IDS ::: Prosthetics ::: Amputation Sites

The loss of function associated with amputation is closely related to the loss of major human joints. As an example, a knee disarticulation amputation will be much more disabling than a transtibial. The prosthetic knee joint can provide several functions such as resistance to extension or flexion and cadence control. It cannot provide useful knee extension or flexion power as the muscles operating around the human joint can.

In the upper limb situation the loss of fine control and power associated with the loss of a major joint can be very disabling. It is fair to say that the substitute function provided by an upper limb prosthesis will normally be much less effective than the equivalent lower limb prosthesis. This is due to the complexity of normal upper limb function in the activities of daily living.

Amputation Site Classification.

Amputations can generally be categorised into one of several classifications. From distal to proximal these are lower limb, upper limb and congenital abnormalities.

Lower limb

Partial Foot – anything between amputation of digits to an ankle disarticulation falls into this category. It includes several classifications which define the surgery involved, often named after the pioneering surgeon e.g. Lisfranc, Chopart, Pirigoff.
Ankle Disarticulation
Transtibial
Knee Disarticulation
Trans-femoral
Hip Disarticulation
Hemi-pelvectomy

Partial Foot

Partial Foot – anything between amputation of digits to an ankle disarticulation falls into this category. It includes several classifications which define the surgery involved, often named after the pioneering surgeon e.g. Lisfranc, Chopart, Pirigoff.

A very proximal partial foot amputation site - calcaneus remains

A partial foot amputation

Donning a partial foot prosthesis

Ankle Disarticulation

Long established ankle disarticulation amputation

Congenial absence equivalent to ankle amputation.

An exoskeletal laminated prosthesis for an ankle disarticulation prosthesis.

Transtibial

Established transtibial amputation in very good condition.

Recent transtibial amputation

Knee Disarticulation

A knee disarticulation amputation

Trans-femoral

A trans femoral amputation

A hip disarticulation

A hip disarticulation socket attached to a modular hip joint.

Hemi-pelvectomy

Hemi-pelvectomy

Upper Limb

Missing Digit
Partial Hand
Wrist Disarticulation
Trans-radial
Elbow Disarticulation
Trans-humeral
Shoulder Disarticulation
Forequarter
Congenital abnormality

Missing Digit

Hand with missing digit (thumb)

Same hand with a prosthesis for missing thumb.

Partial Hand

Partial Hand

Wrist Disarticulation

Wrist Disarticulation

Trans-radial

Trans-radial

Elbow Disarticulation

Trans-humeral

Extremely short Trans-humeral amputation.

Shoulder Disarticulation

Shoulder Disarticulation

Forequarter

A cosmetic forequarter endoskeletal prosthesis.

Congenital abnormality

Congenital abnormality can result in a similar situation to an amputation.

Congenital abnormality/shortening
There are two other categories of residual limb which may require prosthetic intervention without amputation. A congenital deformity can result in an absence or significant shortening. Trauma or disease can have a similar effect. The prostheses used when these conditions occur in the lower limb are often referred to as extension prostheses.

A significant upper limb abnormality can be very disabling. A transverse deficiency can result in a very similar presentation to a post amputation residual limb. It is likely that a person with an abnormality will achieve much greater function without a prosthesis than the equivalent amputee. Strictly speaking, the term prosthetic rehabilitation cannot be used. However, in most practical ways the prosthetic approach is very similar.

Extreme shorting due to trauma infection etc. can result in the use of an extension prosthesis. This part had used this solution for decades. Poor and reduced weight bearing was the result.

The same patient with an exoskeletal laminated prosthesis, with a prosthesis foot.

The result - full weight bearing and much better.