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SECOND EDITIONATLAS OF LIMB PROSTHETICS:SURGICAL, PROSTHETIC, AND REHABILITATION PRINCIPLESAmerican Academy of Orthopaedic Surgeons
SECOND EDITIONAtlas of Limb Prosthetics:Surgical, Prosthetic, andReh bilitation PriniiplesAmerican Academy of Orthopaedic SurgeonsEdited byJohn H. Bowker, M.D.Professor and Associate ChairmanDepartment of Orthopaedics and RehabilitationUniversity of Miami School of MedicineDirector, Amputee and Diabetic Foot ServicesJackson Memorial Medical CenterMiami, FloridaJohn W. Michael, M.Ed., C.P.O.Assistant Clinical ProfessorProsthetics and OrthoticsDuke University Medical CenterDirector, Department of Prosthetics and OrthoticsDuke University Medical CenterDurham, North CarolinaMV MosbyYear BookSt Lous nto
Dedicated to Publishing ExcellenceSponsoring Editors: James D. Ryan/Joyce-Rachel JohnAssociate Managing Editor, Manuscript Services: Deborah ThorpProduction Supervisor: Karen HalmProofroom Manager: Barbara KellyCopyright E 1981, 1992 by Mosby-Year Book, Inc.A C.V. Mosby Company imprint of Mosby-Year Book, Inc,Mosby-Year Book, Inc.11830 Westline Industrial DriveSt. Louis, MO 63146All rights reserved. No part of this publication may be reproduced,stored in a retrieval system, or transmitted, in any form or by anymeans, electronic, mechanical, photocopymg, recording, or otherwise, without prior written permission from the publisher. Printed inthe United States of America. Permission to photocopy or reproducesolely for internal or personal use is permitted for libraries or otherusers registered with the Copyright Clearance Center, provided thatthe base fee of 4.00 per chapter plus . 10 per page is paid directly tothe Copyright Clearance Center, 21 Congress Street, Salem, MA01970. This consent does not extend to other kinds of copying, suchas copying for general distribution, for advertising or promotionalpm-poses, for creating new collected works, or for resale1 2 3 4 5 6 7 8 9 O CL MV 96 95 94 93 92Library of Congress Cataloging-in-Publication DataAtlas of limb prosthetics : surgical, prosthetic, and rehabilitationprinciples / American Academy of Orthopaedic Surgeons-2nd ed.p. cm.John H. Bowker, editor.Includes bibliographical references and index.ISBN 0-8016-0209-21. Artificial limbs. 2. Amputation. 3. Amputees-Rehabilitation.I. Bowker, John H. II. American Academy of Orthopaedic Surgeons[DNLM: I. Amputation-atlases. 2. A m p u t e e s - r e h a b i l i t a t i o n -atlases. 3. Artificial Limbs-atlases. WE 17 A88061RD756.A85 199292.12744617.5’8-dc20CIPDNLMDLCfor Library of Congress
CONTRIBUTORSJ. THOMAS ANDREW, C.P.Adjunct ProfessorDepartment of Physical TherapyProsthetic ConsultantRehabilitation DepartmentUniversity of Utah Medical CenterPrimary Children’s HospitalSalt Lake City, UtahDIANE ATKINS, O.T.R.Instructor, Department of RehabilitationDepartment of Physical MedicineBaylor College of MedicineCoordinator, Amputee ProgramThe Institute for Rehabilitation and ResearchHouston, TexasNORMAN BERGER, M.S.Senior Research Scientist EmeritusDepartment of Orthopaedic SurgeryNew York University Medical CenterNew York, New YorkDIETRICH BOCHMANN, C.P.O.(C.), F.C.B.C.Prosthetist and OrthotistGeorge Brown College of Applied Arts andTechnologyCanadian Board of Certification of Prosthetists andOrthotistsConsultant, Hugh Macmillian Rehabilitation CentreToronto, Ontario, CanadaJOHN H. BOWKER, M.D.Professor and Associate ChairmanDepartment of Orthopaedics and RehabilitationUniversity of Miami School of MedicineDirector, Amputee and Diabetic Foot ServicesJackson Memorial Medical CenterMiami, FloridaCARL D. BRENNER, C.P.O.Director of Prosthetic ResearchMichigan Institute for Electronic Limb DevelopmentDetroit, MichiganMICHAEL