Intertrochanteric Femur Fracture Fixation in a Patient with Below-Knee Amputation Presents a Surgical Dilemma: A Case Report

An intertrochanteric fracture (IT) with below-knee (BK) amputation is challenging to manage since it is impossible to provide the ideal amount of traction to reduce the fracture due to the lack of a foot. We emphasize this complex problem and offer solutions to overcome it. A 55-year-old man with a previous ipsilateral BK amputation presented to us after an episode of fall. The patient had been using a BK prosthesis for mobilization before the fall. Radiographs revealed a femoral IT fracture. A proximal femoral nail (PFN) fixation was intended for the fracture, but positioning the patient on the fracture table for surgery proved challenging. The patient had to be carefully positioned on the fracture table during surgery. The reverse boot technique is an effective method for treating an IT fracture in a patient with ipsilateral BK amputation. It involves the usual technique of applying traction, achieving reduction, and fixing the fracture with a PFN of the appropriate size. The patient was able to walk with support the next day after surgery and pre-injury mobility was regained within 3 days. We here emphasize a method of applying traction with this simple modification of the fracture table to apply an adequate amount of traction safely.