Amputation; Artificial limbs; Orthopedics; Surgery, Military
This is brought about as explained on page 48 by mounting the foot
in equinus, and we must here describe the methods by which the
commencement of the movement of extension may be communicated to the
leg so that the heel may be the first part of the foot to touch the
ground.
These methods may be termed _knee extending mechanisms_. They assist
the passive action of the weight of the leg.
In fact the recurrence of extension is brought about by a pendulum
movement of the leg, which, at first oblique downwards and backwards,
swings into a downward and forward obliquity. But this movement
is slow (the pendulum which marks one second is one metre long)
and incomplete. The patient can make it complete with a little
instruction, by extending the thigh slightly as soon as the foot
touches the ground.
This may be sufficient if the stump is long; the leverage is good, and
while the hip is being flexed a swing can be given to the thigh piece
which accentuates the pendulum movement of the leg.
But with a short stump some special mechanism is essential to make
sure that extension will be complete, otherwise the patient will be
obliged to walk with short and calculated steps, to wait whilst the
pendulum action produces extension of his knee and allows him to put
weight upon his foot.
C. _Mechanism for starting extension of the knee during the time the
leg is swinging._--There are two methods which are generally combined:
1. Elastic traction by an artificial muscle.
2. The extending sling.
1. _Artificial muscle._--The action of an artificial muscle made of
elastic (noiseless) or of a coiled steel spring, is easily understood.
(a) The simplest method (that which is commonly used for infantile
paralysis affecting the quadriceps) consists in fixing an elastic band
divided into two slips, one on either side of the patella between the
front of the thigh and of the leg, about the middle of each. (This is
represented in figure 98 in our convertable leg.)
(b) When the apparatus includes the regular artificial knee the makers
generally place this mechanism in the interior of the thigh and leg
pieces, using methods which are often very ingenious. Of these we
illustrate some on pages 40 onwards, with an explanatory description.
In describing these mechanisms, which may be called intra-condylar,
it is necessary to speak at the same time of the _stop to limit
extension_ because, as will be seen, it is combined with the extending
spring.
We have already said that rigidity in extension when the limb is
vertical is essential, but whilst it is necessary for extension to be
_complete_ at this moment it is also necessary to prevent the knee
being forced into the _hyperextended position_, as this would quickly
strain the joint and render the limb useless.
Public-domain text, read in full here on John Shaqi.
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