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

Article information

J Musculoskelet Trauma. 2019;32(4):227-231

Publication date (electronic) : 2019 October 28

doi : https://doi.org/10.12671/jkfs.2019.32.4.227

Tae Young Ahn, M.D.,

, Seung Joon Rhee, Ph.D.

, Sang Ho Kwak, Ph.D.^*

, Hyo Seok Jang, M.D.^†

, Sang Hyun Lee, Ph.D.

Department of Orthopaedic Surgery, Pusan National University Hospital, Busan, Korea.

^*Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.

^†Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan, Korea.

Correspondence to: Sang Hyun Lee, Ph.D. Department of Orthopaedic Surgery, Pusan National University Hospital, Medical Research Institute, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea. Tel: +82-51-240-7248, Fax: +82-51-247-8395, handsurgeon@naver.com

Received 2019 September 22; Revised 2019 October 06; Accepted 2019 October 11.

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

Notes

^{Financial support}

None.

^{Conflict of interests}

None.

References

1. Rotondo MF, Schwab CW, McGonigal MD, et al. ‘Damage control’: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 1993;35:375–382. discussion 382-383.

2. Leclère FM, Mathys L, Juon B, Franz T, Unglaub F, Vögelin E. Macroreplantations of the upper extremity: a series of 11 patients. Arch Orthop Trauma Surg 2012;132:1797–1805.

3. Magee HR, Parker WR. Replantation of the foot. Results after two years. Med J Aust 1972;1:751–755.

4. Bosma NH, Teunis T, Eberlin KR, Jupiter JB. Lower limb replantation after guillotine amputation: a 29-year follow-up. J Reconstr Microsurg 2015;31:681–683.

5. Xie S, Hou J, Dong Q, Zhang H, Wang H, Yang C. [Application of shortened replantation combined with limb lengthening in treatment of severe amputation of middle and distal lower leg]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2017;31:936–940. Chinese.

6. Muneuchi G, Suzuki S, Ito O, Kurokawa M. Successful replantation of an amputated leg with severe crush and avulsion injury in an elderly patient: case report. J Reconstr Microsurg 2003;19:87–92.

7. Hierner R, Berger AK, Frederix PR. Lower leg replantation--decision-making, treatment, and long-term results. Microsurgery 2007;27:398–410.

8. Tantry TP, Kadam D, Shenoy SP, Bhandary S, Adappa KK. Perioperative evaluation and outcomes of major limb replantations with ischemia periods of more than 6 hours. J Reconstr Microsurg 2013;29:165–172.

Supplementary Materials

Supplementary materials can be found via https://doi.org/10.12671/jkfs.2019.32.4.227.

Article information Continued

The Korean Fracture Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.