COMMINUTED SUBTROCHANTERIC FEMUR FRACTURE WITH INTERTROCHANTERIC EXTENSION IN ABOVE KNEE AMPUTEE

Abstract

Fractures around hip in the amputated limbs are rarely seen these days and countable numbers admitted in orthopaedic trauma wards. With the advent of prosthetics, an increasing number of amputees are still ambulant and functionally active. When hip fractures occur in this group of patients, surgical treatment aims to optimize mobility and restore function. An active Paralympic badminton athlete with history of traumatic above knee amputation presented with history of motor vehicle accident. He complained of right hip pain with clinical signs of tenderness, swelling, and limited range of motion. Plain radiograph shows right comminuted subtrochanteric femur fracture with intertrochanteric extension. The patient was treated by open reduction, dynamic condylar screw fixation augmented with screw fixation and cerclage wiring. Post operatively patient was advised on wheelchair ambulation with early rehabilitation session for range of motion and muscle strengthening exercises. By three months, fracture united and patient able to return to his Paralympic sport activities. Fewer studies shows that muscle atrophy could be another cause to increase risk of fracture over amputated limb even with minimal trauma. So, we would like to stress that better stability in terms of types of plate fixation and proper rehabilitations with the advent of prosthesis has shown promising outcomes in treating these types of fracture in above knee amputated limb. Comminuted subtrochanteric femur fracture with intertrochanteric extension in an above knee amputee poses a surgical challenge. Good surgical technique and choice of implant plays an important role in achieving good functional outcome.