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The Journal of Bone & Joint Surgery British Volume
Vol. 38-B, Issue 3 | Pages 611 - 612
1 Aug 1956
Mercer W


The Journal of Bone & Joint Surgery British Volume
Vol. 78-B, Issue 3 | Pages 461 - 467
1 May 1996
Gaine WJ McCreath SW

We assessed 46 Syme’s amputees attending our prosthetic clinics in terms of the clinical and radiological condition of their stumps, their level of function and problems with the prosthesis.

Twenty-five were compared with a matching group of 25 transtibial amputees in regard to activity, function and prosthetic behaviour. Function was similar in the two groups, but Syme’s amputees had a higher incidence of prosthetic failure. Overall, Syme’s amputees were pleased with their prostheses and their function. Childhood amputations were associated with fewer long-term problems in terms of function and stump problems

Syme’s amputation is indicated for congenital foot deformities, fibular hemimelia and severe injury to the foot as long as the heel pad remains viable.


The Journal of Bone & Joint Surgery British Volume
Vol. 44-B, Issue 2 | Pages 431 - 435
1 May 1962
Hulth A Olerud S


The Journal of Bone & Joint Surgery British Volume
Vol. 79-B, Issue 3 | Pages 441 - 443
1 May 1997
Humzah MD Gilbert PM

Skin cover after below-knee amputation has been extensively discussed. We describe the flaps which are commonly used and discuss their vascular basis in the context of the current knowledge of the fasciocutaneous system. An understanding of this vascular system will enable surgeons to plan and shape flaps for surgical exposure and coverage.


The Journal of Bone & Joint Surgery British Volume
Vol. 78-B, Issue 4 | Pages 686 - 686
1 Jul 1996
Klenerman L


The Journal of Bone & Joint Surgery British Volume
Vol. 31-B, Issue 4 | Pages 589 - 595
1 Nov 1949
Keevil JJ


The Bone & Joint Journal
Vol. 103-B, Issue 3 | Pages 553 - 561
1 Mar 2021
Smolle MA Leithner A Kapper M Demmer G Trost C Bergovec M Windhager R Hobusch GM

Aims

The aims of the study were to analyze differences in surgical and oncological outcomes, as well as quality of life (QoL) and function in patients with ankle sarcomas undergoing three forms of surgical treatment, minor or major limb salvage surgery (LSS), or amputation.

Methods

A total of 69 patients with ankle sarcomas, treated between 1981 and 2017 at two tumour centres, were retrospectively reviewed (mean age at surgery: 46.3 years (SD 22.0); 31 females (45%)). Among these 69 patients 25 were analyzed prospectively (mean age at latest follow-up: 61.2 years (SD 20.7); 11 females (44%)), and assessed for mobility using the Prosthetic Limb Users Survey of Mobility (PLUS-M; for amputees only), the Toronto Extremity Salvage Score (TESS), and the University of California, Los Angeles (UCLA) Activity Score. Individual QoL was evaluated in these 25 patients using the five-level EuroQol five-dimension (EQ-5D-5L) and Fragebogen zur Lebenszufriedenheit/Questions on Life Satisfaction (FLZ).


The Bone & Joint Journal
Vol. 103-B, Issue 3 | Pages 430 - 439
1 Mar 2021
Geary M Gaston RG Loeffler B

Upper limb amputations, ranging from transhumeral to partial hand, can be devastating for patients, their families, and society. Modern paradigm shifts have focused on reconstructive options after upper extremity limb loss, rather than considering the amputation an ablative procedure. Surgical advancements such as targeted muscle reinnervation and regenerative peripheral nerve interface, in combination with technological development of modern prosthetics, have expanded options for patients after amputation. In the near future, advances such as osseointegration, implantable myoelectric sensors, and implantable nerve cuffs may become more widely used and may expand the options for prosthetic integration, myoelectric signal detection, and restoration of sensation. This review summarizes the current advancements in surgical techniques and prosthetics for upper limb amputees.

Cite this article: Bone Joint J 2021;103-B(3):430–439.


The Journal of Bone & Joint Surgery British Volume
Vol. 79-B, Issue 6 | Pages 924 - 926
1 Nov 1997
Bhagia SM Elek EM Grimer RJ Carter SR Tillman RM

We reviewed 20 patients after forequarter amputation performed for high-grade malignant tumours of the shoulder girdle (Enneking grades IIB to III). The operations were classified as palliative or curative according to the resection margins and the presence of disseminated disease at the time of the surgery.

