Proximal femur fractures in below-knee amputees pose significant surgical challenges due to difficulties in positioning and stabilizing the residual limb for fracture reduction. In the current literature, there is no consensus on the optimal management strategy, but the inverted boot positioning method seems to be an adequate and non-invasive technique. However, in our case, this method was not possible due to limited knee flexion, so we describe our technique and compare the different modalities described in the literature, highlighting their advantages and disadvantages.
A 69-year-old female patient, who underwent a Burgess amputation 10 years ago, fell from her height onto her ipsilateral side and sustained an intertrochanteric fracture of the left femur. We indicated a cephalomedullary nailing procedure. The dilemma is positioning her correctly on the traction table to achieve a satisfactory reduction, especially since knee flexion was limited to 40° and an invasive method was not desired to spare the skin.
Our non-invasive method allowed for traction and control of rotation to achieve a sufficient reduction with no skin damage in cases where the inverted boot setup is not possible. According to the literature, the inverted traction boot method remains as a practical and effective solution, balancing traction and rotational control with minimal invasiveness among the other previously used methods but requires sufficient knee flexion and stump length for proper support. Future research should refine these techniques, develop standardized protocols, and assess comparative outcomes to improve clinical management in this challenging patient group.