Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 13 , ISSUE 3 ( November, 2018 ) > List of Articles

CASE REPORT

Acute femoral shortening for reconstruction of a complex lower extremity crush injury

Philip K. Lim, Bharat Sampathi, Nathan M. Moroski, John A. Scolaro

Keywords : Femoral shortening, Knee disarticulation, Traumatic amputation, Open femur, Fracture

Citation Information : Lim PK, Sampathi B, Moroski NM, Scolaro JA. Acute femoral shortening for reconstruction of a complex lower extremity crush injury. 2018; 13 (3):185-189.

DOI: 10.1007/s11751-018-0311-4

License: CC BY-NC-SA 4.0

Published Online: 30-11-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Traumatic through-knee or transfemoral amputations with concomitant ipsilateral femoral fractures are extremely rare injuries. The initial goal of management is patient resuscitation and stabilization. Subsequent interventions focus on limb salvage and the creation of a residual limb that can be fitted successfully for a functional lower extremity prosthesis. We present the case of a patient who sustained a traumatic through-knee amputation ipsilateral to an open comminuted femoral fracture. Soft tissue injury prohibited initial primary closure over the distal femoral condyles. A functional residual limb was achieved with acute femoral shortening, maintenance of the femoral condyles and fracture stabilization with a short retrograde intramedullary nail. This approach allowed maintenance of muscular attachments to the femur, soft tissue closure and resulted in a residual limb of acceptable length with a broad weight-bearing surface that was fitted with a prosthesis successfully.


PDF Share
  1. Gordon WT, O'Brien FP, Strauss JE, Andersen RC, Potter BK (2010) Outcomes associated with the internal fixation of longbone fractures proximal to traumatic amputations. J Bone Joint Surg Am 92(13):2312-2318
  2. Tintle SM, Keeling JJ, Shawen SB, Forsberg JA, Potter BK (2010) Traumatic and trauma-related amputations: part I: general principles and lower-extremity amputations. J Bone Joint Surg Am 92(17):2852-2868
  3. Behr J, Friedly J, Molton I et al (2009) Pain and pain-related inter-ference in adults with lower-limb amputation: comparison of knee-disarticulation, transtibial, and transfemoral surgical sites. J Rehabil Res Dev 46:963-972
  4. Pinzur MS (1992) Knee disarticulation: surgical procedures. In: Bowker JH, Michael JW (eds) Atlas of limb prosthetics: surgical, prosthetic and rehabilitation principles, 2nd edn. Mosby-Year Book, St. Louis, pp 479-486
  5. Bowker JH, San Giovanni TP, Pinzur MS (2000) North American experience with knee disarticulation with use of a posterior myofasciocutaneous flap. Healing rate and functional results in seventy- seven patients. J Bone Joint Surg Am 82-A(11):1571-1574
  6. Morse BC, Cull DL, Kalbaugh C, Cass AL, Taylor SM (2008) Through-knee amputation in patients with peripheral arterial disease: a review of 50 cases. J Vasc Surg 48(3):638-643
  7. Pickard-Gabriel CJ, Ledford CL, Gajewski DA, Granville RR, Andersen RC (2007) Traumatic transfemoral amputation with concomitant ipsilateral proximal femoral fracture. A report of two cases. J Bone Joint Surg Am 89(12):2764-2768
  8. Pinzur MS, Gold J, Schwartz D, Gross N (1992) Energy demands for walking in dysvascular amputees as related to the level of amputation. Orthopedics 15:1033-1037
  9. Penn-Barwell JG (2011) Outcomes in lower limb amputation following trauma: a systematic review and meta-analysis. Injury 42(12):1474-1479
  10. Raichle KA, Hanley MA, Molton I, Kadel NJ, Campbell K, Phelps E, Ehde D, Smith DG (2008) Prosthesis use in persons with lowerand upper-limb amputation. J Rehabil Res Dev 45(7):961-972
  11. Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R (2008) Estimating the prevalence of limb loss in the United States: 2005 to 2050. Arch Phys Med Rehabil 89:422-429
  12. Krajbich JI (1998) Lower-limb deficiencies and amputations in children. J Am Acad Orthop Surg 6(6):358-367
  13. Benevenia J, Makley JT, Leeson MC, Benevenia K (1992) Primary epiphyseal transplants and bone overgrowth in childhood amputations. J Pediatr Orthop 12(6):746-750
  14. Vallier HA, Fitzgerald SJ, Beddow ME, Sontich JK, Patterson BM (2012) Osteocutaneous pedicle flap transfer for salvage of transtibial amputation after severe lower-extremity injury. J Bone Joint Surg Am 94(5):447-454
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.