J Korean Fract Soc.  2019 Oct;32(4):227-231. 10.12671/jkfs.2019.32.4.227.

Major Limb Replantation of Lower Leg Amputation with Ipsilateral Distal Femoral Comminuted Fracture in Old Age: A Case Report

• Ahn TY
• Rhee SJ
• Kwak SH
• Jang HS
• Lee SH

• KMID: 2468686
• DOI: http://doi.org/10.12671/jkfs.2019.32.4.227

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.

Keyword

Old age amputation; Ipsilateral fracture; Lower limb replantation

MeSH Terms

Accidents, Traffic
Aged
Amputation*
Canes
Caregivers
Esthetics
Extremities*
Female
Fractures, Comminuted*
Humans
Leg*
Lower Extremity
Rehabilitation
Replantation*
Tibia
Walking
Wounds and Injuries

Figure

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  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.

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  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.

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  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.

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  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.

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  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.

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