Introduction: Cephalomedullary femoral nailing or ORIF for femoral fracture is difficult in bilateral below knee amputees. Setting up the patient for traction is a challenge. These patients have no foot to put in the traction boot and the insertion of Steinman pin in distal femur preventing distal locking of the nail. We describe an upside-down technique of setting up of the fracture table, which is being used in our department.
Technique: On the traction table, since the patient has a short stump below the knees on both sides. The stump on the operation side, acts as a foot and knee on this side will act as heel. The traction boot is put upside down on the traction apparatus of the fracture table. On the non-injured side stirrup is also turned upside down as is the natural attitude of the stump. The stump of the amputee was acting as a foot against the foot plate of the stirrup and the knee was acting as heel. The stumps are then secured as normal.
For distal locking of long cephalomedullary nail, the foot is taken out of the traction & done free hand.