Femoral neck fractures in patients with prior lower-limb amputation: a two-case series and narrative review of surgical decision-making

Background Femoral neck fractures in patients with pre-existing lower-limb amputation are rare clinical conditions that pose unique technical challenges and surgical decision-making dilemmas for orthopedic surgeons. Altered hip biomechanics, reduced bone mineral density, and dependence on prosthetic ambulation complicate preoperative planning and postoperative rehabilitation, and no unified therapeutic consensus has been established in clinical practice ( 1 – 5 ). Case presentation We report two distinct clinical cases of femoral neck fractures in amputees managed with different surgical strategies. The first patient was a 55-year-old male with ipsilateral transfemoral amputation who sustained a minimally-displaced Garden II femoral neck fracture and underwent closed reduction combined with cannulated compression screw (CCS) internal fixation. The second patient was a 70-year-old male who experienced left transtibial amputation in a mining accident in 1984; he sustained a fully-displaced Garden IV femoral neck fracture and received primary total hip arthroplasty (THA). Total follow-up was 12 months for Case 1 and 6 months for Case 2. Both patients achieved satisfactory short-term functional recovery, with validated functional scores recorded at final follow-up, and no major perioperative complications occurred. Conclusions This two-case series combined with a narrative review highlights the need for individualized surgical strategies for amputees with femoral neck fractures. Based on our limited clinical observations, internal fixation may be suitable for younger patients with minimally-displaced fractures and preserved pre-injury hip function, whereas THA may yield favorable functional outcomes in elderly patients with completely-displaced fractures. The proposed treatment algorithm should be regarded only as experience-based guidance rather than universal clinical recommendations.