Purpose: The Less Invasive Stabilisation System (LISS) for fixation of the proximal femur is an automatic preformed fixator with three sizes. The self-perforating self-threading screws are locked into the plate fixator providing angular stability. Unlike conventional implants, the LISS plate is not applied directly to the bone, avoiding friction forces and periosteal damage. Precise adaptation of the implant to the form of the bone is not necessary. The system can also be easily and rapidly used as a “gliding” plate. After reduction via a proximal incision, the plate-fixator is inserted between the anterior tibial muscle and the periosteum and fixed with monocortical screws inserted percutaneously.

Material and methods: Between January 1999 and August 2000, we treated 18 multiple trauma patients with fractures of the proximal femur in 17 patients (nine men and eight women) using the LISS in a prospective multicentric study. Mean age was 50 years (20–89), median, 43 years). The AO classification of the fractures was four type A, four type B, and 13 type C. There were 14 open fractures. We used the LISS in one patient to stabilise a valgus osteotomy. One patient had a 41-C2.3 (Schatzker type VI) fracture with a compartment syndrome. Bone allographs were used in two cases. Clinical and radiographic follow-up data was collected at 6, 12, 24 and 48 weeks.

Results: Two foreign subjects with 41-A3 and 41-B1 fractures were lost to follow-up. For the other patients, bone healing was achieved between six and twelve weeks. Mean follow-up was ten months (three to twenty months). We had one complication, the compartment syndrome mentioned above, which healed without sequelae after fasciotomy and secondary thin skin graft. Joint motion was symmetrical and pain free in all patients three months after surgery. There were no nerve or vessel lesions secondary to epiperiosteal displacement of the fixator, and no case of infection or loosening. We did however observe secondary loss of reduction with development of minimal varus in three patients with complex fractures.

Conclusions: These preliminary results with the LISS demonstrate its usefulness as an alternative to conventional fixation systems. It is undoubtedly a most useful method for intra-articular and metaphyseal fractures with diaphyseal fracture lines and for fractures with two levels. Complications appear to depend on the type of fracture and the quality of the reduction, as with other types of fixators.

The treatment of multifragmentary, intra-articular fractures of the distal humerus is difficult, even in young patients with bone of good quality, but is worse in elderly patients who have varying degrees of osteopenia. We have evaluated the functional outcome of primary total elbow replacement (TER) in the treatment of these fractures in ten elderly patients followed for a minimum of one year. There were no complications in regard to the soft tissues, bone or prosthesis. The mean range of flexion obtained was 125° (110 to 140) and loss of extension was 23.5° (0 to 50). The mean Mayo score was 94 points (80 to 100) and patient satisfaction was high. We feel that TER provides an alternative to open reduction and internal fixation in the management of these complicated fractures in the elderly.

The optimal regime of antithrombotic prophylaxis for patients undergoing total knee arthroplasty (TKA) has not been established. Many surgeons employ intermittent pneumatic compression while others use low-molecular-weight heparins (LMWH) which were primarily developed for total hip arthroplasty. We compared the efficacy and safety of these two techniques in a randomised study with blinded assessment of the endpoint by phlebography.

We randomised 130 patients, scheduled for elective TKA, to receive one daily subcutaneous injection of nadroparin calcium (dosage adapted to body-weight) or continuous intermittent pneumatic compression of the foot by means of the arteriovenous impulse system.

A total of 108 patients (60 in the LMWH group and 48 in the mechanical prophylaxis group) had phlebography eight to 12 days after surgery. Of the 47 with deep-vein thrombosis, 16 had received LMWH (26.7%, 95% CI 16.1 to 39.7) and 31, mechanical prophylaxis (64.6%, 95% CI 49.5 to 77.8). The difference between the two groups was highly significant (p < 0.001). Only one patient in the LMWH group had severe bleeding.

We conclude that one daily subcutaneous injection of calcium nadroparin in a fixed, weight-adjusted dosage scheme is superior to intermittent pneumatic compression of the foot for thromboprophylaxis after TKA. The LMWH scheme was also safe.

We studied the position and rotational changes associated with elevation of the glenohumeral joint, using a three-dimensional magnetic-field tracking system on nine fresh cadaveric shoulders. The plane of maximal arm elevation was shown to occur 23 degrees anterior to the plane of the scapula. Elevation in any plane anterior to the scapula required external humeral rotation, and maximal elevation was associated with approximately 35 degrees of external humeral rotation. Conversely, internal rotation was necessary for increased elevation posterior to the plane of the scapula. The observed effects of this rotation were to clear the humeral tuberosity from abutting beneath the acromion and to relax the inferior capsular ligamentous constraints. Measurement of the obligatory humeral rotation required for maximal elevation helps to explain the relationship of the limited elevation seen in adhesive capsulitis and after operations which limit external rotation.