Bone Health

Notes on amputations from finger tip to wrist disarticulation.
Wheeless' Textbook of Orthopaedics

1933 JBJS Article - Full text

The Amputation Surgery Education Center Dedicated to helping surgeons improve technique and patient outcomes.
The ASEC effort is led by Prosthetics Research Study (Seattle, WA) in collaboration with Otto Bock (Minneapolis, MN), the Amputee Coalition of America, the University of Washington Department of Orthopaedics (Seattle, WA), and Harborview Medical Center (Seattle, WA).

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The elective amputation must be considered plastic and reconstructive in nature. The need to create a dynamic and sensory motor end-organ should be foremost in the surgeon's mind in planning an amputation, and is emphasized here once more. The below-knee stump no longer hangs suspended in an open-end socket. The variable degrees of pressure and weight-bearing over the entire stump surface afforded by the total-contact patellar-tendon-bearing prosthesis enhance the surgeon's opportunity to fashion a functional terminal end-organ.

Lower-extremity amputation is one of the oldest known surgically performed procedures. The original surgical principles as described by Hippocrates remain true today. Refinements of surgical technique such as hemostasis, anesthesia, and improved perioperative conditions have occurred, but only relatively small technical improvements have been made. Amputation is still often viewed as a failure of treatment. The responsibility for performing an amputation may even fall on the most junior member of the surgical team. Whatever the reason for performing an extremity amputation, it should not be viewed as a failure of treatment. Amputation can be the treatment of choice for severe trauma, vascular disease, and tumors. Patients and family members must be aware of their options and have realistic expectations of surgical outcomes in order to make informed decisions regarding amputation.
Synonyms and related keywords: hemipelvectomy, hip disarticulation, above-knee amputation, AKA, below-knee amputation, BKA, knee disarticulation, Symes amputation, hindfoot amputation, Boyd amputation, Chopart amputation, Lisfranc amputation, transmetatarsal amputation, toe disarticulation, toe amputation, peripheral vascular disease
Ertl, Ertl & Pritchett 2008

Surgical techniques that fail to anticipate an amputee's functional needs are in part to blame for a disappointing lack of improvement in prosthetic outcomes over the last four decades. Prosthetic outcomes for amputees haven't improved over the past 40 years, according to a new study by a team from the Rochester, MN-based Mayo Clinic. Not only that, but rates of amputation appear primed to double by 2030. Before her team compiled its research, Andrews had believed that 80% of amputees ended up using prosthetic devices successfully. Instead, the proportion was more like 32.4% total, or 47% for below-the-knee amputees and 13% for above-the-knee amputees.

From the Curtin Podiatry Site
1.0 Introduction.
2.0 Incidence.
3.0 Indications.
4.0 Procedures.
5.0 Conclusion.
6.0 References.

An amputation is the removal of an extremity or appendage from the body. Amputations in the upper extremity can occur as a result of trauma, or they can be performed in the treatment of congenital or acquired conditions. Although successful replantation represents a technical triumph to the surgeon, the patient's best interests should direct the treatment of amputations. The goals involved in the treatment of amputations of the upper extremity include the following: (1) preservation of the functional length, (2) durable coverage, (3) preservation of useful sensibility, (4) prevention of symptomatic neuromas, (5) prevention of adjacent joint contractures, (6) early return to work, and (7) early prosthetic fitting.1, 2 These goals apply differently to different levels of amputation.
Synonyms and related keywords: finger amputations, upper-extremity amputations, arm amputations, ray amputations, finger replantation, thumb amputations, transcarpal amputation, wrist disarticulations, Krukenberg procedure, above-elbow amputation, below-elbow amputation, elbow disarticulations
Author: Bradon J Wilhelmi, MD 2008

Upper extremity amputations largely follow the same basic principles as those of any amputation. This article highlights the special considerations involved in acquired amputations at or above the elbow. Below-elbow amputations are discussed in separate articles. Although acquired amputations in children are discussed (because pediatric patients deserve special consideration), patients with congenital limb amputations and deficiencies are beyond the scope of this article.
Synonyms and related keywords: elbow disarticulation, dismemberment, prosthetics, prosthesis, transcondylar amputations, supracondylar amputations, transhumeral amputations, shoulder disarticulation, forequarter amputation, radical forequarter amputation, Tikhoff-Linberg procedure, shoulder girdle amputation, interscapulothoracic amputation
Edwards & Osterman 2007

Amputation is one of the most emotionally upsetting and traumatic events that a patient can undergo. However, with a team approach by the medical staff, the negative effects can be minimized and the positive benefits emphasized. Equipping the patient with a prosthesis not only greatly improves the patient's functional status but also helps his or her psyche.
Synonyms and related keywords: walk, walking, ambulate, ambulation, propulsion, mobility, amputee, prosthetics, prosthesis, biomechanics, stride, leg amputations, amputations of the lower extremity, foot amputations, peripheral vascular disease, diabetes
Ellis & Kishner 2007

Since the first replant 40 years ago, thousands of severed body parts have been reattached, preserving the quality of life for thousands of patients through improved function and appearance that the void remaining after amputation cannot provide. Ronald Malt performed the first replantation on May 23, 1962 at Massachusetts General Hospital on a 12-year-old boy who had his right arm amputated in a train accident (Malt, 1978). This amputation occurred at the level of the humeral neck.
Synonyms and related keywords: hand amputation, hand replantation, multiple-digit replantation, severed body part repair, trauma, replant, amputee, tendon transfers, wrist arthrodesis, guillotine amputation, avulsion amputation
Wilhelmi, Lee & May 2006

Historical account, indications and technique for amputation at various levels

Patients with infected, painful, or necrotic lower extremities can be restored to a better functional level by means of a properly selected and performed amputation. This procedure should be considered reconstructive and restorative. In what follows, I address amputations across the toe, the forefoot, the leg, and the thigh.

Amputations of the upper extremity largely follow the same basic principles as those of any amputated limb, some of which are covered in this article. However, the primary purpose of this article is to highlight the special considerations involved in acquired amputations at the wrist and forearm (below the elbow). Discussions of amputation at or above the elbow, as well as the various hand and digital amputations, are reserved for a separate article. Although acquired amputations in children are discussed because this group of patients deserves special consideration, congenital limb amputations and deficiencies are beyond the scope of this article.
Synonyms and related keywords: amputation, disarticulation, dismemberment
Edwards & Osterman 2003