Dynamic Hip Screw Fixation of a Proximal Femur Fracture in a Patient With Ipsilateral Above-Knee and Contralateral Hindquarter Amputations

TL;DR

A 77-year-old woman with amputations had a hip fracture treated using a modified traction method for safe and effective surgery.

Contribution

A reproducible skeletal traction strategy for hip fracture fixation in patients with major limb amputations.

Findings

Closed reduction was achieved using a Steinmann pin and stirrup for controlled traction.

The patient regained pre-injury mobility after successful DHS fixation.

The method allows safe imaging and controlled reduction without a contralateral limb.

Abstract

Intertrochanteric hip fractures are usually managed with dynamic hip screw (DHS) fixation, but standard positioning and traction are difficult in patients with major lower-limb amputations. We describe a 77-year-old woman with a right above-knee amputation and no contralateral limb who sustained an intertrochanteric fracture after a wheelchair fall. The main challenge was achieving axial traction and rotational control on a very short femoral stump without damaging it or compromising imaging. We achieved closed reduction by inserting a distal femoral Steinmann pin and attaching a stirrup to apply controlled traction and rotation on the fracture table, followed by standard DHS fixation through a lateral approach. The patient returned to her pre-injury level of bed-to-wheelchair transfers, and this case outlines a reproducible positioning and traction strategy for similar complex presentations. This case highlights a reproducible skeletal traction strategy that provides safe imaging corridors and controlled reduction even in the absence of the contralateral limb.

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