Amputation; Artificial limbs; Orthopedics; Surgery, Military
If the top of the bucket is narrower than the circumference of the
top of the limb, measured below the ischium, it may be circular and
still give support to the ischium, which will not slip into it. If
the ischium does slip into the bucket, the result will be that it no
longer serves as the support, the pressure coming instead upon the
rami of the pubis and ischium and upon the perineum.
The constriction thus exerted upon the top of the stump may easily
become insupportable. The correct solution of the problem is to cut
down the upper border of the bucket opposite the perineum, letting it
rise again posteriorly beneath the tuberosity of the ischium, and
gain a good support there.]
The same slope may be given to both edges of the bucket (Fig. 5).
This obliquity in the posterior part serves no useful purpose: it is
better on the contrary to lower the posterior border combining this
semioblique fitting with a rise beneath the ischium and a depression
under the perineum (Fig. 6).
These conditions are easily carried out in a well-made wooden bucket,
represented in figures 8 and 9, in which it may further be seen that
from the front it is convex outwards; from the side, convex forwards
(Fig. 9). This form, which is that of some good American appliances,
ought to be generally used.
_The curve outwards_, by drawing away the soft parts from it, frees
the region of the ischium and allows the tuberosity of the ischium to
press upon the bucket (Fig. 8).
_If the thigh piece is curved forwards_, and particularly if the limb
is built with a very slight flexion of the knee, the stump remains
slightly flexed at the hip and the patient feels as if he is sitting
in the apparatus.
When the thigh piece is straight, an uncomfortable pressure is
produced by the edge of the bucket against the ischium. It may be
added that extension of the hip is very often impaired, particularly
in patients with a short stump: The extensor muscles being divided,
the flexors cause contraction into a flexed position, the more so the
shorter the stump is. If the thigh piece is straight, the short stump
cannot follow the movement of extension necessary in walking; it slips
out of the bucket if the anterior lip of the latter is too low.
The principles are the same for the leather bucket, known as the
_French pattern_.
[Illustration: FIG. 4.
FIG. 5.
FIG. 6.
FIG. 7.
FIG. 8.
FIG. 9.
Figure 4 shows the circular bucket (almost always too large) of the
poor man's peg leg, attached to the body by a belt which is fastened
to a projection upwards from the outer side of the bucket.
Public-domain text, read in full here on John Shaqi.
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