Amputations and prostheses for the lower limb

Abstract

Amputations in the lower limb are now carried out principally in the elderly because of vascular disease. The management and rehabilitation of the amputee is best achieved by a team approach with the close cooperation of the different disciplines. Attention should be paid to the psychological state of the patient who should be encouraged to mobilise as soon as possible. Prosthesis design and manufacture has changed greatly in recent years. Widespread use is now made of lightweight plastic materials. Modern technology is being applied to the design and manufacture of prostheses, with increasing use of modular systems of components.

Osteocartilaginous Transfer of the Proximal Part of the Fibula for Osseous Overgrowth in Children with Congenital or Acquired Tibial Amputation

“…Human and animal studies have implicated periosteal or endosteal abnormalities, endochondral ossification, heterotopic ossification, and metaplasia of fibrous tissue 1,12,[26][27][28][29] . As with any poorly understood problem, a variety of treatment options have been tried 1,2,9,11,[14][15][16][17][18][19][20][21][22][23][24] . From these options, the idea of some sort of "capping" of the end of the residual limb has emerged as the most effective treatment of terminal overgrowth 15,17,25 .…”

“…From these options, the idea of some sort of "capping" of the end of the residual limb has emerged as the most effective treatment of terminal overgrowth 15,17,25 . Described donor sites include the fibula, iliac crest, and various tarsal bones 15,[21][22][23][24] . More recent reports of synthetic polytetrafluoroethylene caps describe outcomes equivalent to previously published results with biologic caps, without donor site morbidity 17 .…”

“…strategies include simple excision 1,2,9,11,15 ; the use of silicone 16 , polyethylene 17 , or Teflon (polytetrafluoroethylene) 17 caps; modifications of the Ertl tibiofibular osteomyoplasty 18 ; skin flaps 14,19 ; calcaneocutaneous pedicle grafts 20 ; and biologic stump capping 15,[21][22][23][24] . The requirement for surgical revision following these various approaches has ranged from 86% after simple resection to 29% after use of biologic autologous osteocartilaginous or Teflon caps 17 . Marquardt and Correll are generally acknowledged as the first to utilize an autologous osteocartilaginous cap to treat overgrowth on the basis of the observation that overgrowth did not occur following through-joint amputations 21,22,25 .…”

“…The requirement for surgical revision following these various approaches has ranged from 86% after simple resection to 29% after use of biologic autologous osteocartilaginous or Teflon caps 17 . Marquardt and Correll are generally acknowledged as the first to utilize an autologous osteocartilaginous cap to treat overgrowth on the basis of the observation that overgrowth did not occur following through-joint amputations 21,22,25 .…”

The use of vascularised bone capping to prevent and treat amputation stump spiking in the paediatric population

“…Initial clinical management of stump spiking includes prosthetic or lifestyle adjustments, followed by operative revision if signs or symptoms persist. Reported surgical strategies used to treat terminal osseous overgrowth once it has occurred include simple excision (Abraham et al, ; Aitken, ; Davids, ; Jorring, ); the use of silicone (Swanson, ), polyethylene or Teflon caps (Tenholder, Davids, Gruber, & Blackhurst, ); modifications of the Ertl tibiofibular osteomyoplasty (Drvaric & Kruger, ); calcaneo‐cutaneous pedicle flaps (Weber, ); as well as vascularised and non‐vascularised bone capping (Benevenia, Makley, Leeson, & Benevenia, ; Bernd, Bläsius, Lukoschek, & Lücke, ; Davids et al, ; Marquardt & Correll, ).…”