Department of Orthopedic Surgery, Pusan National University Yangsan Hospital.
Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, Yangsan.
Medicine (Baltimore). 2021 Jan 15;100(2):e24233. doi: 10.1097/MD.0000000000024233.
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.
Both patients presented with left hip pain resulting from a fall.
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.
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.
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.
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.
一般情况下，对于转子间骨折，手术是在骨折复位台上进行的，通过将患者的脚固定在靴件上来完成。在下肢截肢的患者中，无法将脚固定在靴件上；因此，无法维持骨折部位的牵引和旋转，导致患者定位不当。在这种情况下，术中无法使用骨折复位台来稳定骨折部位。我们报告了 2 例使用骨折复位台成功治疗膝下或膝上截肢患者转子间骨折的病例。
两位患者均因跌倒导致左髋部疼痛就诊。
2 例老年男性患者均有既往膝下或膝上截肢史，表现为转子间髋部骨折。既往同侧下肢截肢使得术中难以使用骨折复位台来稳定骨折部位。
我们为每位患者使用改良的骨折复位台进行骨折复位。通过改变靴件的旋转，并使用额外的皮肤牵引带，我们可以维持适当的患者体位和旋转方向，并获得足够的牵引力。
选择的结果是随访结束时骨折对线和愈合情况，以及行走和进行日常生活活动的能力。在这两种情况下，使用骨折复位台进行复位和髓内钉固定均获得成功。在 6 个月内获得了适当的骨折愈合，两位患者的术前行走能力和日常生活活动均得到恢复，随访时间分别为 28 个月和 24 个月。
对通常的骨折复位台进行修改，以适应下肢截肢的患者，有助于我们成功地进行转子间髋部骨折手术，获得骨折部位所需的通常牵引和旋转程度。
