Skip to main content
SpringerLink
Log in

Minimally invasive treatment for fractures of lower extremity amputees using a rapid reductor

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

A traction table is recommended for lower limb fractures, while it is unavailable for amputees to immobilize the ipsilateral foot to remain stationary and reduce the fracture. For these patients, our rapid reductor can be applied to guarantee stable fixation and optimal reduction, allowing satisfactory implant positioning. This study aims to evaluate the prognosis of amputee patients with lower limb fractures treated by minimally invasive techniques that employ a rapid reductor to reduce the fracture.

Methods

Between 2013 and 2014, 11 cases of amputees suffering from a lower limb fracture were enrolled in the study, including four transtibial amputees with a tibial plateau fracture, three transtibial amputees with a femoral shaft fracture, and four transfemoral amputees with a femoral neck fracture. All fractures involved the amputated ipsilateral lower limbs, which were all reduced in a closed fashion using a rapid reductor. During the operation, the rapid reductor was connected to the injured limb for skeleton traction to reduce the fracture and then used to maintain the reduction for subsequent minimally invasive fixation. The operation time, reduction time, fluoroscopy time, and intra-operative blood loss were recorded. Follow-ups were conducted to evaluate the union of the fractures and the functional recovery.

Results

All 11 cases were treated successfully using this minimally invasive technique, with anatomical or nearly anatomical reduction reached in all fractures. The average operative time, reduction time, fluoroscopy time, and intra-operative blood loss were 60 minutes (range, 46–90 minutes), 13.2 minutes (range, 7–20 minutes), 19.8 seconds (range, 6–65 seconds), and 95 mL (range, 80–170 mL), respectively. No incidents of reductor-induced complications occurred during the operation. Patients were followed up for an average of 20.8 months (range, 18–24 months). All fractures healed well on an average of six months. At the latest follow-up, all 11 cases reported satisfactory functional recovery of the fixed limbs, which were similar to that before the fractures.

Conclusions

The rapid reductor can be used to efficiently reduce and maintain ipsilateral fractures of the amputated lower extremity in a closed fashion, which can facilitate minimally invasive fixation of the fractures. The patients can achieve excellent outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Chen W, Zhang T, Wang J et al (2016) Minimally invasive treatment of displaced femoral shaft fractures with a rapid reductor and intramedullary nail fixation. Int Orthop 40(1):167–172. https://doi.org/10.1007/s00264-015-2829-0

    Article  CAS  PubMed  Google Scholar 

  2. Alharthy A, Abed R, Campbell AC (1997) Manipulation of hip fracture in the below-knee amputee. Injury 28(8):570

    Article  CAS  Google Scholar 

  3. Berg AJ, Bhatia C (2014) Neck of femur fracture fixation in a bilateral amputee: an uncommon condition requiring an improvised fracture table positioning technique. BMJ Case Rep 2014. https://doi.org/10.1136/bcr-2013-203504

  4. Russek AS (1961) Management of lower extremity amputees. Arch Phys Med Rehabil 42:687–703

    CAS  PubMed  Google Scholar 

  5. Boussakri H, Alassaf I, Hamoudi S et al (2015) Hip arthroplasty in a patient with transfemoral amputation: a new tip. Case Rep Orthop 2015:1–5. https://doi.org/10.1155/2015/593747

    Article  Google Scholar 

  6. Meena U, Meena R, Balaji S et al (2015) Management of neglected femoral neck fracture in above knee amputated limb: a case report. Chin J Traumatol 18(6):370–372

  7. Davarinos N, Ellanti P, McCoy G (2013) A simple technique for the positioning of a patient with an above knee amputation for an ipsilateral extracapsular hip fracture fixation. Case Rep Orthop 2013:1–3. https://doi.org/10.1155/2013/875656

    Article  Google Scholar 

  8. Kandel L, Hernandez M, Safran O et al (2009) Bipolar hip hemiarthroplasty in a patient with an above knee amputation: a case report. J Orthop Surg Res 4(1):30. https://doi.org/10.1186/1749-799X-4-30

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sherk VD, Bemben MG, Bemben DA (2008) BMD and bone geometry in transtibial and transfemoral amputees. J Bone Miner Res 23(9):1449–1457. https://doi.org/10.1359/jbmr.080402

    Article  PubMed  Google Scholar 

  10. Wong CK, Chen CC, Welsh J (2013) Preliminary assessment of balance with the Berg balance scale in adults who have a leg amputation and dwell in the community: Rasch rating scale analysis. Phys Ther 93(11):1520–1529. https://doi.org/10.2522/ptj.20130009

    Article  PubMed  Google Scholar 

  11. Amanatullah DF, Trousdale RT, Sierra RJ (2015) Total hip arthroplasty after lower extremity amputation. Orthopedics 38(5):e394–e400. https://doi.org/10.3928/01477447-20150504-56

    Article  PubMed  Google Scholar 

  12. Sament R, Mayanger JC, Tripathy SK et al (2012) Closed reduction and percutaneous screw fixation for tibial plateau fractures. J Orthop Surg (Hong Kong) 20(1):37–41. https://doi.org/10.1177/230949901202000108

    Article  Google Scholar 

  13. Edwards DS, Langdown AJ, Gandhe AJ (2013) Simple, cheap and non-invasive intraoperative traction of the femur in amputees. Ann R Coll Surg Engl 95(3):225. https://doi.org/10.1308/rcsann.2013.95.3.225

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. McCabe MP, Davila J (2015) Hip arthroscopy in patients with lower-extremity amputations: patient positioning and traction technique. Arthrosc Tech 4(6):e775–e779. https://doi.org/10.1016/j.eats.2015.07.026

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This study was financially supported by the Youth Science and Technology Project of Hebei Provincial Health and Family Planning Commission (Grant no. 20180429).

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China

    Shilun Li, Yingchao Yin, Ruipeng Zhang, Wei Chen & Yingze Zhang

Authors
  1. Shilun Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yingchao Yin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ruipeng Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wei Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yingze Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yingze Zhang.

Ethics declarations

The Institutional Review Board of the local hospital approved this study after a thorough examination. The study was performed in accordance with the ethical standards of the Declaration of Helsinki from 1964.

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of informed consent

Signed informed consent was obtained from all patients.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, S., Yin, Y., Zhang, R. et al. Minimally invasive treatment for fractures of lower extremity amputees using a rapid reductor. International Orthopaedics (SICOT) 43, 1473–1478 (2019). https://doi.org/10.1007/s00264-018-4072-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-018-4072-y

Keywords

Search

Navigation