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RLE Orthopaedic Injury Management
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Jowan Penn-Barwell, Daniel Christopher Allison
In general, attempts should be made to preserve upper extremities at the most distal level possible because of their functional importance and the lack of equivalent prosthetic compensation. In a similar vein, the significantly improved function and increased prosthetic wear associated with below-knee amputation when compared with above-knee amputation should prompt the surgeon to save the knee joint when safely possible. If the patellar tendon insertion is preserved, a prosthesis can be fashioned to preserve at least some degree of knee function. Along the same lines, above-knee amputation at any level is significantly preferred over hip disarticulation, as long as it does not risk the patient’s life.
Principles of lower limb prosthetics and rehabilitation
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Rajiv S Hanspal, John Sullivan
The Syme's ankle disarticulation can produce a functional end bearing stump. It is now unusual to come across a Syme's amputation and prosthetic manufacture needs to be bespoke to achieve a good prosthetic outcome. Disadvantages include the bulbous shape, poor cosmesis around the ankle and limited options for components. An advantage of a Syme's is the ability to mobilise on the stump without a prosthesis. It remains an excellent operation in growing children and is effectively treated as a ‘below-knee’ amputation in terms of prosthetic provision.
Arterial disorders
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The major choice is between an above- and below-knee operation. A below knee amputation preserves the knee joint and gives the best chance of walking again with a prosthesis. However, an above knee amputation is more likely to heal and may be appropriate if the patient has no prospect of walking again. If the femoral pulse is absent, the amputation should be above the knee. Unfortunately, the presence of a femoral pulse does not guarantee healing of a below-knee amputation, and sometimes a failed below-knee amputation may require revision to an above-knee procedure.
Advances in additive manufacturing processes and their use for the fabrication of lower limb prosthetic devices
Published in Expert Review of Medical Devices, 2023
Shaurya Bhatt, Deepak Joshi, Pawan Kumar Rakesh, Anoop Kant Godiyal
When a person loses the part of the leg below-knee (BK), i.e. the knee joint is intact, then the amputation is known as below-knee amputation, and the prosthesis used in this case is below-knee prostheses or transtibial prostheses. SLS process has been used to fabricate energy storage and return (ESAR) feet for transtibial amputees [44]. Compared with a carbon fiber foot, its mechanical loading response and locomotor patterns were within permissible range and showed promising results [44]. Even a home 3D-printing technology can prove to be a viable method for producing prostheses [80]. A prosthesis was developed using the FDM technique using PLA material and produced an ESAR foot, which provides better comfort than solid ankle cushioned heel (SACH) foot. On testing for plantarflexion and dorsiflexion, 3D-printed feet showed promising results compared to SACH foot [80]. Acrylonitrile butadiene (ABS) has been used with FDM to fabricate an ESAR foot for transtibial amputees [81]. The FEM analysis and physical testing of the developed foot showed that it fulfills the structural strength requirements and can be used as a passive ESAR foot [81]. PLA material has also been used to develop transtibial prosthetic foot by 3D printing [57].
Predictive factors and nomogram to evaluate the risk of below-ankle re-amputation in patients with diabetic foot
Published in Current Medical Research and Opinion, 2022
Wentong Dai, Yuan Li, Zexin Huang, Cai Lin, Xing-xing Zhang, Weidong Xia
Consecutive patients diagnosed with diabetic foot and underwent amputation from 1st January 2015 to 31st December 2019 in the First Affiliated Hospital of Wenzhou Medical University, China, were identified. The inclusion criteria for our study were: (a) patients diagnosed with type 2 diabetes and diabetic foot; (b) patients who had undergone amputation (toe and foot); (c) patients with at least one year of follow-up. Type 2 diabetes mellitus was diagnosed in accordance with the World Health Organization criteria. The diagnosis of diabetic foot was based on the diagnostic criteria of the World Health Organization18. The exclusion criteria were: (a) patients diagnosed with any type of cancer; (b) patients with incomplete and inaccurate baseline data, results of laboratory or case history (e.g. missing serum albumin); (c) patients failed to be followed up or died within 1 year; (d) patients had undergone major amputation (above and below knee amputation). Only patients with toe or foot amputations below the ankle were included in the study. Because the overall proportion of patients with major amputations was small, the inclusion of these patients could have skewed the study significantly. The ethical committee of the First Affiliated Hospital of Wenzhou Medical University approved this study protocol (No. 2020-116).
The relationship between self-reported physical functioning, mental health, and quality of life in Service members after combat-related lower extremity amputation
Published in Disability and Rehabilitation, 2022
Susan L. Eskridge, Jessica R. Watrous, Cameron T. McCabe, Mary C. Clouser, Michael R. Galarneau
The interaction between amputation level and mental-health screening results was not statistically significant, likely due to the small sample size for each amputation group. However, upon stratification by mental-health screen status (PTSD and depression separately), the relationship between functional status and amputation level was significant in those who screened negative for PTSD or depression. Specifically, Service members with bilateral amputations had significantly lower functional scores relative to those with unilateral below knee amputations for both those who screened negative for PTSD and those who screened negative for depression. The fact that amputation groups were similar in their level of functionality among those who screened positive for a mental-health disorder suggests mental health may have a greater impact on function than amputation severity. Such a finding illustrates the potential deleterious effects, mental-health disorders, such as PTSD and depression, can have on physical health outcomes [43,44]. Service members with a unilateral below knee amputation demonstrated the largest difference in mean functional score between those with and without a positive mental-health screen. The large self-reported functional decline in those with a unilateral amputation and a positive mental-health screen may be due to the higher overall functioning in those with unilateral below knee amputation, allowing for a greater potential for decline.