D. BRNCICK, M.Ed., C.P.O.Associate in Orthotics and ProstheticsNorthwestern University Medical SchoolInterim DirectorNorthwestern University Prosthetic-Orthotic CenterChicago, IllinoisWILTON H. BUNCH, M.D.Professor, Department of Orthopaedic SurgeryUniversity of Alabama at BirminghamMedical DirectorLakeshore HospitalBirmingham, AlabamaERNEST M. BURGESS, M.D., Ph.D.Professor of Orthopaedic SurgeryUniversity of WashingtonSeattle, WashingtonRONALD0 S. CARNEIRO, M.D.Associate ProfessorDepartment of Orthopaedics and RehabilitationUniversity of Miami School of MedicineHand SurgeonJackson Memorial Medical CenterMiami, FloridaDUDLEY S. CHILDRESS, Ph.D.Professor of Orthopaedic Surgery and BiomedicalEngineeringNorthwestern UniversityChicago, IllinoisCURTIS R. CLARK, B.S., P.T.Physical TherapistUniversity of MiamiSupervisor of Amputee ServiceJackson Memorial HospitalMiami, FloridaDAVID N. CONDIE, B.Sc., C. Eng., M.I.Mech. E.Honorary Senior LecturerDepartment of Orthopaedic and Traumatic SurgeryUniversity of DundeeArea Rehabilitation EngineerTayside Rehabilitation Engineering ServicesDundee Limb Fitting CentreDundee, Scotland
viContributorsROBIN COOPER, C.P., B.A., F.B.I.S.T.BERTRAM GOLDBERG, M.D., F.A.C.S.Executive, Head of Research and DevelopmentHugh Steeper LimitedRoehampton Disability CentreQueen Mary’s University HospitalLondon, United KingdomAssociate Clinical ProfessorDepartment of Orthopaedic SurgeryUniversity of Colorado School of MedicineDenver, ColoradoDONALD CUMMINGS, C.P.Adjunct Clinical FacultyProsthetics Orthotics ProgramSchool of Allied Health SciencesUniversity of Texas Southwestern Medical Center atDallasDirector of ProstheticsTexas Scottish Rite Hospital for ChildrenDallas, TexasH.J.B. DAY, M.R.C.S., L.R.C.P.Formerly Senior Medical OfficerDisablement ServiceWithington, Manchester, United KingdomRUTH DICKEY, M.A., O.T.R.Research AssociateDepartment of Rehabilitation MedicineThe Mount Sinai Medical SchoolInstructor in Occupational TherapyColumbia University College of Physicians andSurgeonsDirector, Electronic Technical AidsChief, Occupational Therapy in ProstheticRehabilitationMount Sinai HospitalNew York, New YorkJOAN E. EDELSTEIN, M.A., P.T.Senior Research ScientistClinical Assistant Professor of Orthopaedic SurgeryAdjunct Professor of Physical Therapy and Prostheticsand OrthoticsNew York University School of Medicine andPost-Graduate Medical SchoolNew York, New YorkJOHN R. FISK, M.D.Associate ProfessorDepartment of SurgerySouthern Illinois University School of MedicineSpringfield, IllinoisCHARLES M. FRYER, B.S., M.S.Director EmeritusNorthwestern UniversityProsthetic Orthotic CenterChicago, IllinoisROBERT S. GAILEY, Jr., M.S., Ed., P.T.Instructor, Department of Orthopaedics andRehabilitationDivision of Physical TherapyUniversity of Miami School of MedicineMiami, FloridaFRANK GOTTSCHALK, M.D., F.R.C.S. Ed.Associate Professor of Orthopaedic SurgeryUniversity of Texas Southwestern Medical CenterDallas, TexasGREG GRUMAN, C.P.President and Chief Executive OfficerWinkley Orthopedic LaboratoriesMinneapolis, MinnesotaFREDERICK L. HAMPTON, C.P.Former Adjunct ProfessorNorthwestern University Prosthetic andOrthotic CenterChicago, IllinoisFormer Adjunct ProfessorUniversity of Miami School of MedicineMiami, FloridaCRAIG W. HECKATHORNE, M.Sc.-ElecEngineeringResearch EngineerRehabilitation Engineering Program and theProsthetics Research LaboratoryNorthwestern UniversityProsthetist (Intern)Orthotic/Prosthetic Clinical ServicesRehabilitation Institute of ChicagoChicago, IllinoisDAVID HELFET, M.D.Associate ProfessorCornell University Medical CollegeHospital for Special SurgeryNew York, New YorkSTEPHEN C. JACOBSEN, Ph.D.Professor, Mechanical and Industrial EngineeringDepartmentDirector, Center for Engineering DesignUniversity of UtahSalt Lake City, UtahSUSAN KAPP, C.P.Assistant Professor and Acting DirectorProsthetics-Orthotics ProgramUniversity Texas Southwestern Medical Center atDallasDallas, TexasROBERT D. KEAGY, M.D., M.S.Associate Professor of Clinical Orthopaedic SurgeryNorthwestern University Medical SchoolAttending Orthopaedic SurgeonLouis A. Weiss Memorial HospitalChicago, Illinois
