• A T Mehlhorn, P C Strohm, C A Müller, L Konstantinidis, H Schmal, and N P Südkamp.
• Department für Orthopädie und Traumatologie, Klinikum der Albert-Ludwigs-Universität Freiburg. alexander.mehlhorn@uniklinik-freiburg.de
• Z Orthop Unfall. 2009 Sep 1; 147 (5): 561-6.

AimThe aim of the study was to evaluate the application of a locked internal fixator in complex fractures of the proximal femur, in which the internal fixation with standard implants was not possible due to poor quality of bone or already failed internal fixation in the past.MethodTen patients suffering from a pertrochanteric (n = 5), periprosthetic (n = 1) or subtrochanteric (n = 4) femural fracture between 2003 and 2008 were prospectively registered, underwent open reduction and internal fixation with an "upside-down" femur LISS (less invasive stabilisation system) and were followed up. In all these patients a primary internal fixation had failed or the local bone situation and circulation were poor. The mean follow-up was 14 +/- 25 months. X-ray images and a clinical examination were performed at each appointment.ResultsAll fractures reached a primarily stable fixation with the locked internal plate fixator. Seven patients showed a complete bone healing after 3 months of follow-up and could bear full body weight afterwards. Three patients with preoperatively existing vascular disease or chronic osteomyelitis showed a deep wound infection postoperatively, which led to the explantation of the implant.ConclusionsThe "reversed" locked internal fixator could be a successful alternative implant for stabilisation of proximal femur fractures which could not be fixated by standard implants due to poor bone quality and circulation. It can also be used as a salvage procedure after internal failed fixation in proximal femur fractures.Georg Thieme Verlag KG Stuttgart, New York.

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