Amputation; Artificial limbs; Orthopedics; Surgery, Military
1. The artificial limb.
2. The attachment of this limb to the trunk.
The artificial limb itself is divided into two parts:
1. A conical socket.
2. A part which replaces the missing limb and is in fact a terminal
functional appliance.
Two conditions must be considered, whether or not there remains
attached to the trunk a segment of the limb capable of being fitted
into the base of the artificial limb, to which it gives support, and
to which, in addition, it can communicate movement. Accordingly the
artificial limb differs essentially for:
1. Disarticulation of the shoulder and of the hip.
2. Amputation of the arm and of the thigh.
In the first case we attach to the trunk an instrument which is
entirely passive.
In the second we attempt to turn to account the active movements of
the stump.
These various parts do not lend themselves to a general description
applicable at once to the upper and lower limbs. Not only are
the modes of attachment and the functional artificial limb quite
different, but the bucket does not serve the same purposes.
_The position of the scar._--The stump, which fits the bucket exactly,
transmits to it two kinds of force:
1. The force of vertical pressure.
2. Lateral force corresponding to the angular movements of the joint
above.
The lateral force is transmitted by the whole of one surface of the
stump to the corresponding lateral surface of the bucket: by the
anterior and posterior surfaces only in the case of hinge joints such
as the elbow and the knee: by all surfaces in the case of joints with
movements of circumduction such as the shoulder and the hip.
Vertical pressure exercised upwards or downwards may cause the limb to
press upon the bucket at two points: (1) on the summit of the cone,
_i.e._ on the extremity of the stump; (2) on the base of the cone,
_i.e._ on the bony prominences around the last remaining joint. The
adjustment is never sufficiently accurate for the relief due to the
fitting of the stump in the bucket to be of much importance.
We should take it as a general rule that a scar cannot stand pressure
or friction; and that in consequence, when we amputate under
favourable conditions, we should arrange to place the scar in such a
position that from our knowledge of the suitable prosthetic apparatus
these two evils will be avoided. It should be added, however, that
after perfect primary union, the narrow and mobile scar is very
tolerant, but it must also be remembered--especially as will be
seen in the lower limb--that this condition is rarely realised in war
surgery.
The length of the stump is often estimated by reference to that of the
other limb; amputation at the upper, middle, or lower third of the
thigh, of the leg, of the arm, or of the forearm. This is convenient,
starting from a certain minimum length, but there is an _absolute
minimum length_ below which the stump has insufficient leverage and
tends moreover to escape from the bucket.
Public-domain text, read in full here on John Shaqi.
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