A Simple Method for Positioning the Traction Table during Fixation Surgery for a Displaced Femoral Trochanteric Fracture in a Patient Following Ipsilateral Above-the-knee Amputation: A Case Report.

introductionIt is difficult to use a traction table during surgery for an ipsilateral displaced femoral trochanteric fracture following above-the-knee amputation. However, there are few reports regarding such cases. We describe the simple method we used for positioning the traction table and reducing fracture site during fixation surgery for a displaced femoral trochanteric fracture in this patient following above-the-knee amputation. CASE REPORT: An 80-year-old man was injured in a head-on collision with an oncoming vehicle. We diagnosed him with traumatic gastric perforation, multiple right lower leg fractures, and right lower leg severe crush wound. We performed right above-the-knee amputation and laparoscopic gastrorrhaphy for lifesaving purposes. Thereafter we performed internal fixation for the right femoral trochanteric fracture on the 5th day after the injury. In that operation, we first inserted a 2.4 mm Kirschner wire under fluoroscopic guidance 3 cm proximal to the femoral cut end and attached a horseshoe and traction rope to it. Then, we tightened the rope to the foot piece of the traction table and secured it. Although shortening of the bone fracture was reduced by traction, rotation control was impossible; therefore, the horseshoe was manually controlled through clean sheets during surgery to reduce rotational displacement. We performed internal fixation surgery using a trochanteric femoral nail in the usual manner.

conclusionIn the osteosynthesis surgery of displaced femoral trochanteric fractures following above-the-knee amputation, the method of inserting the Kirschner wire at the distal end of the patient's femur and pulling it through the rope enables surgeons to reduce fracture shortening. Reduction of rotational displacement was possible by controlling the horseshoe by hand. In this way, intramedullary nail fixation could be performed without trouble under fluoroscopic guidance.