title: Early results of reverse less invasive stabilization system plating in treating elderly intertrochanteric fractures: a prospective study compared to proximal femoral nail.
abstract: BACKGROUND
  Intertrochanteric femur fracture is common in elderly population. Though multiple treatment options are available, the choice of implant remains controversial. The reverse less invasive stabilization system (LISS) plating was introduced for treatment of a patient with ipsilateral intertrochanteric and midshaft femoral fractures. The aim of this research was to compare such technique to intramedullary nailing (proximal femoral nail, PFN) for intertrochanteric fractures.
  
  
  METHODS
  Fifty-six patients with an age of at least sixty-five years and an AO/OTA type-A1 or A2 fractures were included and divided into LISS and PFN treatment group.
  
  
  BACKGROUND
  parameters, fracture and surgery details were documented. Follow-up time was at least 12 months. Radiology, complication, Harris Hip Score and Rapid Disability Rating Score (RDRS) were recorded to evaluate fixation status and hip function for each patient during follow-up.
  
  
  RESULTS
  There was no significant difference between the two groups in surgical time ((48.0 ± 8.6) minutes, vs. (51.8 ± 10.8) minutes, P = 0.3836) and intraoperative blood loss ((149.1 ± 45.1) ml vs. (176.4 ± 25.4) ml, P = 0.0712). The LISS group had less postoperative haemoglobin (Hb) reduction ((10.2 ± 4.5) g/L Hb, vs. (15.1 ± 5.9) g/L Hb, P = 0.0475). There was no complication observed in PFN group. All 31A1 type fracture in LISS group showed 100% maintenance of reduction. One nonunion with locking screw breakage and 2 varus union were found in the LISS group. Postoperative hip function was similar between the two groups.
  
  
  CONCLUSIONS
  Though reverse LISS plating may not be recommended as a routine fixation method for elderly unstable intertrochanteric fractures compared to PFN, it may possibly be reserved for rapid fixation and damage control in polytrauma patients and ORIF of subtrochanteric and reverse oblique intertrochanteric fractures.
authors.affiliation: Department of Orthopaedics, Shanghai No. 6 People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Yao
authors.forename: Chang-qing
authors.initials: CQ
authors.lastname: Zhang
authors.forename: Dong-xu
authors.initials: DX
authors.lastname: Jin
authors.forename: Yun-feng
authors.initials: YF
authors.lastname: Chen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005269:Femur / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome