Amputation; Artificial limbs; Orthopedics; Surgery, Military
These limbs are infinitely more durable than the French. They may
last three years, whereas the French limb used by a young and active
patient is worn out at the end of the first year, and it was for this
reason that a limb with a free knee joint used to be considered a
luxury.[9]
[9] That is the reason that amputation at four fingers' breadth below
the knee used to be called for the working class, amputation at "the
seat of election," a name which is no longer applicable and which is
liable to mislead the operator.
This wooden bucket is shaped very accurately to the bony prominences,
and by passing the fingers over its inner surface the three hollows
corresponding to the points of pressure enumerated above can be
distinctly felt.
It is important to describe the shape of the upper edge of the bucket
in order to guard against two points which may interfere with flexion--
I. Pinching of the tissues behind the knee.
II. The tendency of the stump, when it is short, to tilt forward
in the bucket (Fig. 108).
_Pinching of the flesh behind the knee_ in flexion takes place between
the edge of the leg piece and that of the thigh corset.
If the top of the bucket is horizontal, it must inevitably occur, even
if the edge of the thigh corset is well cut away (Fig. 106).
It can be avoided by cutting away these two edges into concavities
opposite each other.
[Illustration:
FIGS. 105 and 106.--Limb in which the upper edge of the leg
bucket is almost horizontal; in the sitting position (Fig. 106) the
flesh at the back of the thigh is pinched even if the lower end of the
thigh corset is well cut away.]
In the French limbs made of leather it is usual to make the leg piece
very high in front, _i.e._ as high as the middle of the patella.
This is quite useless. The posterior border is cut down to a depth
of two fingers' breadth below the axis of the joint. Pinching is
thus avoided, but the posterior support is insufficient, the stump
tilts forward as described above and the bucket gapes in front (Fig.
108). If the top of the bucket is horizontal--as in certain American
limbs--there is, as we have already said, pinching of the popliteal
tissues and compression of the popliteal vessels and nerves (Fig.
106). A concavity is therefore necessary, but one reaching to one
finger's breadth below the axis of the joint is sufficient. In front
the edge of the bucket reaches up to the joint line, this is quite
sufficient to enclose the bony prominences (Fig. 109).
The posterior concavity of the leg piece is combined with a concavity
in the thigh piece varied in accordance with the thickness of the
popliteal soft parts.
[Illustration:
FIGS. 107 and 108.--If the leg bucket is hollowed out too
much at the back, the stump is tilted obliquely forward (Fig. 108),
the knee loses contact with the bucket, and the flesh at the back of
the thigh is pinched.]
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