Intertrochanteric Fracture Fixation Using a Traction Table in a Patient with Ipsilateral Above-knee Amputation - A...

Although commonly encountered in clinical practice and considered among the "bread and butter" cases in trauma and orthopedics, intertrochanteric fractures of the femur in certain scenarios pose a challenge to the orthopedic surgeon. Good reduction and stable fixation are a key for good outcome, and certain anatomical limitations such as amputations make that difficult to achieve. Ipsilateral above-knee amputation is a scenario where positioning of the patient on an orthopedic fracture table and reduction of the fracture becomes challenging.

An active 59-year-old female with good functional baseline and ipsilateral above-knee amputation presented with an intertrochanteric fracture of the right proximal femur. The fracture was treated operatively and fixed with a dynamic hip screw (DHS). This case report highlights the technique of positioning of the patient and reduction of the fracture on a traction table using skeletal traction though the amputation stump with a Denham pin connected to the traction device.

This technique provides a reliable and stable means of reducing the fracture using skeletal traction through the bone itself and will be helpful to any orthopedic surgeon faced with a similar situation. This report also sheds light on current literature regarding different ways of overcoming the challenge of positioning and reducing intertrochanteric/intracapsular neck femur fractures using the orthopedic traction table in patients with ipsilateral limb amputations.