© Springer-Verlag France 2015
Cyril Mauffrey and David J. Hak (eds.)Passport for the Orthopedic Boards and FRCS Examination10.1007/978-2-8178-0475-0_43Amputation and Prosthetics of the Lower Extremity
(1)
Department of PMNR, University of Colorado, Aurora, CO, USA
(2)
Department of PMNR, University of Colorado Hospital, Aurora, CO, USA
1 Amputation: Lower Extremity
Take-Home Message
Amputation is a reconstructive procedure which serves as a means to return the patient to a more functional status
Syme amputation is the most common level of amputation in the foot and provides an excellent weight-bearing surface as well as a long lever arm.
Ideal length of transtibial amputation is the meeting point of the upper third and middle third of the tibia.
Ambulation requires increased levels of energy consumption.
Definition
Major amputation: any amputation performed above the level of the ankle.
Etiology/Epidemiology
97 % of all amputations involve the lower limb.
130,000 lower limb amputations annually in the United States.
82 % dysvascular
16 % trauma
<1 % malignancy
<1 % congenital
Long-term survival after vascular amputation 69 % at 1 year, 35–45 % at 5 years
Goals of Amputation
Removal of diseased, damaged, or dysfunctional portion of limb
Wound healing
Reconstruction of the residual limb
Restore maximal functional independence
Classification
Principles of Limb Length
Longer lever arm provides better mechanical advantage for muscle function.
More proximal level almost always less energy efficient.
Avoid limb length discrepancies; anticipate space required by prosthetic joint/terminal device.
Levels of Amputation
Partial toe amputation, toe disarticulation, and metatarsal ray resection – preserves length of foot and provides mechanical advantage.
Partial foot
Transmetatarsal amputation – preserves attachment of dorsiflexors and plantar flexors
Lisfranc amputation (tarsometatarsal junction) – can develop significant equinovarus deformity
Chopart amputation (through transverse tarsal joints, preserves talus and calcaneus) – can develop significant equinovarus deformity
Ankle disarticulation (Syme) – attachment of distal heel pad to end of tibia. Maintains length of limb and provides excellent weight-bearing surface.
Transtibial amputation (below knee, BKA) – ideal limb length is meeting point of upper and middle thirds of tibia; provides better flap at expense of length of lever arm.
Too long: longer than distal 2/5 of tibia creates difficult skin and soft tissue management.
Too short: proximal to tibial tubercle; lose knee extension.
Boyd amputation – ankle disarticulation with calcaneotibial arthrodesis
Knee disarticulation – long lever arm with excellent end-bearing but challenging to fit with prosthesis
Transfemoral amputation (above knee, AKA) – standard level 35–60 % of femur. Difficult to fit with prosthesis if very short (just below lesser trochanter)
Hip disarticulation – removal of entire lower limb by transection through hip joint
Hemipelvectomy – removal of entire lower limb and ilium. Bear weight on abdominal visceraRelated posts:
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