Arch Orthop Trauma Surg (2006) 126: 427–428
DOI 10.1007/s00402-006-0149-y
LETTER TO THE EDITOR
Oguz Cebesoy · Kamil Cagri Kose
Periprosthetic fractures of femur: LISS plate
Received: 10 March 2006 / Published online: 23 May 2006
© Springer-Verlag 2006
Dear Sir,
We have read the article by Kaab et al. [1] and want
to congratulate the authors for their valuable contribu-
tion to the literature. Although periprosthetic fractures
can be treated conservatively [2], surgical treatment is
mandatory for most cases, as conservative treatment is
associated with high nonunion and malunion rates [3].
The major risks for periprosthetic fractures include
osteoporosis and osteolysis and these risks are very high
after revision total hip arthroplasty due to low bone
quality and local bone deWciency or resorption [4]. As
most of these fractures occur with minor trauma [5] they
frequently need bone grafting for an eVective union.
Vancouver B1 periprosthetic femur fracture, deWned as a
fracture occurring at or near the distal tip of well-Wxed
prosthesis, is associated with a high complication rate as
it is an inherently unstable fracture pattern [5].
As the authors have already stated, LISS plate is a
valuable option especially for distal femoral and proxi-
mal tibial periprosthetic fractures [6–9]. But the tech-
nique requires successful use of new and unfamiliar
surgical principles to ensure an accurate reduction, espe-
cially for the fractures at the distal tip of the femoral
stem.
There are certain problems associated with the LISS
plate. Although single cortex purchase of a LISS screw is
enough to ensure stability, in the setting of a peripros-
thetic femoral fracture, because of the presence of the
femoral stem and the cement mantle, percutaneous Wxa-
tion is not as easy as it seems to be. In the classical tech-
nique of LISS plate application, the distal fragment is
Wxed Wrst and this is followed by proximal Wxation. The
accurate placement of the proximal screws can, in some
patients, be very problematic in this setting because of
the presence of hardware. The number of cemented and
cementless stems is also not given in the text. We think it
is important to know whether the patients who had com-
plications had cemented or cementless stems inside.
As stated above (and also in the present study), hard-
ware removal or graft application is necessary in some
patients and this leads to a normo-invasive procedure
instead of a classical minimal invasive LISS application.
In this setting we generally prefer original cable-plate
systems which are also cheaper than LISS application
[10, 11]. They ensure immediate stability and, even in the
presence of femoral stem, double cortex purchase of the
screw can be possible by angulating the screw anterior or
posterior to the stem. Also if a single cortex Wxation is
used, Wxation of the medial cortex can always be
achieved with cables above and below the screw. This
technique also enables the application of a cortical strut
graft especially in type B1 fractures with a short time of
surgery.
LISS has certain advantages like minimally invasive
application and stability with single cortex W
xation but it
requires a thorough understanding and meticulous appli-
cation of the technique and may be problematic for rela-
tively inexperienced surgeons who have just started to
deal with periprosthetic fractures. Because of low
implant costs, general familiarity with the implants and
ease of use, we recommend plate-screws and wire Wxation
of the periprosthetic fractures especially in cases which
require graft application or implant removal.
References
1. Kaab MJ, Stockle U, Schutz M, Stefansky J, Perka C, Haas NP
(2006) Stabilisation of periprosthetic fractures with angular sta-
ble internal Wxation: a report of 13 cases. Arch Orthop Trauma
Surg 126(2):105–110
O. Cebesoy (&)
Orthopedic and Traumatology Department,
Gaziantep University Faculty of Medicine,
27060 Gaziantep, Turkey
E-mail: ocebesoy@yahoo.com
Tel.: +90-532-3975652
K. C. Kose
Orthopedic and Traumatology Department,
Afyon Kocatepe University Faculty of Medicine,
Afyon, Turkey
E-mail: kacako@hotmail.com