Positioning and Traction Application Technique in Patient with Below Knee Amputation Using the Patients Own Prosthesis for Intertrochanteric Femur Fracture Fixation Surgery: A Case Report with Review of Literature.
- 1Department of Orthopaedics, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India.
Abstract
Surgical fixation of an intertrochanteric femur fracture in a patient with a below-knee amputation (BKA) is a challenging scenario for the orthopedic surgeon. Applying traction to reduce the fracture and maintaining it until definitive fixation is done with an implant is difficult, because the shortened limb cannot be secured to the foot attachment of a standard fracture table. Reported techniques are either invasive, requiring pins or wires, or need additional equipment. We describe a non-invasive alternative and discuss the various techniques available to address this problem. A 69-year-old woman with a right BKA presented with right hip pain and inability to bear weight following a fall at home. Before injury, she was independently ambulatory using a prosthesis. The stump was healthy and well healed. Radiographs revealed an intertrochanteric femur fracture with varus angulation. Closed reduction and internal fixation using a proximal femoral nail was planned. The prosthesis was secured to the stump using its velcro straps, additional bandages, and adhesive tapes and attached to the fracture table in the routine manner. Gradual traction was applied with internal rotation of the foot, and reduction was confirmed fluoroscopically. Fixation was performed using an 11 × 240 mm PFN with a 135° neck-shaft angle. Post-operative radiographs showed satisfactory alignment and stable fixation. She mobilized non-weight-bearing with a walker on post-operative day 1 and resumed full weight-bearing using the prosthesis at one month. Six-month follow-up demonstrated satisfactory radiological and functional outcomes. Using the patient's own BK prosthesis for positioning, traction, and rotational control effectively achieved and maintained the lower limb traction required during surgery. It allowed satisfactory reduction and stable fixation while avoiding invasive procedures or soft-tissue complications, and is simple, available, and cost-effective because it relies on a device the patient already uses. It adds a non-invasive option to the reduction methods available for hip fractures in amputees.
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BibTeX
@article{ranjankar2026positioning,
title = {{Positioning and Traction Application Technique in Patient with Below Knee Amputation Using the Patients Own Prosthesis for Intertrochanteric Femur Fracture Fixation Surgery: A Case Report with Review of Literature.}},
author = {Mangesh C Ranjankar and Akshay Pawar and Pratik Thorat},
journal = {Journal of orthopaedic case reports},
year = {2026},
month = nov,
doi = {10.13107/jocr.2026.v16.i11.8424},
url = {https://europepmc.org/article/MED/42996983},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Positioning and Traction Application Technique in Patient with Below Knee Amputation Using the Patients Own Prosthesis for Intertrochanteric Femur Fracture Fixation Surgery: A Case Report with Review of Literature.
AU - Mangesh C Ranjankar
AU - Akshay Pawar
AU - Pratik Thorat
PY - 2026
DA - 2026/11/01
JO - Journal of orthopaedic case reports
DO - 10.13107/jocr.2026.v16.i11.8424
UR - https://europepmc.org/article/MED/42996983
AB - Surgical fixation of an intertrochanteric femur fracture in a patient with a below-knee amputation (BKA) is a challenging scenario for the orthopedic surgeon. Applying traction to reduce the fracture and maintaining it until definitive fixation is done with an implant is difficult, because the shortened limb cannot be secured to the foot attachment of a standard fracture table. Reported techniques are either invasive, requiring pins or wires, or need additional equipment. We describe a non-invasive alternative and discuss the various techniques available to address this problem. A 69-year-old woman with a right BKA presented with right hip pain and inability to bear weight following a fall at home. Before injury, she was independently ambulatory using a prosthesis. The stump was healthy and well healed. Radiographs revealed an intertrochanteric femur fracture with varus angulation. Closed reduction and internal fixation using a proximal femoral nail was planned. The prosthesis was secured to the stump using its velcro straps, additional bandages, and adhesive tapes and attached to the fracture table in the routine manner. Gradual traction was applied with internal rotation of the foot, and reduction was confirmed fluoroscopically. Fixation was performed using an 11 × 240 mm PFN with a 135° neck-shaft angle. Post-operative radiographs showed satisfactory alignment and stable fixation. She mobilized non-weight-bearing with a walker on post-operative day 1 and resumed full weight-bearing using the prosthesis at one month. Six-month follow-up demonstrated satisfactory radiological and functional outcomes. Using the patient's own BK prosthesis for positioning, traction, and rotational control effectively achieved and maintained the lower limb traction required during surgery. It allowed satisfactory reduction and stable fixation while avoiding invasive procedures or soft-tissue complications, and is simple, available, and cost-effective because it relies on a device the patient already uses. It adds a non-invasive option to the reduction methods available for hip fractures in amputees.
SN - 2250-0685
SN - 2321-3817
ER -