Femur Fracture

The higher fracture rate in this OPRA cohort compared with other BAP studies may be partly explained by older patient age and much longer mean follow-up of 13.2 years. The 11% femur fracture rate in this cohort exceeds the world's highest age-standardised hip fracture incidence recorded for Scandinavia (approximately 5–6%). All fractures in the cohort were femur fractures and all occurred on the same side as the BAP fixture. Most fracture mechanisms involved falls, consistent with increased fall risk known in lower-limb amputees. Ipsilateral femoral bone loss following amputation may increase susceptibility to fracture in BAP patients. Eleven percent of patients in the cohort sustained femur fractures after OPRA surgery. Femur fracture fixation is surgically challenging in BAP patients because the implant may obstruct preferred osteosynthesis approaches.