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Operative Positioning Technique for an Intertrochanteric Fracture in a Patient with an Ipsilateral Above-the-Knee Amputation - Technical Note -
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Dae-Hyun Park, Yong-Uk Kwon, Dong-Seok Kim
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J Korean Fract Soc 2021;34(4):137-141. Published online October 31, 2021
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DOI: https://doi.org/10.12671/jkfs.2021.34.4.137
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 Abstract
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- A 45-year-old man with a remote history of a left above-the-knee amputation presented to the emergency department with left hip pain after a mechanical fall. This case was an operative challenge because commonly used intraoperative traction methods could not be applied to a patient with an above-the-knee amputation. We describe a rarely utilized surgical technique of applying traction to an amputated extremity via a Steinmann pin during closed reduction and internal fixation of an intertrochanteric fracture.
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Citations
Citations to this article as recorded by  - Periprosthetic Femur Fractures in Osseointegration Amputees
Jason Shih Hoellwarth, S. Robert Rozbruch
JBJS Case Connector.2022;[Epub] CrossRef
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Paradoxical hypertrophy as a cause of insufficiency femoral fractures analyzed through differences in force application in Korea: three case reports
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Yong-Uk Kwon, Dae-Hyun Park, Hyoung-Gu Kang
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Received December 13, 2025 Accepted February 9, 2026 Published online February 24, 2026
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DOI: https://doi.org/10.12671/jmt.2025.00388
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Abstract
- Previous studies have extensively examined the association between femoral insufficiency fractures and prolonged bisphosphonate therapy. However, alternative etiologies remain insufficiently characterized. This study aimed to analyze non-pharmacologic factors associated with femoral insufficiency fractures, with particular emphasis on paradoxical cortical hypertrophy and altered biomechanical load distribution. We reviewed three cases of femoral insufficiency fracture that were surgically treated at our institution between January 2018 and January 2022. None of the patients had a history of bisphosphonate use. Clinical histories—including underlying comorbidities, prior surgical procedures, and radiographic findings—were evaluated. Serial radiographs obtained before and after fracture occurrence were analyzed to characterize fracture morphology and associated cortical changes. Case 1 involved a patient with post-traumatic hip synostosis; case 2 involved a patient with osteogenesis imperfecta; and case 3 involved a patient who had previously undergone intramedullary nailing for an intertrochanteric fracture. Lateral femoral bowing and cortical hypertrophy preceded fracture development in two cases, whereas focal cortical hypertrophy at the distal locking screw site was observed in the third case. No history of bisphosphonate therapy was identified in any patient. Fractures developed at sites characterized by increased cortical remodeling and abnormal load concentration. Femoral insufficiency fractures can occur in the absence of bisphosphonate therapy. Paradoxical cortical hypertrophy and altered biomechanical force distribution appear to be important contributing factors.
Level of evidence: IV.
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