مستوى البتر في الاطراف - amputation level - البروفيسور فريح...

11/7/2014

Professor Freih Abuhassan -

University of Jordan 1

Freih Odeh Abu Hassan,F.R.C.S(Eng),F.R.C.S(Tr.& Orth.)

Professor of Orthopedics

University Hospital-Amman

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University of Jordan

1- Chose the least mutilating procedure.

e.g preservation of the K.J

mobility after rehabilitation.

2- The indication for amputation

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In malignancy Remove the limb at a level that includes the

joint proximal to the lesion.

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In trauma The amputation site should be as distal as possible

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In ischaemia Removing dead or near-dead tissue and

a proximal site sufficient to ensure healing

of the wound.

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In the remote past, amputation

through specific levels was

Necessary for proper fitting of

prostheses.

The cardinal rule is to preserve all

Possible length consistent with

good surgical judgment.

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With modern total contact

sockets and sophisticated

prosthetic-fitting techniques,

the level of amputationis less

important

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The amputation should be

through tissues that will heal

Satisfactorily and at a level that

will remove the diseased or

abnormal part.

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Levels of Upper Extremity Amputation

Partial Hand e.g Finger amputation

Wrist Disarticulation (W/D)

Below Elbow (B/E)

Elbow Disarticulation (E/D)

Above the Elbow (A/E)

Shoulder Disarticulation (S/D)

Forequarter or Interscapular-Thoracic Amputation

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Partial Hand

The amputation of one or more fingers or the loss of a portion of the hand.

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Below Elbow (B/E) Amputation

The removal of the arm anywhere between the elbow and the wrist.

Ideal:18 cm from tip of olecranon

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Above the Elbow (A/E) Amputation

The removal of the arm anywhere between the shoulder and the elbow

joints. Ideal: 20 cm from acromion

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Forequarter or Interscapular-Thoracic Amputation

The most severe upper extremity amputation, in which the entire arm, clavicle, and scapula are removed.

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Lower Extremity Amputations Levels

Foot

Symes (S)

Below -Knee (B/K)

Through Knee (K/D) or Gritti-Stokes

Above-Knee (A/K)

Hip Disarticulation (H/D)

Hemipelvectomy (hindquarter amput.)

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TransmetatarsalAmputation (TM)

Transmetatarsal amputation is removal of a portion of the foot.

Presently there is interest in preserving as much of the foot as possible.

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The more of the foot and toes that can be preserved, the less of a functional deficit will result.

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Symes Amputation (James Symes Scottish surgeon 1799-1870)

The Symes amputation is performed by removal of the foot at the ankle.

This procedure leaves the individual with an end-bearing stump that can be used for short-distance ambulation in the house without a prosthesis.

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Pirogoffs Calcaneum osteotomised, rotated and

arthrodesis performed with the distal tibia.

Pirogoff & Boyd

both rely on fusion of the tibiocalcaneal arthrodesis.

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Below-Knee Amputation (B/K)

B/K amputation is the removal of the lower leg anywhere between the knee and the ankle.

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BKA * Ideal length - ~ 15 cm below med. tibial

articulation surface

* Stumps less than 12 cm less efficient,

those < 6 cm do not function as BK

stumps at all

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The knee joint is important to preserve for functioning even if a very short B/K amputation is performed.

An individual with a B/K amput. will use about 10% more energy walking on level ground than a person without one.

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"A foot for every activity"

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Foot

•Peg leg

•Static foot

•Multi-axis foot

•Energy Storing Foot (ESF)

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knee Disarticulation(K/D)

• It provides greater proprioceptive (the detection of motion or position of the limb by responding to stimuli arising within the body itself) feedback.

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1. Large end bearing surfaces of distal

femur are preserved

2. Long lever arm controlled by strong

muscles is created

3. The prosthesis used on the stump is

stable

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Above-Knee Amputation (A/K)

A/K amputation is the removal of the leg anywhere between the hip and the K.J.

AKA ideally between 12 cm above knee &

18 cm below G. trochanter

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attachment of the adductor magnus to

the lateral part of femur

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attachment of the quadriceps over the adductor

magnus

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the proposed skin flaps and level of bone section

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The person with an A/K amputation expends about 60% more energy walking the same distance as a person without one.

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Running

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Hip Disarticulation (H/D) Amputation

H/D amputation is removal of leg at the hip joint.

This type of amputation causes the individual a major functional deficit.

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Many persons with this type of amputation would rather use crutches than a prosthesis.

With a prosthesis, individuals with a H/D amputation will use 75% more energy than a person without one to walk the same distance.

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Hemipelvectomy (H/P)

H/P amputation is total removal of L.L and 1/2 of the pelvis.

This is also called a hindquarter amp.

The sitting bone (ischial T) is usually absent.

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مستوى البتر في الاطراف - amputation level - البروفيسور فريح...

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