ContributorsBERNICE KEGEL, B.Sc. (PHYSIO) RAND.PETERT. McCOLLUM, M.B., M.Ch., F.R.C.S.I.Amputee RehabilitationPrivate PracticeSeattle, WashingtonHonorary Senior Lecturer in SurgeryUniversity of DundeeConsultant Vascular SurgeonNinewells HospitalDundee, ScotlandJ. IVAN KRAJBICH, M.D., F.R.C.S.(C).Assistant ProfessorDepartment of SurgeryUniversity of TorontoClinic ChiefAmputee Prosthetic Clinic ProgramHugh MacMillan CenterToronto, CanadaAssociate Clinical Professor of OrthopaedicsUniversity of Colorado Medical CenterChief, Juvenile Amputee ClinicThe Children’s HospitalDenver, ColoradoLEON M. KRUGER, M.D.JOHN W. MICHAEL, M.Ed., C.P.O.Clinical ProfessorDepartment of Orthopaedic SurgeryNew York University and Boston UniversityBoston, MassachusettsDirector, Department of Prosthetics and OrthoticsAssistant Clinical Professor of Prosthetics andOrthoticsDuke University Medical CenterDurham, North CarolinaH. RICHARD LEHNEIS, Ph.D., C.P.O.Former Research Associate Professor of RehabilitationMedicineNew York University Medical CenterChief, Rehabilitation Research and Development LabsVeterans Affairs Medical CenterNew York, New YorkS. WILLIAM LEVY, M.D.Clinical Professor of DermatologyUniversity of California at San FranciscoAttending DermatologistChildrens HospitalSan Francisco, CaliforniaTERRY R. LIGHT, M.D.Professor of Orthopaedics and RehabilitationLoyola University Stritch School of MedicineAttending SurgeonLoyola University Medical CenterMaywood, IllinoisDUANE G. MESSNER, M.D.WALID MNAYMNEH, M.D.ProfessorDepartment of Orthopaedics and RehabilitationUniversity of Miami School of MedicineChief of Orthopaedic Reconstructive Service andOrthopaedic OncologyJackson -Memorial Medical CenterMiami, FloridaTHOMAS J. MOORE, M.D.Assistant ProfessorDepartment of Orthopaedic SurgeryEmory University School of MedicineAtlanta, GeorgiaJAMES A. NUNLEY II, M.D.Associate Professor of SurgeryDepartment of SurgeryDuke University Medical CenterDurham, North CarolinaEVELYN J. MACKIN, P.T.DANIEL G. OGLESBY Jr., B.A., C.P.O.Executive Director of Hand TherapyHand Rehabilitation FoundationPhiladelphia, PennsylvaniaPrivate PracticeNew Orleans, LouisianaERNST MARQUARDT, M.D.Associate ProfessorDepartment of Orthopaedics and RehabilitationChief, Division of Hand SurgeryUniversity of Miami School of MedicineJackson Memorial Medical CenterMiami, FloridaConsulting Orthopaedic SurgeonUniversity of HeidelbergOrthopaedic HospitalHeidelberg, GermanyJOHN A. McAULlFFE, M.D.Assistant ProfessorHand Surgery ServiceDepartment of Orthopaedics and RehabilitationUniversity of MiamiMiami, FloridaELIZABETH ANNE OUELLETTE, M.D.CAROL J. PAGE, B.S.(P.T.)Physical Therapy Supervisor and CoordinatorHandicapped Sports ProgramThe Children’s HospitalDenver, Coloradovii
