FRACTURE OF THE NECK OF FEMUR IN LOWER LIMB AMPUTEES

Abstract

Introduction: Fractures of the neck of femurs in amputees have been reported sporadically in literature. We reviewed a series of 19 amputees who presented with a fracture neck of femur to analyse their mobility and pain scores at the end of one year and compared them with other patients presenting with the same condition.

Methods: We retrospectively analysed prospectively collected data for fractures of the proximal femur on all patients with amputations of the lower limb. Details on admission of all consecutive admission to one hospital were recorded from 1989 onwards including age, sex, type of amputation, fracture type, mechanism of injury, peri-operative mobility and rehabilitative status up to 1 year post operatively.

Results: Nineteen (19) patients with 22 amputations, sustaining 20 fractures of the neck of femurs were treated among approximately 6500 neck of femur fractures in our hip fracture database. Of these 7 were male and 12 were female. The mean age was 79 years with a range of 50–89 years. 17 patients had undergone below knee amputations (BKA) and 5 above knee amputations (AKA). Thirteen patients came from their own homes with thirteen patients being mobile pre-operatively while 6 were bed bound. All patients were alert and scored well on mental test scores. Intracapsular fractures were the most common type with AO Screw fixation being the most common operative management. Hospital stay was an average of 7 days with a range of 1–90 days. Thirteen of our cohort of patients survived more than a year after the fracture operation. Post operative mobility scoring revealed that most of our patients returned to their preoperative mobility level except for those that did not survive for the first year.

Discussion: Fractures of the neck of femurs have an increasing incidence in an expanding aging population with nearly 60000 fractures treated in the United Kingdom every year. Amputees suffer from accelerated bone density loss and are at an increased risk for osteoporosis and fragility fractures in the hip. The future prospect with an increasing population of amputees with fracture neck of femurs must be addressed so that appropriate management plans can be implemented to allow such patients to return to full mobility and active lifestyle. This also decreases other co-morbidities such as pressure sores and infection.

Approximately one third of our patients survived between 1 to 4 years and another third survived between 5 to 10 years with one patient surviving over 10 years with nearly returning to their pre-injury status. We suggest that satisfactory post operative function is achievable with either internal fixation or hemiarthroplasty.

We conclude that these fractures should be treated with the same urgency and expertise as similar fractures in non-amputees as long term survival and good quality of life can be expected.