Proximal Femoral Fractures Following Ipsilateral Transfemoral Amputation in Working-Age Men: A Report of Two Cases

Lower limb amputation is associated with progressive loss of bone mineral density (BMD) in the residual limb, particularly at the amputated-side proximal femur. However, proximal femoral fractures in working-age individuals with transfemoral amputation who are independently ambulatory with a prosthesis remain insufficiently described. We report the cases of two working-age men who sustained ipsilateral proximal femoral fractures after minor falls at home while not wearing their prostheses. Case 1 sustained a left femoral neck fracture classified as Garden grade I six years after amputation, whereas Case 2 sustained a nondisplaced two-part pertrochanteric fracture (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 31-A1) 16 months after amputation. Before fracture, both patients had achieved independent prosthetic ambulation and returned to work. Open reduction and internal fixation (ORIF) were performed at acute care hospitals, after which the patients were admitted or transferred to our specialized prosthetic rehabilitation facility. Prosthetic refitting and progressive gait rehabilitation enabled both patients to regain independent prosthetic ambulation and return to their pre-fracture occupations, including physically demanding industrial work in Case 2. In Case 1, only the socket was refabricated; in Case 2, the socket was refabricated, and the prosthetic knee joint was changed to meet occupational demands rather than as a consequence of the fracture. These cases are hypothesis-generating and suggest that site-specific skeletal deterioration and proximal femoral fracture may occur relatively early after transfemoral amputation, even in active, working-age prosthesis users. They raise, but cannot establish, the value of early BMD surveillance and of fall prevention strategies that specifically address mobility without the prosthesis. When a fracture occurs, prompt surgical stabilization followed by coordinated, specialized prosthetic rehabilitation may facilitate restoration of prosthetic function and return to work, and the scope and timing of prosthetic refitting should be kept to the minimum necessary and matched to the dimensional stability of the residual limb.