.ContributorsVIIIJOANNA GRACE PATTON, B.S., O.T.R.Associate Specialist and Occupational TherapistChild Amputee Prosthetics ProjectUniversity of California at Los AngelesSenior Clinical Occupational TherapistChild Amputee Prosthetics ProjectUCLA Rehabilitation CenterShriners Hospital for Crippled ChildrenLos Angeles, CaliforniaJACQUELIN PERRY, M.D.Professor of OrthopaedicsUniversity of Southern CaliforniaChief, Pathokmesiology ServiceRanch0 Los Amigos Medical CenterLos Angeles, CaliforniaROY SANDERS, M.D.Clinical Assistant ProfessorDepartment of Orthopaedic SurgeryUniversity of South FloridaAssociate Director Orthopaedic TraumaTampa General HospitalTampa, FloridaSHAHAN K. SARRAFIAN, M.D.Associate Professor of Orthopaedic SurgeryNorthwestern UniversityChief, Section of OrthopaedicsGrant HospitalChicago, IllinoisC. MICHAEL SCHUCH, C.P.O.JEAN PILLET, M.D.Manager, Greenville Orthopaedic Appliance CompanyGreenville, South CarolinaDirector, Centre de Prosthese PlastiqueParis, FranceMAURICE D. SCHNELL, M.D.MICHAEL S. PINZUR, M.D.Associate ProfessorDepartment of Orthopaedics and RehabilitationLoyola University Medical SchoolChief, Special Teams for Amputations, Mobility,Prosthetics/OrthoticsLoyola University Medical CenterMaywood, IllinoisPRADIP D. POONEKAR, M.B.B.S., M.S.(Gen. Surg.)Visiting ClinicianDepartment of Orthopaedics and RehabilitationUniversity of MiamiMiami, FloridaCHARLES H. PRITHAM, C.P.O.Lecturer, Northwestern UniversityProsthetic and Orthotic CenterChicago, IllinoisMICHAEL J. QUIGLEY, C.P.O.Lecturer, Northwestern UniversityProsthetic and Orthotic CenterChicago, IllinoisJOHN C. RACY, M.D.Professor of PsychiatryUniversity of ArizonaPsychiatrist, University Medical CenterTucson, ArizonaBOB RADOCY, M.S. THERAPEUTICRECREATIONClinic MemberDenver Childrens HospitalDenver, ColoradoDAN ROWE, C.P.O.Consultant, Minneapolis Shriners HospitalMinneapolis, MinnesotaMedical Director of Mercy Regional RehabilitationCenterMercy HospitalSt. Luke’s HospitalDavenport, IowaHAROLD H. SEARS, Ph.D.General ManagerMotion Control, IOMED, Inc.Salt Lake City, UtahDOUGLAS G. SMITH, M.D.Assistant Professor of Orthopaedic SurgeryUniversity of WashingtonThe Prosthetic Research StudyHarborview Medical CenterSeattle, WashingtonMELVIN L. STILLS, C.O.Assistant ProfessorUniversity of Texas Southwestern Medical CenterParkland Memorial HospitalDallas, TexasTERRY SUPAN, C.P.O.Assistant ProfessorDepartment of SurgeryDivision of Orthopaedics and RehabilitationSouthern Illinois School of MedicineSpringfield, IllinoisCARMAN TABLADA, C. P.Sacramento, CaliforniaJOSE J. TERZ, M.D.Chairman, Division of SurgeryCity of Hope National Medical CenterDuarte, California
ContributorsROBERT E. TOOMS, M.D.F. WILLIAM WAGNER, Jr., M.D.Professor, Department of Orthopaedic SurgeryUniversity of Tennessee at MemphisChief of StaffCampbell ClinicMemphis, TennesseeClinical Professor of Orthopaedic SurgeryUniversity of Southern CaliforniaChief, Foot and Ankle ClinicOrthopaedic HospitalMedical DirectorWagner Foot and Ankle InstituteLos Angeles, CaliforniaFRANCIS J. TROST, M.D.Clinical Associate ProfessorUniversity of MinnesotaClinic ChiefAmputee ClinicShriners Hospital for Crippled ChildrenMinneapolis, MinnesotaTONY VAN DER WAARDE, B.Sc., D.P.(Prosthetics and Orthotics)MICHAEL A. WALKER, M.D., F.R.C.S.Ed.Senior Registrar in SurgeryNinewells HospitalDundee, ScotlandROBERT L. WATERS, M.D.Certified ProsthetistSabolick Prosthetic and Research CenterOklahoma City, OklahomaClinical Professor of Orthopaedic SurgeryUniversity of Southern CaliforniaMedical DirectorRanch0 Los Amigos Medical CenterLos Angeles, CaliforniaRICHARD VONER, C.P.O.A. BENNETT WILSON Jr., B.S.M.E.Whittier, CaliforniaLAWRENCE D. WAGMAN, M.D., F.A.C.S.Assistant Clinical Professor of SurgeryUniversity of California at San DiegoSenior SurgeonCity of Hope National Medical CenterDuarte, CaliforniaAssociate Professor (Retired)Department of Orthopaedic SurgeryUniversity of VirginiaCharlottesville, VirginiaJOSEPH H. ZETTL, C.P.Clinical Assistant ProfessorDepartment of RehabilitationUniversity of WashingtonSeattle, Washingtonix
