Femoral fracture fixation followed by ipsilateral amputation: A case report

Abstract

Severe crushing injury of the lower limb presenting as a concomitant femoral subtrochanteric fracture, ipsilateral open knee dislocation, and associated popliteal artery injury is unusual. Due to poor general and local conditions, despite a vascular repair, we performed a femoral fracture fixation followed by transfemoral amputation of the lower limb. The report aimed to demonstrate the effectiveness of this definitive treatment as one of the options in these difficult cases. The knee dislocation reduction was performed in the emergency operating room and the lower limb was stabilized with an external fixator. Vascular surgeons performed revascularization of the extremity with a femoropopliteal vascular bypass. Leg fasciotomies were performed and broad-spectrum antibiotics were administered. Several attempts at fasciotomy revisions and necrotic tissue debridement were made by plastic surgeons. Ten days after hospitalization, concomitant local rhabdomyolysis and deep soft-tissue infection lead to life-threatening sepsis. An above-the-knee amputation was quickly required. We performed an emergency proximal nailing of the femoral fracture and, subsequently, a transfemoral amputation at the distal third. In this case, we described the successful use of intramedullary nailing as a good option for stabilizing acute subtrochanteric fracture of a limb that required an above-the-knee amputation. This strategy saved the patient’s life, and intramedullary fixation with a short nail provided reliable bone stability for rapid and better functional recovery.