title: [The reversed locked internal plate fixator as an alternative internal fixation of problematic proximal femur fractures].
abstract: OBJECTIVE
  The aim of the study was to evaluate the application of a locked internal fixator in complex fractures of the proximal femur, in which the internal fixation with standard implants was not possible due to poor quality of bone or already failed internal fixation in the past.
  
  
  METHODS
  Ten patients suffering from a pertrochanteric (n = 5), periprosthetic (n = 1) or subtrochanteric (n = 4) femural fracture between 2003 and 2008 were prospectively registered, underwent open reduction and internal fixation with an "upside-down" femur LISS (less invasive stabilisation system) and were followed up. In all these patients a primary internal fixation had failed or the local bone situation and circulation were poor. The mean follow-up was 14 +/- 25 months. X-ray images and a clinical examination were performed at each appointment.
  
  
  RESULTS
  All fractures reached a primarily stable fixation with the locked internal plate fixator. Seven patients showed a complete bone healing after 3 months of follow-up and could bear full body weight afterwards. Three patients with preoperatively existing vascular disease or chronic osteomyelitis showed a deep wound infection postoperatively, which led to the explantation of the implant.
  
  
  CONCLUSIONS
  The "reversed" locked internal fixator could be a successful alternative implant for stabilisation of proximal femur fractures which could not be fixated by standard implants due to poor bone quality and circulation. It can also be used as a salvage procedure after internal failed fixation in proximal femur fractures.
authors.affiliation: Department für Orthopädie und Traumatologie, Klinikum der Albert-Ludwigs-Universität Freiburg. alexander.mehlhorn@uniklinik-freiburg.de
authors.forename: A T
authors.initials: AT
authors.lastname: Mehlhorn
authors.forename: P C
authors.initials: PC
authors.lastname: Strohm
authors.forename: C A
authors.initials: CA
authors.lastname: Müller
authors.forename: L
authors.initials: L
authors.lastname: Konstantinidis
authors.forename: H
authors.initials: H
authors.lastname: Schmal
authors.forename: N P
authors.initials: NP
authors.lastname: Südkamp
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D001863:Bone Screws; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D005594:Fracture Fixation, Intramedullary; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000601:surgery; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation