مستوى البتر في الاطراف - amputation level - البروفيسور فريح...
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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
11/7/2014 2
Professor Freih Abuhassan -
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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Professor Freih Abuhassan -
University of Jordan
In malignancy Remove the limb at a level that includes the
joint proximal to the lesion.
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Professor Freih Abuhassan -
University of Jordan
11/7/2014 5
Professor Freih Abuhassan -
University of Jordan
11/7/2014 6
Professor Freih Abuhassan -
University of Jordan
In trauma The amputation site should be as distal as possible
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Professor Freih Abuhassan -
University of Jordan
In ischaemia Removing dead or near-dead tissue and
a proximal site sufficient to ensure healing
of the wound.
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Professor Freih Abuhassan -
University of Jordan
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.
11/7/2014 9
Professor Freih Abuhassan -
University of Jordan
With modern total contact
sockets and sophisticated
prosthetic-fitting techniques,
the level of amputationis less
important
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Professor Freih Abuhassan -
University of Jordan
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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Professor Freih Abuhassan -
University of Jordan
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Professor Freih Abuhassan -
University of Jordan
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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Professor Freih Abuhassan -
University of Jordan
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Professor Freih Abuhassan -
University of Jordan
Partial Hand
The amputation of one or more fingers or the loss of a portion of the hand.
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Professor Freih Abuhassan -
University of Jordan
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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Professor Freih Abuhassan -
University of Jordan
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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Professor Freih Abuhassan -
University of Jordan
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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Professor Freih Abuhassan -
University of Jordan
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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Professor Freih Abuhassan -
University of Jordan
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Professor Freih Abuhassan -
University of Jordan
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Professor Freih Abuhassan -
University of Jordan
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Professor Freih Abuhassan -
University of Jordan
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.
11/7/2014 23
Professor Freih Abuhassan -
University of Jordan
11/7/2014 24
Professor Freih Abuhassan -
University of Jordan
11/7/2014 25
Professor Freih Abuhassan -
University of Jordan
11/7/2014 26
Professor Freih Abuhassan -
University of Jordan
The more of the foot and toes that can be preserved, the less of a functional deficit will result.
11/7/2014 27
Professor Freih Abuhassan -
University of Jordan
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Professor Freih Abuhassan -
University of Jordan
11/7/2014 29
Professor Freih Abuhassan -
University of Jordan
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.
11/7/2014 30
Professor Freih Abuhassan -
University of Jordan
11/7/2014 31
Professor Freih Abuhassan -
University of Jordan
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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Professor Freih Abuhassan -
University of Jordan
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Professor Freih Abuhassan -
University of Jordan
Below-Knee Amputation (B/K)
B/K amputation is the removal of the lower leg anywhere between the knee and the ankle.
11/7/2014 34
Professor Freih Abuhassan -
University of Jordan
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Professor Freih Abuhassan -
University of Jordan
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
11/7/2014 36
Professor Freih Abuhassan -
University of Jordan
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.
11/7/2014 37
Professor Freih Abuhassan -
University of Jordan
"A foot for every activity"
11/7/2014 38
Professor Freih Abuhassan -
University of Jordan
Foot
•Peg leg
•Static foot
•Multi-axis foot
•Energy Storing Foot (ESF)
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Professor Freih Abuhassan -
University of Jordan
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.
11/7/2014 40
Professor Freih Abuhassan -
University of Jordan
11/7/2014 41
Professor Freih Abuhassan -
University of Jordan
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
11/7/2014 42
Professor Freih Abuhassan -
University of Jordan
11/7/2014 43
Professor Freih Abuhassan -
University of Jordan
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
11/7/2014 44
Professor Freih Abuhassan -
University of Jordan
attachment of the adductor magnus to
the lateral part of femur
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Professor Freih Abuhassan -
University of Jordan
attachment of the quadriceps over the adductor
magnus
11/7/2014 46
Professor Freih Abuhassan -
University of Jordan
the proposed skin flaps and level of bone section
11/7/2014 47
Professor Freih Abuhassan -
University of Jordan
11/7/2014 48
Professor Freih Abuhassan -
University of Jordan
11/7/2014 49
Professor Freih Abuhassan -
University of Jordan
The person with an A/K amputation expends about 60% more energy walking the same distance as a person without one.
11/7/2014 50
Professor Freih Abuhassan -
University of Jordan
Running
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Professor Freih Abuhassan -
University of Jordan
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.
11/7/2014 52
Professor Freih Abuhassan -
University of Jordan
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.
11/7/2014 53
Professor Freih Abuhassan -
University of Jordan
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.
11/7/2014 54
Professor Freih Abuhassan -
University of Jordan
11/7/2014 55
Professor Freih Abuhassan -
University of Jordan
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