A simple technique to position patients with bilateral above-knee amputations for operative fixation of intertrochanteric fractures of the femur: a case report
© Aqil et al; licensee BioMed Central Ltd. 2010
Received: 29 March 2010
Accepted: 30 November 2010
Published: 30 November 2010
Intertrochanteric fractures of the femur are common fractures in the elderly, and management includes operative fixation after patient positioning on the fracture table. Patients with bilateral above-knee amputations are challenging in terms of positioning on the table. We describe a simple technique to overcome this special problem.
A 75-year-old wheelchair-bound Caucasian man with bilateral above-knee amputations presented to our hospital after a fall. Plain radiographs showed an intertrochanteric fracture of the femur, and operative fixation with a dynamic hip screw was planned. His positioning on the table posed a particular problem, and therefore we developed a technique to overcome this problem.
Positioning of patients for fixation of intertrochanteric fractures of the femur poses a particular problem that can be solved by using our simple technique.
Fracture of the neck of the femur is a common indication for admission to trauma units . Currently, the dynamic hip screw (DHS) is a common implant used in the fixation of extracapsular fractures of the proximal femur . This involves positioning the patient on a fracture table and applying traction and rotation on the legs, after placing the feet in special boots fixed to the table. Therefore, positioning of patients with bilateral above-knee amputations is challenging, as their feet and part of their legs are missing.
A few methods have been described for patients with bilateral below-knee amputations undergoing fixation for intertrochanteric fractures [3, 4]. We describe a simple technique for patients with above-knee amputations to overcome this problem.
Patients with bilateral below-knee amputations and intertrochanteric fractures pose a special problem, as positioning them on the fracture table is difficult because of the absence of the feet and part of the legs.
The process of setting up the patient is important in achieving and maintaining fracture reduction while not causing skin injuries. Generally, the foot of the affected limb is put into a boot, and applying traction to this allows the fracture to be 'jacked out' and reduced. Internal rotation can then be applied if needed to achieve optimal fracture reduction. The unaffected limb is flexed at the hip and knee and strapped to allow the image intensifier to be moved into the groin region.
Closed reduction is preferred, but open-reduction techniques of such fractures have been described [3, 4]. However, this conventional method could not be used in our patient, who had bilateral above-knee amputations with short stumps (10 cm on the left and 12 cm on the right). So far, one relevant operation technique was published in the literature regarding closed reduction and fixation of such a fracture in a patient with a unilateral below-knee amputation [5, 6]. The authors describe flexing the knee and securing the padded stump to the inverted traction boot; the stump and knee act as a pseudo foot and ankle, thus allowing traction to be applied to the limb.
In the case of an above-knee amputation, even this technique cannot be applied.
Fixation of intertrochanteric fractures of the femur in patients with above-knee amputations is a difficult problem for the surgeon in terms of positioning on the operating table. We describe a simple technique to overcome this problem and offer the surgeon an option to use when a similar case is encountered in trauma practice.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
- Parker M, Johansen A: Hip fracture: clinical review. BMJ. 2006, 333: 27-30. 10.1136/bmj.333.7557.27.PubMed CentralView ArticlePubMed
- Parker MJ, Handoll HHG: Extramedullary fixation implants and external fixators for extracapsular hip fractures in adults. Cochrane Database Syst Rev. 2006, 1: CD000339-PubMed
- May JMB, Chacha PB: Displacement of trochanteric fractures and their influence on reduction. J Bone Joint Surg (Br). 1968, 50: 318-323.
- Said GZ, Farouk O, Said HGZ: An irreducible variant of intertrochanteric fractures: a technique for open reduction. Injury. 2005, 36: 871-874. 10.1016/j.injury.2005.01.011.View ArticlePubMed
- Al-Harthy A, Abed R, Campbell AC: Manipulation of hip fracture in the below knee amputee. Injury. 1997, 28: 570-10.1016/S0020-1383(97)00118-6.View ArticlePubMed
- Rethnam U, Yesupalan RS, Sohaib A, Ratnam TK: Hip fracture fixation in a patient with below-knee amputation presents a surgical dilemma: a case report. J Med Case Rep. 2008, 2: 296-10.1186/1752-1947-2-296.PubMed CentralView ArticlePubMed
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.