title: The outcome of unstable proximal femoral fracture treated with reverse LISS plates.
abstract: BACKGROUND
  The Russel-Taylor type 2B fractures compromised the trochanteric region and medial buttress of proximal femur. This fracture pattern limits the choice of implants and raises the risk of adverse outcomes. We aimed to (i) determine the outcome of Russel-Taylor type 2B fractures treated using reverse less invasive stabilization system plates (LISS-DF) and to (ii) learn what factors affected outcomes after osteosynthesis with reverse LISS plates.
  
  
  METHODS
  A retrospective study SETTING: The study was conducted at a Level III trauma center in Taiwan.
  
  
  METHODS
  Twenty-five consecutive patients presenting with a Russel-Taylor type 2B fracture were enrolled. All cases were treated with reverse LISS plates. A Modified Radiographic Union Scale for Femur (RUSF), Radiographic parameters, functional scores, and complications were assessed.
  
  
  RESULTS
  Union occurred in 21 cases at an average of 18.8 weeks. The average immediate postoperative neck-shaft angle was 130° (range: 122-135°) compared with 139° (range: 135-141°, p=0.05) on the contralateral side. Two cases had complications of proximal screws cutting out and two cases had broken implants. Finally, all 4 cases required repeated surgeries (16%). Malunion occurred in 4 patients and early mechanical failure (proximal screws cut out) occurred in 2. There was a significant difference in the purchase index of the proximal screws between cases with redisplacement and those without (26.4mm and 98.6mm, p=0.01).
  
  
  CONCLUSIONS
  The use of reverse LISS plate appeared to be an alternative procedure for the specific pattern in the present study. We recommend using this reverse locking plate to treat unstable proximal femoral fractures with meticulous techniques of placing plates. Adequate purchase of the proximal locking screws might decrease the risks of complications.
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors.forename: Shih-Jie
authors.initials: SJ
authors.lastname: Lin
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; Change Gung University, Taoyuan, Taiwan.
authors.forename: Kuo-Chin
authors.initials: KC
authors.lastname: Huang
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors.forename: Po-Yao
authors.initials: PY
authors.lastname: Chuang
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors.forename: Chien-Yin
authors.initials: CY
authors.lastname: Lee
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; Change Gung University, Taoyuan, Taiwan. Electronic address: b8601081@cgmh.org.tw.
authors.forename: Tsan-Wen
authors.initials: TW
authors.lastname: Huang
authors.affiliation: Change Gung University, Taoyuan, Taiwan; Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Taiwan. Electronic address: bone@doctor.com.
authors.forename: Mel S
authors.initials: MS
authors.lastname: Lee
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; Change Gung University, Taoyuan, Taiwan.
authors.forename: Robert Wen-Wei
authors.initials: RW
authors.lastname: Hsu
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D017102:Fracture Healing; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D011859:Radiography; D012189:Retrospective Studies; D013624:Taiwan; D014193:Trauma Centers; D016896:Treatment Outcome; D055815:Young Adult
keywords: Locking plate; Pertrochanteric; Proximal femur; Reverse LISS; Unstable fracture