Abstract
Background
Hip fractures in amputees pose a significant challenge for the orthopedic surgeon due to technical difficulties and there is no standardisation in their management. Their treatment is consequently left to the surgeon’s ingenuity. The aim of this study is to describe the clinical characteristics and outcome of a series of hip fractures in lower limb amputees.
Methods
A total of 12 patients and 15 hip fractures in lower limb amputees were included. Amputations below the malleoli and prosthetic surgery due to osteoarthritis constitute the exclusion criteria. Demographic, amputation-related and fracture data as well as radiological, functional, and clinical outcomes were collected through the patients' medical records.
Results
Age at fracture and at amputation were different depending on the cause of amputation. Most patients (10/12) were male. Seven patients had an infracondylar amputation and five patients had a supracondylar amputation. Ten hip fractures were on the same side of the amputation, three were contralateral and one was bilateral. Pertrochanteric (6/15) and subcapital (5/15) were the main types observed. Different traction methods and surgical procedures were used. We observed no significant differences in terms of outcome regardless of the fracture, traction method, and surgical management. No complications related to surgery or during follow-up were found. Mortality at one year postoperatively was absent.
Conclusion
Provided an experienced orthopaedic surgeon, a pre-operative assessment, a comprehensive surgical planning, and a multidisciplinary rehabilitation strategy are present; a satisfactory outcome is to be expected.
Similar content being viewed by others
References
Brunner, L. C., Eshilian-Oates, L., & Kuo, T. Y. (2003). Hip fractures in adults. American Family Physician, 67, 537–542.
Kim, D. S., Shon, H. C., Kim, Y. M., et al. (2008). Postoperative mortality and the associated factors for senile hip fracture patients. Journal of Korean Orthopaedic Association, 43, 488–494.
Ziegler-Graham, K., MacKenzie, E. J., Ephraim, P. L., Travison, T. G., & Brookmeyer, R. (2008). Estimating the prevalence of limb loss in the United States: 2005 to 2050. Archives of Physical Medicine and Rehabilitation, 89(3), 422–429.
Miller, R., Ambler, G. K., Ramirez, J., Rees, J., Hinchliffe, R., Twine, C., Rudd, S., Blazeby, J., & Avery, K. (2021). Patient reported outcome measures for major lower limb amputation caused by peripheral artery disease or diabetes: A systematic review. European Journal of Vascular and Endovascular Surgery, 61(3), 491–501.
Kulkarni, J., Pande, S., & Morris, J. (2006). Survival rates in dysvascular lower limb amputees. International Journal of Surgery, 4, 217–221.
Bowker, J. H., Rills, B. M., Ledbetter, C. A., Hunter, G. A., & Holliday, P. (1981). Fractures in lower limbs with prior amputation. A study of ninety cases. Journal of Bone and Joint Surgery [Am], 63, 915–920.
Flint, J. H., Wade, A. M., Stocker, D. J., Pasquina, P. F., Howard, R. S., & Potter, B. K. (2014). Bone mineral density loss after combat-related lower extremity amputation. Journal of Orthopaedics Trauma, 28(4), 238–244.
Berg, A. J., & Bhatia, C. (2014). Neck of femur fracture fixation in a bilateral amputee: An uncommon condition requiring an improvised fracture table positioning technique. BMJ Case Representation, 2014, bcr2013203504.
Gamulin, A., & Farshad, M. (2015). Amputated lower limb fixation to the fracture table. Orthopedics, 38, 679–682.
Freitas, A., Souto, D. R. M., da Silva, J. F., et al. (2015). Treatment of an acute fracture of the femoral neck in a young female adult with a transfemoral amputation: A case report. JBJS Case Connector, 5, e58.
Nejat, E. J., Meyer, A., Sánchez, P. M., Schaefer, S. H., & Westrich, G. H. (2005). Total hip arthroplasty and rehabilitation in ambulatory lower extremity amputees: A case series. Iowa Orthopaedic Journal, 25, 38–41.
