AMPUTATION - AKA: Transfemoral Amputation

LEVELS OF AMPUTATION - Minimal stump length = 4 in below tip of greater

trochanter to control and fit prosthesis.
 LE: FOOT AND ANKLE - Difficulty in learning control of prosthesis and gait
1. Syme (Transmalleolar) since knee proprioception is lost.
- Disarticulation at ankle joint; may include malleoli - Px bears weight at ischial tuberosity.
removal. A. Short stump – FAB d/t pull of TFL
- Prosthesis: difficult B. Long AK stump – FAB d/t intact Abductor group
2. Boyd
- Amputation including tibial – calcaneal fusion  LE: HIP AND PELVIS
- allows for complete weight bearing Hip Disarticulation
3. Pirogoff - amputation through hip with intact pelvis
- Removal of forefoot and talus with calcaneotibial - avoided since no substitute for anatomical
arthrodesis joint.
4. Chopart (Surgeon’s) Hemipelvectomy (Hind Quarter Ablation)
- Through the talonavicular and calcaneocuboid - resection of lower half of pelvis.
joints Hemicorporectomy (Humpy – Dumpy)
- creates equinus deformity - Amputation of both lower limbs and pelvis
- Similar to a foot of a horse below L4 or L5 level.
5. Lisfranc
- Through tarsometatarsal joint SURGICAL LEVELS OF GREATEST UTILITY
- distorts muscle balance of foot creating equinus  Vascular level should be relatively good.
deformity  The lower the amputation, the less energy
6. Transmetatarsal consumption for ambulation.
- Midsection of all metatarsals 1. Transmetatarsal, Symes and BKA (1st choice)
2. Ultrashort BKA (2nd choice)
7. Partial foot/ Ray Resectioning
- Resection of 3rd, 4th, and 5th metatarsals and digits
8 Partial toe
- Excision of any part of one or more toes
9. Toe Disarticulation
- Through the MTP joint

 LE: BELOW THE KNEE

Below Knee Amputation (BKA)
- Aka: Transtibial amputation
- Best done at the junction of mid and upper thirds
of tibia
Types:
A. Short below knee - <20% tibial length
B. Long below knee - >50% tibial length

 LE: KNEE PROCEDURES

1. Gritti Stokes
- Supracondylar; patella is fastened with quadriceps
ligament to the cut surface of the lower end of
femur.
- Best kind of amputation; durable
- preserved patella
2. Kirk’s
- Supracondylar (higher) tendoplastic; quadriceps
tendon is cut close to its patellar attachment and
sutured to fascia posteriorly.
- No patella
3. Callendar
LEVELS OF AMPUTATION
- Supracondylar (lower) but minimum tissue
 UE
dissection.
1. Forequarter (Interscapulothoracic)
- No muscle tissue is excised.
 removal of scapula and most of clavicle
- Patella is removed from its bed at quads tendon,
2. Shoulder Disarticulation
thus leaving patellar ligaments intact.
 through the glenohumeral joint
4. Roger’s
3. Very short AE
- Knee disarticulation with femur and patella fusion.
4. Short AE
- No cutting of supracondylar.
5. Standard AE
5. Knee disarticulation
6. Long AE
- Through the knee joint
7. Elbow Disarticulation
6. Long above knee
- Through the elbow joint
- Amputation of more than 60% femoral length
- In this type, mechanical elbow joint is required to
place the forearm and terminal device in use.
 LE: ABOVE THE KNEE
8. Very short BE
Above Knee Amputation (AKA)
9. Short BE
10. Long BE
11. Wrist Disarticulation
12. Carpal Disarticulation

 UE: ELBOW PROCEDURES

Krukenberg procedure
- For Below Elbow amputation
- converted to crude pinching mechanism
- Separation of radius and ulna
- D/t ↑ tactile sensation and pinch function,
It is best for:
 blind and (B) below elbow amputee

PERCENTAGE OF HAND FUNCTIONING

Hand Percent

Thumb 40

Index 20

Middle 20

Ring 10

Pinky 10

AMPUTEE ENERGY EXPENDITURES

Amputation Percent

Single BKA 40

Double BKA 41

Single AKA 65

Double AKA 110

With prosthesis 60

Without prosthesis 70

1 AKA + 1 BKA 75

Wheelchair 9