Freedom Nail Lengthening Followed by Press-Fit Osseointegration for the Transfemoral Amputee with Very Short Residual Bone

Transfemoral osseointegration usually provides better mobility and quality of life versus socketed prosthesis rehabilitation. This is particularly the situation for patients with such short residual femurs that a socket prosthesis cannot be worn, rendering them functionally equivalent to a hip disarticulation amputee. The absolute minimum canal length for successful implant stability is uncertain, but a longer bone does have more area where osseointegration can occur and also a longer moment arm for muscles to control the extremity. This case illustrates the use of a motorized intramedullary lengthening nail (MILN) to lengthen a very short femur in preparation for osseointegration. The patient was a farmer who sustained bilateral femur traumatic amputations. The right side was long enough for routine osseointegration. The left side, which is the focus of this chapter, was shorter than both the standard osseointegration implant and also the shortest lengthening nail, which therefore required customized linkage techniques.