There were five palliative and 15 curative procedures. Two patients died from unrelated causes, septicaemia and suicide. Eight died in the first two years, four of whom had had a palliative operation. Four died between two and five years after surgery, one after a palliative operation. Five patients are alive, at a mean of 89.4 months after surgery, four of whom are free from disease. The median survival after a palliative amputation was 20.6 months. Our overall five-year survival (palliative and curative cases) was 21.2%, for curative cases it was 30.2%. None of the patients use an artificial prosthesis.

Despite the disfigurement which results from this operation, it still has a useful role to play in the management of high-grade malignant tumours of the upper limb.


The Journal of Bone & Joint Surgery British Volume
Vol. 78-B, Issue 1 | Pages 133 - 136
1 Jan 1996
Finsen V Russwurm H

In nine patients of median age 34 years who had sustained an amputation of the thumb at a median 24 (5 to 131) months previously, we lengthened the first metacarpal by 30 (17 to 36) mm. Seven amputations had been through the proximal phalanx and two through the metacarpal.

The first two patients had autogenous grafting at a second stage, but the other seven had callotasis alone. In these patients the external fixators were removed at a median 189 (115 to 271) days after osteotomy. In six cases the adductor pollicis tendon was transferred proximally and the first web deepened. There was late fracture or palmar flexion of the callus in five patients, but this required further surgery in only one. Treatment was complete at 326 (140 to 489) days after osteotomy. The extended thumb retained its sensitivity; both grasp and key-pinch strength were satisfactory and only one patient felt that the result did not warrant the long course of treatment.

Metacarpal lengthening by this method is a prolonged procedure, but provides a valuable alternative to more complex reconstructions.


The Journal of Bone & Joint Surgery British Volume
Vol. 56-B, Issue 1 | Pages 110 - 114
1 Feb 1974
Persson BM

1. A sagittal technique for below-knee amputation for ischaemic gangrene based on mediolateral musculo-cutaneous flaps is described, similar to the one independently presented by Tracy (1966).

2. The results with this method are illustrated by the evolution of the below-knee healing rate over six years in 172 patients with ischaemic gangrene.

3. A comparison between sagittal and conventional flap techniques shows a reamputation rate of six out of fifty-eight in the former and sixteen out of forty-one in the latter.

4. The overall relative knee joint preservation during 1971 was 82 per cent, and the frequency of attempted below-knee amputation was 93 per cent.

5. It is concluded that the sagittal technique has several advantages in comparison to the posterior flap technique, and that the potential for healing is on the same high level.

6. A fully controlled comparison between different techniques is proposed.


Bone & Joint Research
Vol. 7, Issue 2 | Pages 131 - 138
1 Feb 2018
Bennett PM Stevenson T Sargeant ID Mountain A Penn-Barwell JG

Objectives

The surgical challenge with severe hindfoot injuries is one of technical feasibility, and whether the limb can be salvaged. There is an additional question of whether these injuries should be managed with limb salvage, or whether patients would achieve a greater quality of life with a transtibial amputation. This study aims to measure functional outcomes in military patients sustaining hindfoot fractures, and identify injury features associated with poor function.

Methods

Follow-up was attempted in all United Kingdom military casualties sustaining hindfoot fractures. All respondents underwent short-form (SF)-12 scoring; those retaining their limb also completed the American Academy of Orthopaedic Surgeons Foot and Ankle (AAOS F&A) outcomes questionnaire. A multivariate regression analysis identified injury features associated with poor functional recovery.


The Journal of Bone & Joint Surgery British Volume
Vol. 55-B, Issue 1 | Pages 179 - 182
1 Feb 1973
Edvardsen P

1. A case of congenital bowing of the tibia is described in which pseudarthrosis developed and recurred after nine operations performed by the age of ten years.

2. Union was finally secured by a procedure based on deep impaction of the trimmed upper fragment into the reamed-out lower fragment. This was followed by a Boyd type of partial amputation of the foot with calcaneo-tibial arthrodesis.

3. The end-bearing stump four years later is entirely satisfactory and the simple prosthesis gives equality of leg lengths.