Azagra, R., López-Expósito, F., Martin-Sánchez, J. C., Aguyé, A., Moreno, N., Cooper, C., Díez-Pérez, A., & Dennison, E. M. (2014). Changing trends in the epidemiology of hip fracture in Spain. Osteoporosis International, 25(4), 1267–1274.
Mattisson, L., Bojan, A., & Enocson, A. (2018). Epidemiology, treatment and mortality of trochanteric and subtrochanteric hip fractures: Data from the Swedish fracture register. BMC Musculoskeletal Disorders, 19(1), 369.
Moxey, P. W., Gogalniceanu, P., Hinchliffe, R. J., Loftus, I. M., Jones, K. J., Thompson, M. M., et al. (2011). Lower extremity amputations—A review of global variability in incidence. Diabetic Medicine, 28(10), 1144–1153.
Godlwana, L., Nadasan, T., & Puckree, T. (2008). Global trends in incidence of lower limb amputation: a review of the literature. South Afr J Phys, 64(1), 8–12.
Edwards, D. S., Guthrie, H. C., Yousaf, S., Cranley, M., Rogers, B. A., & Clasper, J. C. (2016). Trauma-related amputations in war and at a civilian major trauma centre—Comparison of care, outcome and the challenges ahead. Injury, 47(8), 1806–1810.
Jain, A., Bansal, H., Mittal, S., Kumar, A., & Trikha, V. (2022). Intracapsular fracture of the proximal femur in a bilateral above-knee amputee: a case report with technical tips for intraoperative positioning and literature review. Chinese Journal of Traumatology, 25(5), 306–310.
Rethnam, U., Yesupalan, R. S., Shoaib, A., et al. (2008). Hip fracture fixation in a patient with below-knee amputation presents a surgical dilemma: A case report. J Med Case Rep, 9, 296.
Aqil, A., Desai, A., Dramis, A., et al. (2010). A simple technique to position patients with bilateral above-knee amputations for operative fixation of intertrochanteric fractures of the femur: A case report. Journal of Medical Case Reports, 30, 390.
Anjum, S. N., & McNicholas, M. J. (2006). Innovative method of traction on fracture table in femoral neck fracture fixation in a below knee amputee. Injury Extra, 37(8), 277–278.
Kandel, L., Hernandez, M., Safran, O., et al. (2009). Bipolar hip hemiarthroplasty in a patient with an above knee amputation: A case report. Journal of Orthopaedic Surgery and Research, 4, 30.
Davarinos, N., Ellanti, P., & McCoy, G. (2013). A simple technique for the positioning of a patient with an above knee amputation for an ipsilateral extracapsular hip fracture fixation. Case Reports in Orthopedics, 2013, 875656.
Haleem, S., Yousaf, S., Hamid, T., Nagappa, S., & Parker, M. J. (2021). Characteristics and outcomes of hip fractures in lower limb amputees. Injury, 52(4), 914–917.
Miller, W. C., Speechley, M., & Deathe, B. (2001). The prevalence and risk factors of falling and fear of falling among lower extremity amputees. Archives of Physical Medicine and Rehabilitation, 82, 1031–1037.
Gonzalez, E. G., & Mathews, M. M. (1980). Femoral fractures in patients with lower extremity amputations. Archives of Physical Medicine and Rehabilitation, 61(6), 276–280.
Hassan, A., Shah, S., & Dartnell, J. (2019). Technical tip when performing a dynamic hip screw in a below-knee amputee: Novel use of foot holder. Annals of the Royal College of Surgeons of England, 101(4), 305–306.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Ethical standard statement
This article does not contain any studies with human or animal subjects performed by any of the authors.
Informed consent
For this type of study informed consent is not required.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Huguet, J., Mariscal, G., Balfagón, A. et al. Management and Outcomes of Hip Fractures in Lower Limb Amputees: A Case Series. JOIO 57, 1063–1067 (2023). https://doi.org/10.1007/s43465-023-00890-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s43465-023-00890-x