability of this approach in the treatment of ASD.

Download Full-text