Successful management of femoral trauma in a through-knee amputee with a previous malunited fracture: Implications and functional outcome.

BACKGROUND: After amputation patients are more likely to injure their residual limb. An injury of a previously amputated limb, especially if the residuum is not anatomically normal, poses a dilemma for management. Case Description and Methods: This case report discusses a femoral fracture sustained proximal to a through-knee amputation. Findings and outcomes: The fracture was at the site of a malunited fracture. A shortening osteotomy with bone graft was undertaken to improve alignment and prosthetic fit and remove poor-quality bone. This was stabilised using an intramedullary nail, supplemented with an anti-rotation plate. This fracture went on to uneventful union, and the patient was able to comfortably use a prosthesis with increased functionality compared with prior to the recent injury. DISCUSSION: This management enabled quick healing of the fracture without the need to resort to a more proximal amputation. CONCLUSION: In these unusual cases, careful planning is necessary to ensure all aspects of the problem is dealt with. Each case should be treated on its own merits. Clinical relevance This case demonstrates the difficulty in care of complex limb trauma and offers a solution for management of similar cases. Excellent results are possible when all surgical options are considered.