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Christian Krettek - One of the best experts on this subject based on the ideXlab platform.
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Use of the Less Invasive Stabilization System (LISS) in patients with distal femoral (AO33) fractures: a prospective multicenter study
Archives of Orthopaedic and Trauma Surgery, 2005Co-Authors: Michael Schütz, Christian Krettek, Dankwart Höntzsch, Mathias Müller, Pietro Regazzoni, Christian Werken, Norbert HaasAbstract:Introduction The Less Invasive Stabilization System (LISS) is an internal fixator that can be inserted percutaneously by means of a minimally invasive surgical approach. This paper presents the use of this system exclusively in patients with AO33 distal femoral fractures, a group in which fracture management is often complicated by multiple trauma and soft-tissue damage. Materials and methods A series of 62 patients (mean age 52 years) with 66 AO33A or C fractures received the LISS implant and were followed prospectively for 12 months. Assessments included the radiographic evaluation of implant placement and healing, measurement of valgus/varus and sagittal joint malalignment, and the assessment of weight-bearing capacity and range of motion. Results The mean duration of surgery was 85 min (range 40–135 min) for 33A fractures and 149 min (range 50–300 min) for 33C fractures. Postoperative radiographic assessments showed that the LISS implant was positioned correctly in 59 cases (89%). Assessment of valgus/varus alignment showed correct axial alignment in 49 cases (74%), a deviation of 5–10° in 13 cases, and a 10–20° deviation in 1 case. Correct sagittal alignment was observed in 56 cases (85%), 5–10° malalignment in 5 cases, and 10–20° in 2 cases. During the course of the 1-year follow-up, 8 patients (9 fractures) died; 2 other patients were not available for follow-up. Complete fracture healing was achieved in 85% of the followed-up patients. Forty-eight patients were capable of full weight-bearing. After fracture healing, maximum flexion of the injured limb was on average 80% of the range of the uninjured limb. An extension deficit of more than 5° was measured in 3 cases. Of the 62 patients, 14 underwent further operations during the course of follow-up. Of these, 6 required bone grafting and 3 refixation of the implant due to implant loosening. Deep infections requiring several debridements occurred in 2 patients. No complications relating solely to the implant were observed. Conclusion The LISS showed good overall results in the treatment of these difficult fractures. It is a good alternative to conventional extramedullary and intramedullary stabilizing techniques, especially in more complex fracture situations.
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use of the less invasive stabilization system LISS in patients with distal femoral ao33 fractures a prospective multicenter study
Archives of Orthopaedic and Trauma Surgery, 2005Co-Authors: Michael Schütz, Christian Krettek, Dankwart Höntzsch, Mathias Müller, Pietro Regazzoni, Christian Van Der Werken, N. P. HaasAbstract:Introduction The Less Invasive Stabilization System (LISS) is an internal fixator that can be inserted percutaneously by means of a minimally invasive surgical approach. This paper presents the use of this system exclusively in patients with AO33 distal femoral fractures, a group in which fracture management is often complicated by multiple trauma and soft-tissue damage.
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LISS PLT: design, mechanical and biomechanical characteristics.
Injury, 2003Co-Authors: T. Goesling, A. Frenk, A. Appenzeller, R. Garapati, A. Marti, Christian KrettekAbstract:Following the development of the Less Invasive Sabilization System for Distal Femur a similar system for proximal tibia fractures (LISS PLT) was designed. Anatomical studies were carried out to define the shape of the plate and the position and orientation of the screws. Standard mechanical tests were performed to ensure that the LISS PLT fixation provides similar fatigue resistance to that of conventional plates. Finally, cadaver tibia pairs were used to compare the biomechanical performance of the new device to that of bilateral plating. An unstable intra-articular proximal tibia fracture model was used. The medial condyle of the tibias were submitted to loading cycles with increasing load levels and the vertical subsidence of the medial condyle during the loading cycles was monitored. Comparable stability against secondary loss of reduction was observed for the LISS PLT and the bilateral plating constructs.
