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Hip fracture fixation in a patient with below-knee amputation presents a surgical dilemma: a case report
© Rethnam et al; licensee BioMed Central Ltd. 2008
Received: 20 August 2007
Accepted: 09 September 2008
Published: 09 September 2008
Hip fracture fixation surgery in patients with below-knee amputations poses a challenging problem to the surgeon in terms of obtaining traction for reduction of the fracture. The absence of the foot and part of the leg in these patients makes positioning on the fracture table difficult. We highlight this difficult problem and suggest techniques to overcome it.
A 73-year-old man with bilateral below-knee amputations presented with a history of fall. Radiographs revealed an inter-trochanteric fracture of the femur. A dynamic hip screw fixation was planned for the fracture but the dilemma was on how to position the patient on the fracture table for the surgery. Special attention was needed in positioning the patient and in surgical fixation of the fracture.
Hip fracture fixation in patients with below-knee amputations poses a special problem in positioning for fracture reduction and fixation. In this case report, we share our experience and suggest techniques to use when encountering this difficult problem.
Inter-trochanteric fractures have traditionally been treated by closed reduction and internal fixation with a dynamic hip screw or an intramedullary device (gamma nail, reconstruction nail, proximal femoral nail or intramedullary hip screw) [1–4]. Reduction is usually achieved by positioning the patient on a fracture table with the foot secured to a boot to aid in traction and rotation. These fractures and positioning for their surgical treatment pose a difficult problem when encountered in patients with below-knee amputations. Absence of the foot and part of the leg in these patients makes positioning on the fracture table challenging. We highlight the difficulties encountered in a patient with bilateral below-knee amputations undergoing fixation of an inter-trochanteric fracture and the various techniques available to overcome this problem.
A 73-year-old man presented to our department with a history of fall. He complained of pain in the right hip especially on movement of his hip. He had bilateral below-knee amputations following peripheral vascular disease and had below-knee suction prostheses fitted to his lower limbs for mobility. Radiographs of his pelvis and right hip revealed an undisplaced inter-trochanteric fracture of the femur. A dynamic hip screw fixation was planned for the fracture but the dilemma was how to position the patient on the fracture table for the surgery.
Inter-trochanteric fractures of the femur are quite common in the elderly. Management of these fractures is essentially surgical and the various techniques used include dynamic hip screw fixation, intramedullary nailing and dynamic condylar screw fixation [1–4]. Patients with bilateral below-knee amputations with inter-trochanteric fractures pose a special problem as positioning them on the fracture table is difficult due to the absence of the foot and part of the leg. The problem is accentuated when there is a need to apply traction for obtaining reduction of the fracture. There is little information in the literature on techniques to deal with this problem. We describe a few methods that can be used when this rare and unusual problem is encountered.
Hip fracture fixation surgery in patients with below-knee amputations is a difficult and challenging problem for the surgeon. The dilemma is on how to provide the traction and rotation required for reduction of the fracture. We believe that the techniques mentioned here to overcome this problem are safe and give the surgeon various options to handle this situation.
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.
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