FOREWORDAs was true in the first edition of Atlas of Limb Prosthetics, the editors’ design in this new volume relatesthe surgical procedure of amputation to the rehabilitation of the amputee. The enlightened surgeon will viewan amputation as a reconstructive procedure, and hewill measure his success by the degree to which function can be restored to a previously diseased, damaged,or malformed limb. When amputation is performed,however, a new pathology is introduced. It is of the utmost importance that the newly fashioned limb is compatible with optimum prosthetic restoration. The amputee will achieve maximum functional restoration onlyif a satisfactory union occurs between a well-constructed residual limb and a prosthesis of sound design.The amputation surgeon is therefore obligated tohave some basic knowledge of kmesiology, kinetics, andmodern prosthetic design. Similarly, the prosthetistand therapist must have basic knowledge of each others’ disciplines and of the options available to the surgeon given the clinical situation. The special knowledgepossessed by these three key members of the amputeerehabilitation team ideally should overlap and be constantly reinforced and expanded through working andlearning together in the clinical setting.This atlas, written by recognized experts in the fieldof amputation surgery and rehabilitation, emphasizesthe importance of the interdisciplinary care conceptand provides a common educational source for thoseprofessionals who care for the amputee population. Thereal value of this text to individual practitioners is theopportunity afforded to acquire basic and useful knowledge in disciplines other than their own. In addition,this volume will certainly be an invaluable resource tostudents in all of the health care professions that bearon rehabilitation of the amputee. The most importantbeneficiary of this work, however, will be the individual with congenital or acquired limb loss, whose carewill undoubtedly have been improved by those wholearn from these pages.NE TOX C. MCCOLLOUGH I I I , M . D .Professor of Orthopaedic SurgeryUniversity of South FloridaDirector of Medical AffairsShriners Hospitals for Crippled ChildrenTampa, Floridaxi
FOREWORDThe remarkable advances in prosthetic rehabilitationover the past half century are reflected in the growth ofliterature on this topic. When I began my training as aprosthetist in the 1930s the only available referencematerial was a brief handbook prepared by the Ministryof Pensions summarizing the British experience in managing the influx of amputees following World War I.’The next major text in this field did not appear untilwell after World War II, when the American Academyof Orthopaedic Surgeons produced the progenitor tothis volume: the two-part Orthopaedic Appliances Atlas. 2, ’ Volume? 2: Artijicial Limbs was a landmark publication that introduced the scientific foundation forprosthetic practice, including such innovative conceptsas individualized dynamic alignment, biomechanicalprinciples to guide socket design, the use of externallypowered or fluid-controlled prostheses, and treatmentby a clinic team composed of surgeons, prosthetists,and therapists.An additional 20 years elapsed before the immediatepredecessor to this volume was published, the Atlas ofLimb Prosthetics: Surgical and Prosthetic Principles.4Although several other texts on prosthetics appearedduring those two decades, the Atlas of Limb Prostheticshas been widely acknowledged as the definitive work.The pace of innovation and discovery in prosthetics isreflected in the publication of the present volume,scarcely a decade later. Numerous new chapters highlight recent information on such topics as myoelectricfittings, surgical limb salvage, socket design and componentry, sports and recreational activities, and pediatric management. The new subtitle-Surgical, Prosthetic, and Rehabilitation Principles-emphasizes afocus