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Internal Fixation of Distal Femur Fractures with the Less Invasive Stabilizing System (LISS)
Orthopedics and Traumatology, 2001Co-Authors: Peter Schandelmaier, Michael Blauth, Christian KrettekAbstract:Objective Stable internal fixation of distal femur with an implant resisting angular forces. The technique is minimally invasive, relies on a monocortical screw fixation and obviates the need for bone grafting. Indications Distal femur fractures of types A and C according to the AO classification. Periprosthetic femur fractures after total knee and hip arthroplasty. Contraindications Local infection, osteitis. Surgical Technique For intraarticular fractures: anterolateral parapatellar approach to the knee joint, anatomic reduction and temporary fixation of the articular fragments with Kirschner wires. Closed reduction aligning the block of articular fragments with the shaft. Submuscular introduction of the LISS plate with the help of an aiming device and its adaptation to the femur. Through stab incisions the screws are inserted leading to a stable anchorage of the plate. For extraarticular fractures: stab incisions over the lateral femoral condyle. Results In a prospective study, results of 54 fresh fractures of the distal femur in 51 patients (28 men, 23 women) operated between February 1997 and February 2000 could be assessed. The patients’ average age at the time of injury was 53 (20–93) years. 48 patients suffered from type 33 fractures. Six type 32 fractures were encountered. Ten fractures were open. Six patients fractured their femur above or below a total joint replacement. We noted the following complications: one heterotopic ossification, two deep thrombophlebites with lung embolism and three infections. A loosening of the proximal screws occurred in four patients. 40 patients could be followed up clinically and radiologically, of these 32 after more than 6 months and 27 after more than 1 year. The Neer score of the 27 patients examined after > 1 year amounted to an average of 73.9 (33–88) points, with six excellent, 14 satisfactory, six unsatisfactory results and one poor result. The Lysholm score amounted to 80.5 (40–100) points.
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Distal femoral fractures and LISS stabilization
Injury, 2001Co-Authors: Peter Schandelmaier, A. Partenheimer, B. Koenemann, Orna Grün, Christian KrettekAbstract:In recent years, the technique of surgical stabilization in the distal femur has changed. This change decreased the number of non unions and the need for bone grafting. Minimally invasive surgical techniques with a submuscular plate placement have replaced the emphasis on anatomical reduction in the shaft area. Reconstruction of complex articular injuries has been simplified by more direct visualization of the articular surface with the lateral peripatellar approach. Problems remaining are surgical technique and implant considerations. The Less Invasive Stabilization System (LISS) simplifies the surgical technique for percutaneous plate osteosynthesis. An insertion guide is used to insert monocortical, self-tapping screws through a stab incision. A thread in the plate provides the angular stability for the anchoring of these screws. In extra-articular fractures and simple intra-articular fractures, the distal femoral nail permits intramedullary stabilization. A spiral blade improves fixation of the distal femoral condylar block. Despite the enhanced surgical technique and implant possibilities, a great number of patients show a functional deficiency. These are particularly patients with complex intra-articular fractures. The 'fatigue failure' of the osteoporotic implant-bone construct is a problem in elderly patients. The LISS represents a good option to avoid the addition of bone cement to an osteosynthesis.
R.m. Dwivedi - One of the best experts on this subject based on the ideXlab platform.
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inter sensor comparison between resourcesat LISS iii LISS iv and awifs with reference to coastal landuse landcover studies
International Journal of Applied Earth Observation and Geoinformation, 2008Co-Authors: H.b. Chauhan, R.m. DwivediAbstract:Coastal zone assumes importance due to high productivity of ecosystems, man-made developmental activities, natural hazards and dynamic nature of the coast. As costal ecosystems are unique and fragile, understanding the impact of developmental activities on the sustainability of the coastal zone is very important. Remote sensing, because of repetitive and synoptic nature is an ideal tool for studying this. Time series data analyses for monitoring coastal zone require different type of sensors. Present study deals with atmospheric correction of satellite data, reflectance, selection of coastal features like, mudflat, mangroves, vegetated dune, coastal water, etc. and their inter-comparison using different sensor data of RESOURCESAT sensors. Reflectance values give better separateability for various coastal features in comparison to DN values. LISS IV can be used in place of LISS III or merged (LISS III + PAN) for long-term coastal zone studies.
