- See:
-
Amputation of the Finger and Hand:
-
Above-Elbow Amputation
-
Below-Elbow Amputation
-
Upper Extremity Prosthetics:
-
Wrist Disarticulations
- General Considerations:
- Disability:
- loss of one upper extremity
= 50%
- loss of one hand
= 45%
- thumb amputations
= 23% (50% of one hand)
- Considerations w/ Brachial Plexus Injuries:
- w/ fully flail arm, w/o scapulothoracic control, is a candidate for
AE amputation;
- this disencumbers the patient and the reduction of wt reduces the subluxation of the shoulder;
- w/ one normal arm, the patient will not use a 2 joint AE prosthesis, therefore recommend shoulder
fusion, with pectoral muscle transfer to control elbow and
BE amputation;
- there must be scapulothoracic control, not a completely flail extremity;
- if remaining arm is the dominant arm, and the invovled arm has no scapulo-thoracic contnrol, the patient is not likely to use any prosthesis;
- AE amputataion relieves shoulder distraction;
- fusion is pointless if there will be no forward hand placement;
- Upper Extremity Amputations in Children:
- most children with shoulder level or above-elbow amputations function very well
w/o a prosthesis if they have normal contralateral upper extremity;
- transverse absences of forearm:
- usually do not mandate excision of nubbins for prosthetic fit;
- bilateral amputees may be candidates for Krukenberg procedure,
where radius & ulna are separated to serve as pincers;
- children with a below elbow amputation may or may not choose to wear a prosthesis;
- it used to be taught that early fit of a passive mitten or hand at 6 months
of age would encourage integration of the prosthesis into activities of
daily living, however, this is not seen clinically;
- these children may note that the prosthesis may be hot and sweaty in the
summer and have a negative effect on proprioception;
- at approximately 2 years of age, a functional terminal device can be added if it is requested
by the child or parent;
Myoelectric prostheses. A long-term follow-up and a study of the use of alternate prostheses.
The surgery of arm and forearm amputations.
Baumgartner RF. Orthopedic Clinics of North America. 12(4):805-17, 1981 Oct.
A new approach to the use of the Krukenberg procedure in unilateral wrist amputations. An original functional-cosmetic prosthesis.
Upper limb amputations and prostheses.
The rational selection of treatment for upper extremity amputations.
Brown PW.
Orthopedic Clinics of North America.
12(4):843-8, 1981 Oct.