on individual rehabilitation as well as medical andtechnical expertise.Nearly half the contributing authors to this latest edition are prosthetists, therapists, and engineers-reflecting the maturation of the interdisciplinary teamsince that concept was inaugurated in the original volume more than 30 years ago. In addition to presentingthe best in contemporary thinking and the most recentadvances in prosthetic technology and management,the second edition reflects the sustained efforts of allmembers of the rehabilitation team to enable the amputee to enjoy an active, productive, and independentlife.CARLTON FILLAUER, C. P. 0.Vice President for Research and DevelopmentDurr-FiJJauer Orthopaedic, Inc.Chattanooga, TennesseeREFERENCESMinistry of Pensions: Artzjicial Limbs and Their Relationto Amputations. London, His Majesty’s Stationery Office,1939, p 90.American Academy of Orthopaedic Surgeons: OrthopaedicAppliances Atlas, Vol 1: Braces, Splints, 5 Shoe Alterations. Ann Arbor, Michigan, J.W. Edwards, 1952, p 588.American Academy of Orthopaedic Surgeons: OrthopaedicAppliances Atlas, Vol 2: Art cial Limbs. Ann Arbor,Michigan, J.W. Edwards, 1960, p 499.American Academy of Orthopaedic Surgeons: Atlas ofLimb Prosthetics: Surgical and Prosthetic Principles. St.Louis, Mosby-Year Book, Inc, 1981, p 668.XIII
PREFACEThe present volume is the third generation in a seriessponsored by the American Academy of OrthopaedicSurgeons on the subject of prosthetic limbs and theclosely related subjects of amputation surgery and amputee rehabilitation. Volume 2 of the Orthopaedic Appliances Atlas: Artijkial Limbs, published in 1960, wasthe first compendium specifically designed to be usefulto all members of the emerging prosthetic team. Slowbut steady progress in prosthetic research, development, and application occurred over the next two decades. This was augmented by the education of teamsconsisting of amputation surgeons, prosthetists, andtherapists given at several major universities. The demonstrated need for an updated version of the Atlas ledto the publication in 1981 of the first edition of the A&las of Limb Prosthetics, which further reflected the interdisciplinary nature of this vital work.Over the past decade, explosive growth, fueled bytwo preeminent forces, has occurred in the field ofprosthetics. One has been the progressive availability,through technology transfer, of lighter, stronger, andmore durable metal and plastic materials with remarkable ranges of flexibility and fatigue resistance. Progressive prosthetists and engineers were quick to incorporate these materials in new socket and componentdesigns. A second force has been consumer demand forlighter, stronger, more comfortable, and more functional prosthetic devices that can allow a return to thefull range of activities enjoyed before limb loss, including participation in active sports and recreation. Theamputee of today is no longer a passive consumer ofservices, but is often well informed on suitable amputation techniques and the latest in prosthetic design,through a nationwide network of support/educationgroups.The present edition has attempted to incorporatemost of the significant advances of the past decadewhile retaining desirable features of the previous edition, such as its overall organization and a few classic,but updated chapters. Discussions of therapy and pros-thetic use-training, which were formerly repeated foreach amputation level, now appear as major cohesivechapters in each section to provide greater clarity andto avoid redundancy. The chapter on prevention andcorrection of complications has been greatly expandedto enhance its practical usefulness.Because of recent advances in vascular and tumorsurgery resulting