Amputation; Artificial limbs; Orthopedics; Surgery, Military
A metal hip piece is fixed below the iliac crest and held in place
by a belt which passes above the iliac crest of the opposite side
(Figs. 20 to 24). This piece is attached to the thigh bucket by a
joint shown in figure 19 (see also Fig. 22), which allows both flexion
and abduction of the hip, and which forms the suspension of the
outer side of the limb. The inner border is suspended by means of a
perineal strap, shown in figures 21 and 22. In figure 21 is shown how
a suspending brace may be easily added. Figure 23 shows the action of
a single hinge joint, allowing only flexion and extension at the hip
joint. On page 27 will be seen similar joints which, however, move on
the pelvic attachment as well as on the thigh piece. The object of
this is to prevent the pinching of the abdominal wall by the top of
the thigh bucket when the patient sits. It is indispensable in short
stumps. On page 21 will be seen a joint which allows abduction of the
hip, and thus relieves the strain upon the hinge joint; without it the
latter is easily broken.]
B. SUSPENSION BY MEANS OF BRACES (American method).--The
American method of suspension has the advantage of leaving the pelvis
free; the patient does not feel the pull of the hip piece. Besides,
when the belt is used, if the patient sits down, the buttock on
the side of the stump is raised, to an extent corresponding to the
thickness of the bucket, an obliquity of the pelvis, which is both
uncomfortable and unsightly, being produced. The braces being relaxed
in the sitting posture, the patient can avoid this inconvenience; for
the stump may be slipped partly out of its bucket, the upper extremity
of which is then beyond the level of the edge of the chair. This
position is very comfortable, because it is normal, but the patient
must replace his stump in the bucket whenever he stands up.
[Illustration: FIG. 24.
FIG. 25.
Braces composed of straps passing over the shoulders and down the
front, attached to the bucket by buckles. Posteriorly they are joined
together by a cross strap between the scapulæ, and beyond this are
continued in the form of elastic straps.]
This form of suspension is essential for those artificial limbs with a
free knee-joint, in which, as we shall see, the braces serve to extend
the joint.
We illustrate here two methods of attaching the braces to the thigh
piece, that which we use in the limb supplied by the Fédération (Figs.
24 and 25) and that which is used in the American limb of Marks
(Figs. 26 and 27).
[Illustration: FIG. 26.
FIG. 27.
FIG. 26.--Braces which end below in looped thongs of leather.
FIG. 27.--These loops, held in to the thigh piece by passing
beneath a loop of leather, pass over two pulleys about the middle of
the inner and outer sides of the thigh piece respectively. The outer
brace tends to abduct the limb if it is tightened.]
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