Treatment of distal femur fractures in a regional Australian hospital

Table 1 Biomechanic principles and recommended insertion technique of the Less Invasive Stabilisation System[10,11]

The approach to the distal femur should be minimally invasive, through either a lateral or antero-lateral incision

Stable fixation of the joint fragments is done under direct visualisation

The metaphyseal part of the fracture is reduced in a closed manner under image intensifier guidance. Direct Handling of the fracture is avoided, and the fracture must be reduced before application of the LISS

The LISS implant is inserted sub-muscularly under image intensifier guidance and is positioned alongside the femur.

The LISS is fixed distally and proximally to the femur with locking screws. The screw ratio for the diaphyseal part should be 0.4, meaning that in a 10 hole plate the maximum number of screws should be 4. The diaphyseal screws should have bicortical fixation.

The plate used should have a minimum length of nine holes

Primary bone grafting of the fracture site is not necessary.

LISS: Less Invasive Stabilization System.