in limb salvage, a multisectional chapter on the alternatives to amputation has been added.This is of particular importance in the dysvascular or diabetic patient, in whom the opposite limb remains atrisk of future amputation.The reader will note that the recently adopted International Standards Organization (ISO) nomenclaturehas been used throughout the book to designate bothlevel of amputation and the corresponding prosthesis.The literal translation of these anatomic terms into mostlanguages now makes sense, thereby aiding intemational communication.It is hoped that these changes will enhance thebook’s usefulness to all members of the prostheticteam, including amputation surgeons (whether orthopaedic, vascular, or general), physiatrists, prosthetists,physical and occupational therapists, recreational therapists, bioengineers, rehabilitation nurses, and the amputee consumer.The support of the Board of Directors of the American Academy of Orthopaedic Surgeons made this workof the Committee on Rehabilitation, Prosthetics, andOrthotics possible and is gratefully acknowledged. Section editors Bertram Goldberg, M.D., and Thomas J.Moore, M.D., consultant Sidney Fishman, Ph. D.,Committee Chair David Apple, M.D. and James Ryanof Mosby-Year Book, Inc. contributed greatly to thetimely production of this book. A special thanks is dueour respective secretaries, Ms. Patsy Bain and Mrs. Susan Cronin.J O H N H. BOWKER, M.D.J OHN W. MI C H A E L, M.ED., C.P.O.xv
CONTENTSForeword by Newton C. McCoUough IIIForeword by Carlton FillauerPrefacexixtiP A R T I: I N T R O D U C T I O N199-2276B 1 Harnessing and Controls for Bodv-PoweredDevices133by Charles M. Fryer6C I Components for Adult Externally Powered11 1 History of Amputation Surgery andProsthetics 3.!XJ A. Bennett Wilson, Jr.151Systemslay Craig W. Heckathorne6D/ Control of Limb Prostheses175by Dudley S. Childress2 / The Choice Between Limb Salvage andAmputation 1 72A I Overview17by John H. Bowker-L ’ / Partial-Hand Amputations1997A I Surgical Principles199by Elizabeth Ann Ouellette, John A. McAtd fe,and Ronald0 Carneiro2B / Trauma19IN/ Ro!y Sanders and Da&d Hewet2C I \Iajor Limb Amputation for End-StagePeripheral Vascular Disease: LevelSelection and Alternative Options25lay Peter T. h4cCollum and Michael A. Walker7B I Prosthetic and OrthoticManagement217by John W. Michael7c I Aesthetic Restoration227by Jean Pillet and Euelyn J. Mackin81 Wrist Disarticulation and TransradialAmputation2Df I n f e c t i o n 3 9by John H. Bowker2378A / Surgical Principles237by Elizabeth Anne Ouellette2E 1 Tumor45by Walid Mnaymneh8B I Prosthetic Principles3 1 Planning for Optimal Function in AmputationSurge?59by Thomas J. L\400re241by Carl D. Brenner91 Elbow Disarticulation and TranshumeralAmputation4 I Prosthetic Management: Overview, Methods, andMaterials6i’b!y 34ichael J. QuiglecyPART II: THE UPPER LIMB1076A I Body-Powered Components107by Charles M. Fryer and John W. Michael“’I%lColor Plates within Chapters 7 and 26and 681- 6886 / Upper-Limb Prosthetics2519A / Surgical Principlesby John A. McAuliffe9B I Prosthetic Principlesby J. Thomas Andrew815 / Kinesiology and Functional Characteristics of theUpper Limb 83b y Shahan K. Sarra an25125510 I Shoulder Disarticulation and ForequaterAmputation2651OA / Surgical Principlesby John A. McAuliffe265xvii
