Functional outcomes of reverse distal femoral locking plate in the extra capsular fractures of proximal femur


  • Jaspreet Singh Department of Orthopaedics, Civil Hospital, Rajpura, Ludhiana, Punjab, India
  • Harpal Singh Selhi Department of Orthopaedics, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
  • Rahul Gupta Department of Orthopaedics, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
  • Gurleen Kaur Department of Pharmacology, Adesh Medical College and Hospital, Shahabad (M), Haryana, India



Unstable proximal femoral fractures, Extra-capsular fracture


Background: The optimal management of unstable proximal femoral fractures is controversial. In this prospective study, the functional outcomes of reverse distal femoral locking plate for the treatment of comminuted unstable proximal femoral fractures were assessed. Objectives were to study the functional outcomes of reverse locking plate in extra-capsular fractures of the proximal femur, with respect to quality of reduction, time to bony union, mobility achieved, complications of the procedure, secondary procedures performed (if any) and delayed complications like implant breakage, delayed union, non-union.

Methods: 17 patients with unstable proximal femoral fractures were assessed and managed with reverse distal femur plates, and evaluated with X-ray, physical examination, Palmer and Parker mobility score.

Results: Union was achieved in all the patients, with average time to union 6.43±1.18 months (range 3-12 months). There was one loosening of implant and wound breakdown, which was managed conservatively. One case of loosening of proximal screws was there, but the fracture united in 9 months with some varus angulation. Superficial infection occurred in one patient, which healed after debridement and IV antibiotics.

Conclusions: Taking into consideration the simple surgical technique, good healing rate and minimum complications, it is strongly recommended to use reverse locked distal femoral plates for the management of proximal femoral fractures and further in lean patients, sum-muscular MIPPO should be attempted.


Zuckerman JD. Hip fracture. N Engl J Med. 1996;334(23):1519-25.

Evans PJ, McGrory BJ. Fractures of the proximal femur. Hospital Physician. 2002;30-8.

Austin CA, Lawson PJ, Gibson R, Philp I. Proximal femoral fracture: achievements and prospects. Age Ageing. 1998;27:667-70.

Ma CH, Tu YK, Yu SW, Yen CY, Yeh JH, Wu CH. Reverse LISS plates for unstable proximal femoral fractures. Injury. 2010;41:827-33.

Panjarinen J, Lindahl J, Michelsson O, Savolainen V, Hirvensalo E. Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail. J bone Joint Surg (Br). 2005;87:76-81.

Zhang CQ, Sun Y, Jin DX, Yao C, Chen SB, Zeng BF. Reverse LISS plating for intertrochanteric Hip Fractures in elderly patients. BMC Musculoskelet Disord. 2010;11;166.

Smith WR, Ziran BH, Anglen JO, Stahel PF. Locking plates: tips and Tricks. J Bone Joint Surg Am. 2007;89:2298-307.

Sommer C, Gautier E, Muller M, Helfet DL, Wagner M. First Clinical results of the locking Compression Plate (LCP). Injury. 2003;34(l2):43-54.

Wagner M. General principles for the clinical use of the LCP. Injury. 2003;34(2):31-42.

Kummer FJ, Olsson O, Pearlman CA, Cedar L, Larsson S, Koval KJ. Intramedullary versus extramedullary fixation of subtrochanteric fractures. A biomechanical study. Acta Orthop Scand. 1998;69(6):580-4.

Simmermacher RK, Bosch AM, Van der WC. The AO/ASIF-proximal femoral nail (PFN): A new device for the treatment of unstable proximal femoral fractures. Injury. 1999;30:327-32.

Kish B, Sapir O, Carmel A, Regev A, Masrawa S. Full weight bearing after unstable per and subtrochanteric fracture using proximal femur nail. J Bone Joint Surg Br. 2001;83(3):289.

Anglen JO, Weinstein JN. Nail or plate Fixation of Intertrochanteric Hip Fractures: Changing Pattern of Practice. A Review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg Am. 2008;90:700-7.

Yao C, Zhang CQ, Jin DX, Chen YF. Early results of reverse less invasive stabilization system plating in treating elderly intertrochanteric fractures: a prospective study compared to proximal femoral nail. Chin Med J (Engl). 2011;124:2150-7.

Ning H, Gui XS, Zeng CL, Guo FL, Qing YL, Qing HH, Xin W. Comparison of proximal femoral nail antirotation blade and reverse less invasive stabilization system–distal femur systems in the treatment of proximal femoral fractures. Orthopaedic Sur. 2011;3(1):7-13.

Lewis JRP, Ashcroft GP. Reverse LISS plating for proximal segmental femoral fractures in the polytrauma patient: a case report. Injury. 2007;38(2):235-9.

Ozkaya U, Bilgili F, Kilic, Parmaksizoglu AS, Kabukcuoglu Y. Minimally invasive management of unstable proximal femoral extracapsular fractures using reverse LISS femoral locking plates. Hip Int. 2009;19(2):141-7.

Oh CW, Kim JJ, Byun YS, Oh JK, Kim JW, Kim SY, Park BC, Lee HJ. Minimally invasive plate osteosynthesis of subtrochanteric femur fractures with a locking plate: a prospective series of 20 fractures. Arch Orthop Trauma Surg. 2009;700-21.

French BG, Tornetta P. Use of interlocked cephalomedullary nail for subtrochanteric fracture stabilization. Clin Orthop Relat Res. 1998;(348):95-100.






Original Research Articles