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Inter sensor comparison between RESOURCESAT LISS III, LISS IV and AWiFS with reference to coastal landuse/landcover studies
International Journal of Applied Earth Observation and Geoinformation, 2008Co-Authors: H.b. Chauhan, R.m. DwivediAbstract:Coastal zone assumes importance due to high productivity of ecosystems, man-made developmental activities, natural hazards and dynamic nature of the coast. As costal ecosystems are unique and fragile, understanding the impact of developmental activities on the sustainability of the coastal zone is very important. Remote sensing, because of repetitive and synoptic nature is an ideal tool for studying this. Time series data analyses for monitoring coastal zone require different type of sensors. Present study deals with atmospheric correction of satellite data, reflectance, selection of coastal features like, mudflat, mangroves, vegetated dune, coastal water, etc. and their inter-comparison using different sensor data of RESOURCESAT sensors. Reflectance values give better separateability for various coastal features in comparison to DN values. LISS IV can be used in place of LISS III or merged (LISS III + PAN) for long-term coastal zone studies.
Jihhsi Yeh - One of the best experts on this subject based on the ideXlab platform.
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reverse LISS plates for unstable proximal femoral fractures
Injury-international Journal of The Care of The Injured, 2010Co-Authors: Chengyo Yen, Jihhsi YehAbstract:Abstract The best treatment for unstable proximal femoral fractures is controversial. In this prospective study, we assessed the outcomes of reverse less invasive stabilisation system (LISS) plates for treatment of unstable proximal femoral fractures that are expected to be difficult to nail. From April 2004 to January 2007, 20 patients with unstable proximal femoral fractures that were assessed to be difficult to nail were managed with reverse less invasive stabilisation system–distal femur (LISS–DF) plates, which included (1) subtrochanteric fractures with extension into the piriform fossa, (2) short skeletons with narrow femoral canals, (3) adolescents with open physes and (4) severely bowed or deformed femurs. These patients were enrolled in this study. There were 11 females and nine males, with a median age of 58 years (range, 14–95 years). The average follow-up period was 24 (range, 12–32) months. Functional recovery (Parker and Palmer mobility score), pain, bony union, varus deformity, implant failure and leg length discrepancy were assessed. The fractures united at a median of 7 months (range, 3–15 months) postoperatively. Parker and Palmer mobility scores were 9 points for 17 patients and 6 points for three patients. Pain was absent in 15, mild in three, and moderate in two patients. Patients with poor quality of reduction were more likely to have pain results ( p = 0.009). Although patients with advanced age were not more likely to have pain results, they were more likely to have ‘delayed union’ radiographic results ( p = 0.033). Two limbs were shortened by 1.5 and 2 cm, respectively. Reverse LISS plate fixation led to complete union of unstable proximal femoral fractures without additional procedures. The surgical technique was simple and safe. We recommend considering the use of this locked-plate device as the alternative management of unstable proximal femoral fractures that are unsuitable for nailing procedures.
Yong-ming Huang - One of the best experts on this subject based on the ideXlab platform.
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Failure of Less-Invasive Stabilization System (LISS) plating for periprosthetic distal femur fractures: Three case reports.
