Orthotic, adaptive, protective, and assistive devices are implements and equipment used to support or protect weak or ineffective joints or muscles, and serve to enhance performance.1 The uses of appropriate orthotic, protective, and supportive devices are outlined in this chapter.
The major rationales for amputation include disease (diabetes, peripheral vascular disease [PVD]), infection (post joint replacement, osteomyelitis), tumor, trauma, and fractures that fail to heal (non-union).
- Amputation refers to the cutting of a limb along the long axis of the bone.
- Disarticulation refers to cutting of a limb through the joint.
Major improvements in noninvasive diagnosis, revascularization, and wound healing techniques have lowered the overall incidence of amputations for vascular disease.2
Traumatic amputations may be performed at any level (Table 15–1). Whatever the level the surgeon attempts to maintain the maximum bone length and to keep as many joints intact as possible.2 The specific type of surgery depends on the status of the extremity at the time of amputation. Conservation of the residual limb and uncomplicated wound healing are both important.
Table 15–1. Levels of Amputation
| Favorite Table
| Download (.pdf)
Table 15–1. Levels of Amputation
LEVEL OF AMPUTATION
Excision of any part of one or more toes
Disarticulation of one or more toes at the metatarsophalangeal joint
Partial foot/ray resection
Resection of the third, fourth, fifth metatarsals and digits
Tarsometatarsal (LisFranc) disarticulation
The disarticulation of all five metatarsals and the digits
Amputation through the midsection of all metatarsals leaving only the calcaneus and talus
Ankle disarticulation which may include removal of the malleoli and distal tibial/fibular flares to create a smooth bony distal end with the attachment of the heel pad to the distal end of the tibia.
Long transtibial (below knee)
More than 50% of tibial length
Transtibial (below knee)
Between 20% and 50% of tibial length
Short transtibial (below knee)
Less than 20% of tibial length
Amputation through the knee joint with shaping of the distal femur, squaring the condyles for an even weight-bearing surface. The knee disarticulation is most often used in children and young adults, but is nearly always avoided in the elderly and patients with ischemic disease. Several advantages of the knee disarticulation include:
- A large distal end covered by skin and soft tissues that is naturally suited for weight bearing
- A long lever arm controlled by strong muscles
- Increased stability of the patient's prosthesis
A main disadvantage of the knee disarticulation is cosmetic—the patient's prosthetic leg will have a knee that extends far beyond his own knee in the sitting position.
Long transfemoral (above knee)
More than 60% of the femoral length
Transfemoral (above knee)
Between 35% and 60% of the femoral length...
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessPhysiotherapy Full Site: One-Year Subscription
Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.
Pay Per View: Timed Access to all of AccessPhysiotherapy
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.