title: Successful management of femoral trauma in a through-knee amputee with a previous malunited fracture: Implications and functional outcome.
abstract: 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.
  
  
  CONCLUSIONS
  This management enabled quick healing of the fracture without the need to resort to a more proximal amputation.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Leeds General Infirmary, Leeds, UK.
authors.forename: Beth
authors.initials: B
authors.lastname: Lineham
authors.affiliation: Leeds General Infirmary, Leeds, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Harwood
authors.affiliation: Leeds General Infirmary, Leeds, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Giannoudis
mesh_terms: D000058:Accidental Falls; D000671:Amputation, Surgical / Q000379:methods* / Q000534:rehabilitation; D001186:Artificial Limbs; D005264:Femoral Fractures / Q000175:diagnosis / Q000601:surgery*; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000601:surgery*; D005597:Fractures, Open / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017755:Prosthesis Fitting; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Femur; amputation; diamond concept; osteotomy; prosthesis