# Novel, non-invasive technique for fracture reduction in rare pertrochanteric femur fractures in patients with ipsilateral above-knee amputation: a technical report

## TL;DR

A new non-invasive method for treating hip fractures in patients with above-knee amputations is introduced, avoiding risks of traditional invasive techniques.

## Contribution

A novel, non-invasive fracture reduction technique using a cephalomedullary nail as a joystick is presented.

## Key findings

- Three patients achieved anatomic or acceptable fracture reduction with no surgery-related complications.
- Operative time and hospital stay were 89 minutes and 18 days on average.
- All patients were able to mobilize with full weight-bearing using their exoprostheses.

## Abstract

Pertrochanteric femur fractures in patients with ipsilateral above-knee amputations present unique challenges, as the use of standard reduction techniques such as traction tables is impractical. Modified techniques, including the use of K-wires, Schanz pins, or bone clamps, are often invasive and carry the risk of vascular disruption and surgical site infections. Given these limitations, we developed a non-invasive technique that leverages the cephalomedullary nail as a joystick to reduce the fracture.

Patients with a history of ipsilateral above-knee amputation who subsequently sustained a pertrochanteric femur fracture were treated using the novel technique at our institution between January 2019 and January 2024. Radiological outcomes in these patients were evaluated by assessing fracture reduction quality according to Schipper et al. and fixation quality using the Cleveland and Bosworth quadrant system. The results are summarised in this technical report.

Between January 2019 and January 2024, three patients (two males, mean age 84 ± 11 years) with an ipsilateral above-knee amputation were treated using the novel technique with a cephalomedullary nail using TFN-Advanced™ Proximal Femoral Nailing System or PFNa, Proximal Femur Nail Antirotation (DePuySynthes, Johnson & Johnson MedTech). These patients had a mean Charlson Comorbidity Index of 10± 2.1. Radiological evaluation showed anatomic reduction in two cases and acceptable reduction in one, with optimal femoral neck fixation in two cases. The mean operative time and hospital stay were 89 ± 100 min and 18 ± 15 days respectively. No surgery-related complications occurred, and all patients were mobilised with full weight-bearing using their exoprostheses.

This novel technique provides a safe alternative for fracture reduction in amputees, avoiding the risks associated with invasive hardware. It offers advantages such as minimal soft tissue disruption, which might subsequently improve patient outcomes. Further studies with larger cohorts are necessary to validate its efficacy and determine its broader applicability in clinical practice.