.ContentsXVIII2711OB / Prosthetic Principlesby Robin Cooper11 / Adult Upper Limb Prosthetic Trainingby Diane Atkins12 / Special Considerations27729312A / Brachial Plexus Injuries: Surgical Advancesand Orthotic/Prosthetic Managementby John W. Michael and James A. Nunley12B I Fitting and Training the BilateralUpper-Limb Amputee311by H. Richard Lehneis and Ruth Dickeyl2C / Upper-Limb Prosthetic Adaptations forSports and Recreation325by Bob Radocy12D / Trends in Upper-Extremity Prosthetics345Developmentby Harold H. Sears357P A R T Ill: T H E L O W E R L I M B35913 / Normal Gaitby Jacquelin Perry16 / Surgical Procedures389by F. William Wagner, Jr.16B / Prosthetic and Orthotic Management403by David N. Condie and Melvin L. Stills17 / The Syme Ankle Disarticulation41341317A / Surgical Proceduresby F. William Wagner, Jr.42317B / Prosthetic Managementby Richard Voner and John W. Michael42918A / Surgical Procedures and Immediate429Postsurgical Managementby John H. Bowker, Bertram Goldberg, andPradip D. Poonekar45318B / Prosthetic Managementby Susan Kapp and Donald Cummings19A I Surgical Proceduresby Michael S. Pinzur2OA I Surgical Proceduresby Frank Gottschalk50120B I Prosthetic Managementby C. Michael Schuch47947950921 I Hip Disarticulation and Transpelvic Amputation53521A I Surgical Procedures535by Robert E. Tooms and Frederick L. Hampton21B I Prosthetic Management539by Tony van der Waarde and John W. Michael22 1 Translumbar Amputation (Hemicorporectomy)55355322A I Surgical Proceduresby Lawrence D. Wagman and Jose J. Terz56322B / Prosthetic Considerationsby Greg Gruman and John W. Michael59924A I Fitting and Training the BilateralLower-Limb Amputee599by Douglas G. Smith, Ernest M. Burgess,Joseph H. Zettl38916 / Partial-Foot Amputations19 / Knee Disarticulation50124 / Special Considerations15 / The Energy Expenditure of AmputeeGait381by Robert L. Waters18 / Transtibial Amputation20 I Transfemoral Amputation23 I Physical Therapy Management of AdultLower-Limb Amputees569by Robert S. Gailey, Jr. and Curtis R. Clark37114 I Analysis of Amputee Gaitby LNorman Berger48719B I Prosthetic Managementby John W. Michael24B I Adaptations for Sports and Recreation623by Bernice Kegel24C / Emerging Trends in Lower-LimbProsthetics: Research and Development655by Charles H. P&hamPART IV: MANAGEMENT ISSUES66325 / Musculoskeletal Complications in Amputees:665Their Prevention and Managementby John H. Bowker, Robert D. Keagy, and Bradip D.Poonekar26 / Skin Problems of the Amputeeby S. William Levy68127 / Management of Pain in the Amputeeby Maurice D. Schnell and Wilton H. Bunch28 I Psychological Adaptation to Amputationby John C. Racy689707
xixContents34D / Developmental Approach to PediatricUpper-Limb Prosthetic Training77929 / Critical Choices: The Art of ProsthesisPrescription717by John H. Bowkerby Joanna Grace Patton30 I Special Considerations-Rehabilitation Without721Prostheses: Functional Skills Trainingby Joan E. Edelstein35 / Lower-Limb Deficiencies79579535A I Surgical Managementby Leon M. KrugerPART V: THE CHILD AMPUTEE35B 1 Prosthetic and Orthotic Management835729by Daniel G. Oglesby, Jr., and Carmen Tablada31 I Introduction to the Child Amputee731by John R. Fisk32 I Acquired Amputations in Children735by Robert E. Tom36 I Special Considerations36A / The Multiple-Limb-DeficientChild839by Ernst Marquardt33 I The ISO/ISPO Classification of Congenital LimbDeficiency74336B / Van Nes Rotationplasty in TumorSurgeryby H.J.B. Day341 Upper-Limb Deficiencies34Al Surgical Management839885by J. Ivan Krajbich and Dietrich Bochmann74936C / Juvenile Amputees: Sports and RecreationProgram Development74934B/ Prosthetic and Orthotic Management761by Terry Supan34Cl Externally Powered Prosthesesby Francis J. Trost and Dan Rowe901by Carol J. Page and Duane G. Messnerby Terry R. Light767Zndex909
Consultant, Hugh Macmillian Rehabilitation Centre Toronto, Ontario, Canada JOHN H. BOWKER, M.D. Professor and Associate Chairman Department of Orthopaedics and Rehabilitation University of Miami School of Medicine Director, Amputee and Diabetic Foot Services Jackson Memorial Medical Center Miami, Florida CARL D. BRENNER, C.P.O.
