A simple technique to position patients with bilateral above-knee amputations for operative fixation of intertrochanteric fractures of the femur: a case report

Aqil, Adeel; Desai, Aravind; Dramis, Asterios; Hossain, Saqif

doi:10.1186/1752-1947-4-390

Cited by 16 publications

(10 citation statements)

References 6 publications

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“…There is a method that enables the assistant to maintain reduction during surgery. [ 7 , 18 ] This method is noninvasive and minimally harmful to the stump. However, it is difficult to obtain sufficient traction and torque, and maintain fracture reduction during surgery.…”

Section: Discussionmentioning

confidence: 99%

Manipulation of intertrochanteric fractures in patients with below- or above-knee amputation using a fracture table

Lee

Suh

et al. 2021

Medicine

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Rationale: In general, in the case of an intertrochanteric hip fracture, surgery is performed using a fracture table and by fixing the patient's foot to the boot piece. In patients with amputation of the affected lower limb, it is impossible to fix the foot to the boot piece; therefore, the traction and rotation of the fracture site cannot be maintained, leading to improper patient positioning. In such cases, a fracture table cannot be used intraoperatively to stabilize the fracture site. We report 2 cases of successful intertrochanteric fracture reduction using a fracture table for patients with below- or above-knee amputation. Patient's concerns: Both patients presented with left hip pain resulting from a fall. Diagnosis: Two elderly male patients with prior limb amputations below or above the knee presented with intertrochanteric hip fractures. Previous amputation of the lower limb on the same side of the fracture made it difficult to use a fracture table intraoperatively to stabilize the fracture site. Intervention: We performed fracture reduction using a modified fracture table for each patient. By altering the rotation of the boot piece and using additional skin traction bands, we could maintain proper patient positioning and rotation direction and obtain sufficient traction force. Outcomes: The chosen outcomes were fracture alignment and union at the end of follow-up and the ability to walk and perform activities of daily living. Reduction and intramedullary nail fixation using the fracture table were successful in both cases. Appropriate fracture union was achieved within 6 months, and the preoperative walking ability and activities of daily living were recovered in both patients, who were followed-up for 28 and 24 months. Lessons: Modification of the usual fracture table to suit patients with lower limb amputation helped us successfully perform intertrochanteric hip fracture surgery with the usual levels of traction and rotation required of the fracture site.

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Section: Discussionmentioning

confidence: 99%

Manipulation of intertrochanteric fractures in patients with below- or above-knee amputation using a fracture table

Lee

Suh

et al. 2021

Medicine

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“…The authors used a radiolucent thigh support on the surgical side and a gutter support for the contralateral side 11. While this technique permitted adequate imaging for the authors it does not provide rotational control.…”

Section: Discussionmentioning

confidence: 99%

Neck of femur fracture fixation in a bilateral amputee: an uncommon condition requiring an improvised fracture table positioning technique

Berg

Bhatia

2014

BMJ Case Reports

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SUMMARYWhile neck of femur fractures are common it is rare to see this injury in a bilateral leg amputee. Special consideration needs to be given to the management of these patients. We report the case of a 58-year-old man with bilateral leg amputation who presented to the emergency department with left hip pain following a fall. A fracture of the left neck of femur with extension into the femoral shaft was diagnosed. Internal fixation was planned with a dynamic hip screw. Standard fracture table setup, which allows for traction of the fractured limb and positioning of the contralateral limb such that anteroposterior and lateral X-rays can be obtained, was not possible in this case due to the amputations. We highlight considerations that need to be made in positioning a bilateral amputee for neck of femur fracture fixation and also highlight an improvised technique that can be utilised by other surgeons. BACKGROUND

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“…Despite this frequency, to our knowledge, there is nothing recorded in the literature giving technical advice regarding the operative technique for a patient requiring hip fracture fixation with an ankylosed contralateral hip. There are case reports describing patient positioning for the closed reduction and internal fixation of femoral neck fractures in the presence of associated lower limb amputations or an ipsilateral ankylosed (or arthrodesed) hip joint, but these accounts offered little assistance in the management of our patient (4–5–6–7–8–9).…”

Section: Discussionmentioning

confidence: 99%

Challenges and solutions in the fixation of a hip fracture in the presence of a contralateral ankylosed hip: a case report

2014

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Preoperative literature review revealed no operative strategy or case report describing how best to perform closed reduction and internal fixation of a femoral neck fracture with a co-existing contralateral ankylosed hip joint. We hope our experience will aid other surgeons who find themselves in a similar clinical scenario. We will present the difficulties faced and the adaptations made to our surgical technique which we utilised to achieve an anatomical fixation.

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A simple technique to position patients with bilateral above-knee amputations for operative fixation of intertrochanteric fractures of the femur: a case report

Cited by 16 publications

References 6 publications

Manipulation of intertrochanteric fractures in patients with below- or above-knee amputation using a fracture table

Manipulation of intertrochanteric fractures in patients with below- or above-knee amputation using a fracture table

Neck of femur fracture fixation in a bilateral amputee: an uncommon condition requiring an improvised fracture table positioning technique

Challenges and solutions in the fixation of a hip fracture in the presence of a contralateral ankylosed hip: a case report

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