BILATERAL REVERSE FEMORAL LISS PLATE FIXATION FOR PATHOLOGICAL PROXIMAL FEMORAL FRACTURE IN A CASE OF OSTEOPETROSIS

Abstract

Aim: To report the technique of reverse femoral LISS [Limited Invasive stabilisation system] plate fixation of pathological fractures of proximal femora with pre-existing deformity due to multiple fractures in a patient known to suffer with Osteopetrosis

Design: Osteopetrosis, a rare heterogeneous condition, is a result of failure of the bone remodelling. The orthopaedic presentations of which include, back pain, deformity of long bones and multiple fractures. Historically, most fractures in patients with Osteopetrosis were treated nonsurgically with good results, but at the expense of malunion. Operative treatment is indicated, to avoid disabling deformity or to treat nonunion of the fractures. The conventional onlay or inlay devices for fracture stabilisation are difficult to use due to malunion and obliteration of medullary canal, caused by previous fractures and hardness of the bone. The new LISS is an extramedullary, internal fixation system and its main features are an atraumatic insertion technique, minimal bone contact, and a locked, fixed-angle construction. The LISS plate can be used to stabilize the whole length of a femur with multiple deformities.

Subject: A 46-year – old lady who is a known case of autosomal dominant Osteopetrosis sustained 5 left femoral and 4 right femoral pathological fractures, over a period of 25 years. They were treated nonoperatively and the fractures were healed with some malunion. During the recent clinical presentation, her bilateral proximal femoral fractures failed to unite by conservative methods and operative treatment was indicated. We used a bilateral reverse femoral LISS plate as the proximal fragments were short and needed axial and rotational control.

Conclusion: The reverse LISS is a useful implant for treatment of femoral fractures, especially when the femur is deformed and the medullary cavity is obliterated as in cases of Osteopetrosis.