Fractures in amputation stumps: review of treatment of 16 fractures

Abstract

A retrospective study of patients who sustained a fracture of the amputation stump was carried out to determine how these injuries might be prevented and to develop an optimum method of treatment. Review of the records of the Mayo Clinic from 1956 through 1978 revealed that 14 patients had a fracture in the amputation stump and 2 patients had two separate episodes of fracture, for a total of 16 fractures. Each patient's history and the available x-ray films were carefully reviewed. Fifteen fractures involved the femur or hip, and one involved the tibia and fibula. All fractures went on to union, but four of nine treated with internal fixation had comp]lications, three of which required further surgical procedures. At least five fractures in this series might have been prevented by better patient instruction and closer attention to fitting the prosthesis. Half of the fractures resulted from falls in the elderly patient. All five fractures that were treated without internal fixation healed well in a short time. The relatively high complication rate associated with internal fixation contrasted with the relatively rapid rate of union of the fractures treated without internal fixation suggests that these fractures should be treated by conservative measures if possible.