Re: Optimal BK stump length
bradley wheaton
Description
Collection
Title:
Re: Optimal BK stump length
Creator:
bradley wheaton
Date:
1/30/1999
Text:
Hey everyone,
Chris makes an excellent point. Thank god text books or lenghth limits were
not used in my case! I'm 39, recently became a BKA this past May due to a
traumatic injury. I have only 3 inches of bone below the knee and 2 inches
of muscle and tissue which serve somewhat of a cushion below that. My stump
is 90% skin grafted. Luckily for me my attending surgeon disagreed with
the panel who thought best to take my knee, their concern being lack of
lenghth. Your not going to amputate a perfectly good knee joint to
replace it with an artificial one. he told his colleges with stern
determination. The words of a true Othepedic Surgeon.
I've been wearing a prothethis for about 4 months now. Litteraly a virgin,
but I have some excellent prosthetic components. I walk very comfortably
with a slight limp, (working on that) and I wear the prosthesis all day.
I'll admit that i wish I had better flexibility of my knee (liner and Socket
restricts some knee movement), but I would never consider going above the
knee. I'll work with what I have, and make the best of it. It can be done,
and each case should be considered on an individual basis, not by a text
books rule of thumb!!!
Bradley
-----Original Message-----
From: Chris L Johnson < <Email Address Redacted> >
To: <Email Address Redacted> < <Email Address Redacted> >
Date: Saturday, January 30, 1999 10:30 AM
Subject: Re: Optimal BK stump length
>On Fri, 29 Jan 1999 16:42:38 -0600 Greg Penfold < <Email Address Redacted> > writes:
>>We are having a discussion with a local surgeon regarding the optimal
>>length for BK amputation. Although most sources recommend a 12cm to 17cm
>or
>>5 to 7 bone length from the medial joint line, he has a manual which
>>recommends an 18cm to 20cm length. I believe his source is the
>University of
>>Texas. Does anyone know of any published studies or textbooks which
>analyze
>>the pros and cons of different length stumps?
>>
>>Greg Penfold CPO
>
>I have some direct experience with limb length and some general comments.
> Most of you probably already know this, so please pardon me if I'm
>preaching to the choir. Nevertheless, having been burned by text book
>simple surgery more than once, I felt I had to say something.
>
>My initial amputation was long at 30cm. This failed due to poor
>management of soft tissue (unviable skin grafts and poor techniques), and
>the fact that there remained so little soft tissue that there was poor
>bone coverage. I was then revised to 18cm with again, poor results, this
>time due to poor management of both soft and hard tissues. Another
>revision brought me to about 17cm, this time by Ernest Burgess of the
>Seattle area. His was a good job for sure, but I wish I had had an Ertle
>procedure wherein the bone bridge was formed between tibia and fibula.
>Alas, water under the bridge. I still cannot end bear much, but at least
>I wasn't hacked.
>
>Length is important because too little length limits the force an amputee
>can impart to the socket via the distal end and more proximal anterior
>and posterior surfaces. This is particularly true as regards the force
>resulting from extension moment...when the quad muscles push the lower
>leg into extension or resist flexion. The 5-7 recommendation is there
>because it provides generally adequate clearance for prosthetic
>components, and allows adequate lever arm length to do the above.
>
>Length should not be viewed from a text-book simple perspective but
>should consider a wide number of factors such as but not limited to
>viability of the anatomy and limitation of prosthetic components.
>
>If great lengths are made to save a couple of inches through skin grafts,
>for example, yet the skin turns out to be a mess later, why not amputate
>a bit higher if there is still reasonable lever length? If the nerves
>are really messed up, you're asking for a pain history. If the bone is
>raggedy, perhaps spurs will be the rule, as was with me. If the leg is
>really short to begin with, perhaps going for a bit more length is worth
>the risk.
>
>By leaving a leg really long, if the vast majority of components can no
>longer be used is it worth it?
>
>Leg length should not be a function of the surgeons ego, for example,
>when driven by the mentality that amputation is death and not
>rehabilitation. I have been victim to both that and hack and whack
>surgery due to inadequate training (amputation as just something minor
>else to learn in med school).
>
>I am 189cm tall (6 ft+) and have that 17cm BK. I have definable quad
>muscles, in part due to length and a great socket fit and a great
>interface (9mm Alpha). Would I be better off at 19 or 20 cm? Probably
>yes, if I had adequate soft tissue coverage and bone bridge surgery for
>more end bearing capability. The original surgeon shaved off a good deal
>of my muscle because it was recommended by a text book. This leaves me
>with too little material at the end, after atrophy is considered.
>
>This is rambling and incomplete, but the point is, limb length is not a
>text book issue but is rather much more complex.
>
>Chris Johnson, Engineering Director,
>College Park Industries, Inc.
