Intertrochanteric fractures in patients with lower limb amputation

Fracture of the residual limb in an amputee is uncommon. Intertrochanteric fractures of patients who had lower limb amputation have been studied only in several case reports; however clinical studies are lacking. We performed a retrospective clinical study to assess if these patients could return to their pre-fracture activity level after dynamic hip screw (DHS) fixation of their intertrochanteric fractures. Our hypothesis is that DHS fixation of intertrochanteric fractures in these patients would give good results with fracture union and could help to return to the previous activity level. We retrospectively reviewed data of the 12 patients (between the period of January 2006 and March 2013) who underwent DHS fixation of an intertrochanteric fracture on the ipsilateral side of a major lower limb amputation (above knee or below knee amputations). Age, gender, amputation level, amputation reason, time since amputation, mechanism of injury at the time of fracture, operation time, length of hospital stay, time to bone union and activity level were documented. Patient’s activity level after one year of operation and union time were evaluated as primary outcomes. During the study period, 12 patients were included with seven (58.3%) male and five (41.7%) female. Mean age at the time of fracture was 57.6 years (range 48 to 72 years). All of the fractures were classified according to AO/OTA as 31A1. There were four patients (33.3%) with above knee and eight patients (66.7%) with below knee amputation. Mean time to bony union in twelve patients was 18 weeks (range 8 to 24 weeks). Ninety-two percent of these patients returned to pre-fracture activity level. There were no implant failure or nonunion at the minimum two-year follow-up period. DHS fixation of intertrochanteric hip fractures in patients with ipsilateral amputated limb provides good results of returning pre-fracture activity levels. Bone union time found to be similar in these patients when compared with patients with a normal limb.