Amputation; Artificial limbs; Orthopedics; Surgery, Military
The adjustment to the stump is very exact; the contact with the
surface where there is friction is soft and comfortable without
padding; the appliance is light, strong and silent. The best woods
appear to be English willow and lime. The bucket should not present
any flaw or knot, this can be seen on the inner uncovered surface.
But we must emphasise the general fact that _standardisation is
impossible when the bucket is made of wood_. For the other parts it
is possible but not for the bucket, which must be made specially for
each patient, hollows being made for each bony point, which must be
marked out and felt for with the fingers. A plaster cast would appear
more exact: but by this means we do not mark out the bony points. Good
results cannot be obtained, if, as certain people have tried, linear
measurements are sent to a workshop whence an apparatus is forthwith
despatched to a patient whom the maker has never seen.
_CHAPTER II_
GENERAL PRINCIPLES OF FITTING FOR THE LOWER LIMB
Whether we are dealing with an amputation of the leg or an amputation
of the thigh, the principle function of the artificial limb is to
support the weight of the body. The bucket must therefore give support
to this weight. Three bearing points are thus possible: at the base,
upon the surface and upon the end of the stump.
1. _Bearing upon the base._--The principal bearing is that which
is taken by fitting the upper edge of the bucket under the bony
prominences situated around the last joint preserved, i.e. the
tuberosity of the ischium for the thigh, the head of the tibia for the
leg.
2. _Bearing upon the surface of the stump._--Certain makers attribute
to this an importance which we believe to be imaginary, but which
leads them to erroneous conclusions.
It is evident that if a conical stump which is jointless and which
transmits the weight is fitted exactly, point downwards, into a
conical bucket, supported below by a vertical pillar, the weight is
transmitted by the friction of the part enclosed against the bucket,
without any pressure upon the free end. Whence it may be concluded
that, as the end of the stump should not serve as a bearing point, we
should prefer a terminal scar to lateral scars which might be rendered
painful or even ulcerated by friction against the bucket.
But experience shows us that if the pressure of the bucket at this
point is harmful to the lateral scars, it is not less so for most
terminal scars.
Public-domain text, read in full here on John Shaqi.
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