Less invasive stabilization system (LISS) versus proximal femoral nail anti-rotation (PFNA) in treating proximal femoral fractures: a prospective randomized study.

OBJECTIVE: To evaluate the outcome and efficacy of LISS (Less Invasive Stabilization System; Synthes USA, Paoli, PA) for the treatment of proximal femoral fractures to find another appropriate minimally invasive surgery for these fractures in which intramedullary nailing may be difficult.

DESIGN: A consecutive prospective randomized clinical study.

SETTING: University teaching hospital.

PATIENTS: Between May 2006 and March 2008, 64 consecutive patients who had a proximal femoral fracture were randomized to be treated with fixation with either LISS or PFNA (Proximal Femoral Nail Anti-rotation; Synthes USA).

INTERVENTION: LISS or PFNA fixation of proximal femoral fractures.

MAIN OUTCOME MEASUREMENTS: Intraoperative time, intraoperative blood loss, length of hospitalization, hip function (Harris score), general complications, fracture complications.

RESULTS: Fifty-nine patients were evaluated with a mean follow-up time of 26.8 months (range, 21-36 months). No statistical differences in general complications, intraoperative blood loss, length of hospitalization, or hip function could be found between the two groups. The average operative time was longer in the LISS group (98.25 minutes) compared with the PFNA group (65.36 minutes) (P < 0.05). One PFNA case had intrapelvic penetration of the helical blade; two LISS cases had breakage of the screws.

CONCLUSION: There were no major differences in outcome or complications between the treatment groups. LISS can be used effectively in treating proximal femoral fractures, especially for complex fractures patterns in which intramedullary nailing may be difficult.

LEVEL OF EVIDENCE: Therapeutic Level II. See page 128 for a complete description of levels of evidence.