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- Case Report Major Limb Replantation of Lower Leg Amputation with Ipsilateral Distal Femoral Comminuted Fracture in Old Age: A Case Report
- Tae Young Ahn, Seung Joon Rhee, Sang Ho Kwak, Hyo Seok Jang, Sang Hyun Lee
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Journal of Musculoskeletal Trauma 2019;32(4):227-231.
DOI: https://doi.org/10.12671/jkfs.2019.32.4.227
Published online: October 31, 2019
1Department of Orthopaedic Surgery, Pusan National University Hospital, Busan, Korea. handsurgeon@naver.com 
2Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.
3Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan, Korea.
2Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.
3Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan, Korea.
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Abstract
The development of microsurgical techniques has also increased the success rate of replantation surgery. This paper reports the results of limb replantation performed on a lower extremity amputation that was associated with crush amputation and an ipsilateral comminuted fracture in and elderly patient. A 68-year-old female presented with a right distal tibia amputation due to a traffic accident. At that time, with a comminuted fracture in the distal femoral condyle, simple wound repair was recommended, but the caregivers strongly wanted replantation. Three years after surgery, normal walking was possible without a cane and the patient was satisfied with the function and aesthetics. What used to be contraindicated in limb replantation in the past are now indications due to the development of microsurgical techniques, surgical experience, and postoperative rehabilitation treatment. If the patient is willing to be treated, good results in contraindications can be obtained.
J Korean Fract Soc. 2019 Oct;32(4):227-231. Korean.
Published online Oct 28, 2019.
https://doi.org/10.12671/jkfs.2019.32.4.227
Published online Oct 28, 2019.
https://doi.org/10.12671/jkfs.2019.32.4.227
Copyright © 2019 The Korean Fracture Society. All rights reserved.
Case Report
Major Limb Replantation of Lower Leg Amputation with Ipsilateral Distal Femoral Comminuted Fracture in Old Age: A Case Report
Tae Young Ahn
, M.D., ,
Seung Joon Rhee, Ph.D.,
Sang Ho Kwak, Ph.D.,*
Hyo Seok Jang, M.D.,†
and Sang Hyun Lee, Ph.D.
, M.D., ,
Seung Joon Rhee, Ph.D.,
Sang Ho Kwak, Ph.D.,*
Hyo Seok Jang, M.D.,†
and Sang Hyun Lee, Ph.D.
Abstract
The development of microsurgical techniques has also increased the success rate of replantation surgery. This paper reports the results of limb replantation performed on a lower extremity amputation that was associated with crush amputation and an ipsilateral comminuted fracture in and elderly patient. A 68-year-old female presented with a right distal tibia amputation due to a traffic accident. At that time, with a comminuted fracture in the distal femoral condyle, simple wound repair was recommended, but the caregivers strongly wanted replantation. Three years after surgery, normal walking was possible without a cane and the patient was satisfied with the function and aesthetics. What used to be contraindicated in limb replantation in the past are now indications due to the development of microsurgical techniques, surgical experience, and postoperative rehabilitation treatment. If the patient is willing to be treated, good results in contraindications can be obtained.
Keywords
Old age amputation, Ipsilateral fracture, Lower limb replantation
Supplementary Materials
Supplementary materials can be found via https://doi.org/10.12671/jkfs.2019.32.4.227.
Figures
Fig. 1
A 68-year-old female presented to hospital due to traffic accident. (A, B) Her ankles were cut off completely. (C–E) Radiographic evaluation revealed a fracture in the distal ipsilateral femur.
Fig. 2
(A) After arterial anastomosis, the blood circulation of the foot looked good. (B, C) The distal femur was fixed with an Ilizarov external fixator for damage control orthopedics. (D, E) For vascular anastomosis, the amputation site was shortened to 9 cm and an external fixator was added for stability.
Fig. 3
(A) R ehabilitation t herapy w as started after the soft tissue damage at the surgical site had been cured. (B–E) Both distal femoral fractures and distal tibial amputation were also healed.
Fig. 4
(A) In the second year of injury, the patient complained a lot of discomfort due to the shortened lower limbs. (B) Gradual lengthening with an Ilizarov external fixator was performed by bifocal osteogenesis. (C) Seven months later, the consolidation in the lengthening area was confirmed.
Fig. 5
(A, B) Plate in the femur was removed after bone union. (C, D) During the follow-up, a fracture was identified in the previous osteotomy site of the tibia and intramedullary nail was inserted.
Notes
Financial support:None.
Conflict of interests:None.
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