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

Abstract

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.

Operative Traction Technique for an Intertrochanteric Femur Fracture in a Patient with Transfemoral Amputation

“…This technique has been successfully reproduced 9,10 , but it requires a below-knee stump so that the knee joint essentially acts as the ankle joint in the boot. Lee et al 5 published a similar technique for managing an intertrochanteric fracture in a patient with a transfemoral amputation, which included a modified skin traction band attached to the boot piece. However, sufficient reduction is difficult to achieve with skin traction, and this method risks adhesive band loosening.…”

“…This method is not feasible in patients with a transfemoral amputation, so achieving adequate traction for reduction poses a significant challenge. Some studies have described various methods to manipulate the leg in patients with above-knee amputations sustaining hip fractures [5][6][7][8] , but to the best of our knowledge none has described weighted, inline skeletal traction using Schanz pins on a radiolucent table, which may be necessary especially in individuals with multiple extremity injuries. We describe a practical approach to manipulate and reduce an amputated lower extremity and highlight differences from previously documented techniques.…”

Periprosthetic Femur Fractures in Osseointegration Amputees

“…Other authors have reported modified traction techniques for amputees with proximal femur fractures. These include pulling traction through temporary transcutaneous pin-based mechanisms [12][13][14][15] , flexing the knee to fit in an "inverted boot" [16][17][18] , skin traction using elastic adhesive tape 19,20 , and simply providing manual traction 21 . When reduction cannot be achieved using noninvasive or minimally invasive techniques, open reduction may be necessary 22 .…”