Submuscular plating of the distal femur

A variety of implants are available for the treatment of distal femur fractures. However, continued problems include infection, nonunion, need for bone grafting, malunions, joint stiffness, and loss of fixation. "Biological plating" emphasizes maintenance of the soft tissue environment around the fracture. The concept of "biological plating" in supracondylar femur fractures has been very advantageous. The Less Invasive Stabilization System (LISS) for fractures of the distal femur combines these biological advantages of submuscular fixation with the biomechanical advantage of fixed angled, locked screws for fixation of the distal femoral block. The LISS may be particular helpful in the setting of complex articular pathology, a short distal segment, and osteoporotic bone. LISS methodology relies on traditional internal fixation of the articular surface, closed reduction of metaphyseal/diaphyseal component of the fracture, and placement of a submuscular LISS fixator. Percutaneous locking screws are then placed for proximal fixation. In this review, the evolution of submuscular fixation of supracondylar femur fractures and the technique are described.