[Amputation below the fracture site in pseudarthrosis complicated by infection or vascular lesion]

In cases of fractures of the shaft of a bone complicated by non-union, infection and vascular and/or neurological lesions, amputation may be the ultimate possible treatment. In some cases, an amputation at the level of the fracture site would produce too short a stump for a normal prosthesis. The authors consider that, in this type of lesion, it may be wise to preserve some of the distal portion of the bone below the site of the fracture, even in cases of infected non-union. They performed this technique in seven cases, the distal fragment of the bone being covered by an osteomyoplasty, infection being treated by antibiotics. Early rehabilitation was started with immediate weight-bearing in the prosthesis. In all cases, union was obtained secondarily and in five cases infection healed as well. Two still had an intermittent sinus. The authors consider that the infected non-unions healed because of suppression of the weight of the limb. The technique allowed better rehabilitation because of the presence of a sufficiently long stump.