The LISS DF or the distal femur LCP are the locking Ortho Surgical Implants for providing angular stability to the implant of their own choice. If they are not available, then the fixed angle conventional plates like DGS or 95° condylar plate can be used. The major difference between the application of fixed angle implants and the LISS DF is that in the case of LISS DF the reduction for supracondylar fracture components is carried out even before applying the fixators.

While on the other hand in the case of fixed angle Implants the blade of 95° condylar plate or the DCS are inserted in the articular block before reducing the metaphyseal/ diaphyseal fracture components as the manipulation of the articular block is frequently necessary into the valgus position so that it can allow the barrel of the side plate to align with the DCS or allows the 95° condylar plate blade to align with the canal.

The basic steps which are required in the application of LISS DF are as follows:

• On the selected LISS DF, the insertion handle is assembled.
• Through the distal incision and proximal slid the LISS DF is inserted in the submuscular tunnel between the periosteum and vastus lateralis of the lateral femoral cortex until it appears the proximal fixator end in the proximal incision which lies on the femoral shaft’s bilateral aspect. Against the lateral surface, it is required that the distal fixator end must lie flat to the lateral femoral condyle for ensuring an optimal fit.
• In the distal and proximal ends of LISS DF, the K-wires can be inserted through the insertion guide for temporary fixation.
• In relation to the femur along with the rotation and reduction of the injured limb the position of the LISS DF is then checked with the clinical means and image intensifier.
• If there are satisfactory fracture reduction and the LISS DF position, then LHS can be inserted percutaneously with the help of the insertion handle.
• The Locking Plate for Hand Fracture is required to be inserted close to the fracture gap in the fracture fragment. On each fracture side, it is required to use at least four screws. In presence of the osteoporosis, the insertion of more screws can also be required to be inserted biotically.

Followed by the insertion of the screws a final fracture reduction and fixation check is made.

The major steps for the application of the DCS by MIPO are given below.

In the articular block under the guidance of fluoroscopy, the guide wires can be inserted to the femorotibial joint surfaces and patellofemoral surfaces which are 2cm proximal to the articular surface of the distal femur. At the junction of the middle and anterior third of the condyle of the femur the entry point needed to be located in line with the bilateral line of the shaft of the femur.

Within the articular surface, the length of the guidewire is measured and then adjusted according to the triple reamer. Drilling is then followed by tapping if required.

The insertion handles are then connected by the selected condylar screws which pass over the guidewire and then inserted in the articular block.

With the deep pointing barrel, the side plate is made to be proximally deep to the vast lateral along the line of Aspera of the femur.

So that the barrel can point medially, the slide plate is rotated to 180°

On the condylar screw, the parallel is then slipped. In order to facilitate this, the frequent manipulation of the articular block in the valgus position is required.