Medicine, 2020Co-Authors: Zhen-jiang Tian, Yan-jie Liu, Bo-jian Chen, Jun Wang, Cai-li Niu, En-hui Feng, Xiu-jun Mai, Yong-ming HuangAbstract:Rationale Less-Invasive Stabilization System (LISS) plate is an internal fixation commonly used for the periprosthetic distal femur fractures. Failure associated with LISS plate has been rarely reported, and the reasons for LISS plate failure are multitudinous. Various advantages have been reported, but failures continue. Patient concerns We present 3 cases illustrating the failure of Less-Invasive Stabilization System (LISS) plating for periprosthetic distal femur fractures. The shaft screws of the LISS plate broke in 2 cases, and the plate placement was incorrect in 1 case. Early weight bearing, obesity, osteoporosis, and lateral collateral ligament injury due to incorrect plate placement constituted the etiologies of LISS plate failure. Diagnosis Failure of Less-Invasive Stabilization System (LISS) plating for periprosthetic distal femur fractures after Total knee arthroplasty. Interventions Three patients underwent Less-Invasive Stabilization System plates removal with replacement of the total knee arthroplasty revision surgery with rotating hinged knee prosthesis. Outcomes After completing the total knee arthroplasty revision surgery, all patients underwent regular follow-up examinations. Case 2 could walk unaided, without pain, final union was confirmed for both case 1 and case 3. Conclusion Less-Invasive Stabilization System (LISS) plate provides satisfactory results in periprosthetic fractures after Total knee arthroplasty (TKA). The LISS plate has many advantages, but failures continue to occur. The causes for failure were early weight bearing, obesity, osteoporosis, and lateral collateral ligament (LCL) injury due to incorrect plate placement in our series. We recommend that protection or properly delay of weight-bearing, active anti-osteoporosis treatment, and intraoperative fluoroscopy are the effective methods to avoid failure.
Philip J Kregor - One of the best experts on this subject based on the ideXlab platform.
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biomechanical evaluation of the less invasive stabilization system angled blade plate and retrograde intramedullary nail for the internal fixation of distal femur fractures
Journal of Orthopaedic Trauma, 2004Co-Authors: Michael Zlowodzki, Scott Williamson, Peter A Cole, Lyle D Zardiackas, Philip J KregorAbstract:OBJECTIVE: To evaluate the stability of the retrograde intramedullary nail (IMN), angled blade plate (ABP), and a locked internal fixator (Less Invasive Stabilization System [LISS], Synthes, Paoli, PA) for internal fixation of distal femur fractures. DESIGN: Destructive biomechanical testing of matched pairs of fresh-frozen human cadaveric bone-implant constructs. SETTING: Biomechanical laboratory. METHODS: A fracture model was created to simulate an AO/OTA33-A3 fracture. Forty-eight matched pairs of specimens were used. Six groups of 8 pairs each were tested to failure: LISS versus ABP and LISS versus IMN (axial, torsional, and cyclical axial). MAIN OUTCOME MEASUREMENT: Load to failure, mode of failure, energy to failure, displacement at the load to failure, and stiffness. RESULTS: Fixation strength (load/moment to failure) of the LISS constructs was 34% greater in axial loading (P = 0.01) and 32% less in torsional loading (P = 0.05) compared with ABP constructs and 13% greater in axial loading (P = 0.35) and 45% less in torsional loading (P < 0.01) compared with IMN constructs. Loss of distal fixation in axial loading occurred in 1 of 16 cases with the LISS, in 3 of 8 cases with the ABP, and in 8 of 8 cases with the IMN. Cyclical axial loading demonstrated significantly less plastic deformation for the LISS construct compared with ABP constructs (P < 0.01) and similar plastic deformation compared with IMN constructs (P = 0.98). CONCLUSIONS: All 3 fixation devices (LISS, ABP, and IMN) offer sufficient torsional stability and sufficient proximal fixation that withstands axial loading without failing. The LISS provides improved distal fixation, especially in osteoporotic bone, at the expense of more displacement at the fracture site.
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less invasive stabilization system LISS for fractures of the proximal tibia indications surgical technique and preliminary results of the umc clinical trial
Injury-international Journal of The Care of The Injured, 2003Co-Authors: Peter A Cole, Michael Zlowodzki, Philip J KregorAbstract:The surgical treatment of proximal tibia fractures, with or without intraarticular involvement, is associated with well-described patterns of failure and significant complication rates. Recent surgical advances allow for a minimally invasive approach to such injuries, which may improve healing times, increase union rates, and decrease complication rates. The Less Invasive Stabilization System (LISS) for proximal tibia fractures employs a laterally based fixed angled implant, allowing for the placement of locking screws proximal and distal to the fracture, which may be placed percutaneously. This manuscript presents the surgical technique and indications of the Tibia LISS. A preview of the early clinical results of the treatment of bicondylar tibial plateau fractures and proximal tibia diaphysis will also be presented.
