title: Treatment of distal femur fractures in a regional Australian hospital.
abstract: OBJECTIVE
  To review our outcomes and compare the results of the Less Invasive Stabilization System (LISS) to other implants for distal femur fracture management at a regional Australian hospital.
  
  
  METHODS
  The LISS is a novel implant for the management of distal femur fractures. It is, however, technically demanding and treatment results have not yet been assessed outside tertiary centres. Twenty-seven patients with 28 distal femur fractures who had been managed surgically at the Mackay Base Hospital from January 2004 to December 2010 were retrospectively enrolled and assessed clinically and radiologically. Outcomes were union, pain, Lysholm score, knee range of motion, and complication rates.
  
  
  RESULTS
  Twenty fractures were managed with the LISS and eight fractures were managed with alternative implants. Analysis of the surgical techniques revealed that 11 fractures managed with the LISS were performed according to the recommended principles (LISS-R) and 9 were not (LISS-N). Union occurred in 67.9% of fractures overall: 9/11 (82%) in the LISS-R group vs 5/9 (56%) in the LISS-N group and 5/8 (62.5%) in the alternative implant group. There was no statistically significant difference between pain, Lysholm score, and complication rates between the groups. However, there was a trend towards the LISS-R group having superior outcomes which were clinically significant. There was a statistically significant greater range of median knee flexion in the LISS-R group with compared to the LISS-N group (P = 0.0143) and compared with the alternative implant group (P = 0.0454).
  
  
  CONCLUSIONS
  The trends towards the benefits of the LISS procedure when correctly applied would suggest that not only should the LISS procedure be performed for distal femur fractures, but the correct principle of insertion is important in improving the patient's outcome.
authors.affiliation: Ewan Batchelor, Clare Heal, Herwig Drobetz, Department of General Practice and Rural Medicine, James Cook University School of Medicine and Dentistry, Level 1, Building K, Mackay Base Hospital, Mackay QLD 4740, Australia.
authors.forename: Ewan
authors.initials: E
authors.lastname: Batchelor
authors.affiliation: Ewan Batchelor, Clare Heal, Herwig Drobetz, Department of General Practice and Rural Medicine, James Cook University School of Medicine and Dentistry, Level 1, Building K, Mackay Base Hospital, Mackay QLD 4740, Australia.
authors.forename: Clare
authors.initials: C
authors.lastname: Heal
authors.affiliation: Ewan Batchelor, Clare Heal, Herwig Drobetz, Department of General Practice and Rural Medicine, James Cook University School of Medicine and Dentistry, Level 1, Building K, Mackay Base Hospital, Mackay QLD 4740, Australia.
authors.forename: J Kimberly
authors.initials: JK
authors.lastname: Haladyn
authors.affiliation: Ewan Batchelor, Clare Heal, Herwig Drobetz, Department of General Practice and Rural Medicine, James Cook University School of Medicine and Dentistry, Level 1, Building K, Mackay Base Hospital, Mackay QLD 4740, Australia.
authors.forename: Herwig
authors.initials: H
authors.lastname: Drobetz
keywords: Distal femur fracture; Less Invasive Stabilization System; Locking plates; Operative technique; Retrospective