The Journal of Bone & Joint Surgery British Volume
Vol. 49-B, Issue 1 | Pages 142 - 143
1 Feb 1967
Ratliff AHC


The Journal of Bone & Joint Surgery British Volume
Vol. 32-B, Issue 3 | Pages 392 - 395
1 Aug 1950
Smith HG

1. An attempt has been made to rationalise the selection of the site of amputation for gangrene in primary peripheral vascular disease.

2. There is a good chance of the survival of a below-knee stump if the circulation in the skin of the proposed flaps appears adequate clinically, and if the blood supply to the muscles is obviously good at amputation.

3. If the popliteal pulse is present before operation, below-knee amputation should succeed. The absence of a popliteal pulse, however, does not exclude below-knee amputation.

4. Below-knee stumps should be about four inches long in amputations for peripheral vascular disease.

5. Tests for determining the state of the circulation are also necessary before choosing the level for above-knee amputations.


The Journal of Bone & Joint Surgery British Volume
Vol. 31-B, Issue 3 | Pages 410 - 413
1 Aug 1949
Gordon-Taylor G Wiles P


The Journal of Bone & Joint Surgery British Volume
Vol. 49-B, Issue 1 | Pages 144 - 144
1 Feb 1967
Catterall RCF


The Journal of Bone & Joint Surgery British Volume
Vol. 40-B, Issue 4 | Pages 735 - 739
1 Nov 1958
Stevens J Lennox B

A patient with Paget's sarcoma of the femur, alive and well seven years after amputation, is reported. Long survival in two previously reported cases is also mentioned.


The Bone & Joint Journal
Vol. 102-B, Issue 2 | Pages 162 - 169
1 Feb 2020
Hoellwarth JS Tetsworth K Kendrew J Kang NV van Waes O Al-Maawi Q Roberts C Al Muderis M

Aims

Osseointegrated prosthetic limbs allow better mobility than socket-mounted prosthetics for lower limb amputees. Fractures, however, can occur in the residual limb, but they have rarely been reported. Approximately 2% to 3% of amputees with socket-mounted prostheses may fracture within five years. This is the first study which directly addresses the risks and management of periprosthetic osseointegration fractures in amputees.

Methods

A retrospective review identified 518 osseointegration procedures which were undertaken in 458 patients between 2010 and 2018 for whom complete medical records were available. Potential risk factors including time since amputation, age at osseointegration, bone density, weight, uni/bilateral implantation and sex were evaluated with multiple logistic regression. The mechanism of injury, technique and implant that was used for fixation of the fracture, pre-osseointegration and post fracture mobility (assessed using the K-level) and the time that the prosthesis was worn for in hours/day were also assessed.


The Bone & Joint Journal
Vol. 95-B, Issue 2 | Pages 224 - 229
1 Feb 2013
Bennett PM Sargeant ID Midwinter MJ Penn-Barwell JG

This is a case series of prospectively gathered data characterising the injuries, surgical treatment and outcomes of consecutive British service personnel who underwent a unilateral lower limb amputation following combat injury. Patients with primary, unilateral loss of the lower limb sustained between March 2004 and March 2010 were identified from the United Kingdom Military Trauma Registry. Patients were asked to complete a Short-Form (SF)-36 questionnaire. A total of 48 patients were identified: 21 had a trans-tibial amputation, nine had a knee disarticulation and 18 had an amputation at the trans-femoral level. The median New Injury Severity Score was 24 (mean 27.4 (9 to 75)) and the median number of procedures per residual limb was 4 (mean 5 (2 to 11)). Minimum two-year SF-36 scores were completed by 39 patients (81%) at a mean follow-up of 40 months (25 to 75). The physical component of the SF-36 varied significantly between different levels of amputation (p = 0.01). Mental component scores did not vary between amputation levels (p = 0.114). Pain (p = 0.332), use of prosthesis (p = 0.503), rate of re-admission (p = 0.228) and mobility (p = 0.087) did not vary between amputation levels.

These findings illustrate the significant impact of these injuries and the considerable surgical burden associated with their treatment. Quality of life is improved with a longer residual limb, and these results support surgical attempts to maximise residual limb length.

Cite this article: Bone Joint J 2013;95-B:224–9.