> <Email Address Redacted>
>www.college-park.com
Chris makes an excellent point. Thank god text books or lenghth limits were
not used in my case! I'm 39, recently became a BKA this past May due to a
traumatic injury. I have only 3 inches of bone below the knee and 2 inches
of muscle and tissue which serve somewhat of a cushion below that. My stump
is 90% skin grafted. Luckily for me my attending surgeon disagreed with
the panel who thought best to take my knee, their concern being lack of
lenghth. Your not going to amputate a perfectly good knee joint to
replace it with an artificial one. he told his colleges with stern
determination. The words of a true Othepedic Surgeon.
I've been wearing a prothethis for about 4 months now. Litteraly a virgin,
but I have some excellent prosthetic components. I walk very comfortably
with a slight limp, (working on that) and I wear the prosthesis all day.
I'll admit that i wish I had better flexibility of my knee (liner and Socket
restricts some knee movement), but I would never consider going above the
knee. I'll work with what I have, and make the best of it. It can be done,
and each case should be considered on an individual basis, not by a text
books rule of thumb!!!
Bradley
-----Original Message-----
From: Chris L Johnson < <Email Address Redacted> >
To: <Email Address Redacted> < <Email Address Redacted> >
Date: Saturday, January 30, 1999 10:30 AM
Subject: Re: Optimal BK stump length
>On Fri, 29 Jan 1999 16:42:38 -0600 Greg Penfold < <Email Address Redacted> > writes:
>>We are having a discussion with a local surgeon regarding the optimal
>>length for BK amputation. Although most sources recommend a 12cm to 17cm
>or
>>5 to 7 bone length from the medial joint line, he has a manual which
>>recommends an 18cm to 20cm length. I believe his source is the
>University of
>>Texas. Does anyone know of any published studies or textbooks which
>analyze
>>the pros and cons of different length stumps?
>>
>>Greg Penfold CPO
>
>I have some direct experience with limb length and some general comments.
> Most of you probably already know this, so please pardon me if I'm
>preaching to the choir. Nevertheless, having been burned by text book
>simple surgery more than once, I felt I had to say something.
>
>My initial amputation was long at 30cm. This failed due to poor
>management of soft tissue (unviable skin grafts and poor techniques), and
>the fact that there remained so little soft tissue that there was poor
>bone coverage. I was then revised to 18cm with again, poor results, this
>time due to poor management of both soft and hard tissues. Another
>revision brought me to about 17cm, this time by Ernest Burgess of the
>Seattle area. His was a good job for sure, but I wish I had had an Ertle
>procedure wherein the bone bridge was formed between tibia and fibula.
>Alas, water under the bridge. I still cannot end bear much, but at least
>I wasn't hacked.
>
>Length is important because too little length limits the force an amputee
>can impart to the socket via the distal end and more proximal anterior
>and posterior surfaces. This is particularly true as regards the force
>resulting from extension moment...when the quad muscles push the lower
>leg into extension or resist flexion. The 5-7 recommendation is there
>because it provides generally adequate clearance for prosthetic
>components, and allows adequate lever arm length to do the above.
>
>Length should not be viewed from a text-book simple perspective but
>should consider a wide number of factors such as but not limited to
>viability of the anatomy and limitation of prosthetic components.
>
>If great lengths are made to save a couple of inches through skin grafts,
>for example, yet the skin turns out to be a mess later, why not amputate
>a bit higher if there is still reasonable lever length? If the nerves
>are really messed up, you're asking for a pain history. If the bone is
>raggedy, perhaps spurs will be the rule, as was with me. If the leg is
>really short to begin with, perhaps going for a bit more length is worth
>the risk.
>
>By leaving a leg really long, if the vast majority of components can no
>longer be used is it worth it?
>
>Leg length should not be a function of the surgeons ego, for example,
>when driven by the mentality that amputation is death and not
>rehabilitation. I have been victim to both that and hack and whack
>surgery due to inadequate training (amputation as just something minor
>else to learn in med school).
>
>I am 189cm tall (6 ft+) and have that 17cm BK. I have definable quad
>muscles, in part due to length and a great socket fit and a great
>interface (9mm Alpha). Would I be better off at 19 or 20 cm? Probably
>yes, if I had adequate soft tissue coverage and bone bridge surgery for
>more end bearing capability. The original surgeon shaved off a good deal
>of my muscle because it was recommended by a text book. This leaves me
>with too little material at the end, after atrophy is considered.
>
>This is rambling and incomplete, but the point is, limb length is not a
>text book issue but is rather much more complex.
>
>Chris Johnson, Engineering Director,
>College Park Industries, Inc.
> <Email Address Redacted>
>www.college-park.com
Citation
bradley wheaton, “Re: Optimal BK stump length,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/211147.
