Successful management of femoral trauma in a through-knee amputee with a previous malunited fracture: Implications and functional outcome. (October 2017)

• Record Type: Journal Article
• Authors: Lineham, Beth; Harwood, Paul; Giannoudis, Peter
• Is Part Of: Prosthetics and orthotics international. Volume 41:Number 5(2017:Oct.)
• Page Start: 512
• Page End: 516
• Publication Date: 2017-10
• Subjects: Femur -- amputation -- osteotomy -- diamond concept -- prosthesis; Orthopedic apparatus -- Periodicals; Prosthesis -- Periodicals; Implants, Artificial -- Periodicals; 617.905
• DOI: 10.1177/0309364616683821
• Languages: English
• ISSNs: 0309-3646

Abstract

Background: After amputation patients are more likely to injure their residual limb. An injury of a previously amputated limb, especially if the residuum is not anatomically normal, poses a dilemma for management. Case Description and Methods: This case report discusses a femoral fracture sustained proximal to a through-knee amputation. Findings and outcomes: The fracture was at the site of a malunited fracture. A shortening osteotomy with bone graft was undertaken to improve alignment and prosthetic fit and remove poor-quality bone. This was stabilised using an intramedullary nail, supplemented with an anti-rotation plate. This fracture went on to uneventful union, and the patient was able to comfortably use a prosthesis with increased functionality compared with prior to the recent injury. Discussion: This management enabled quick healing of the fracture without the need to resort to a more proximal amputation. Conclusion: In these unusual cases, careful planning is necessary to ensure all aspects of the problem is dealt with. Each case should be treated on its own merits. Clinical relevance: This case demonstrates the difficulty in care of complex limb trauma and offers a solution for management of similar cases. Excellent results are possible when all surgical options are considered.