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1407 E. Michigan Ave., Jackson 517-784-1142 770 Riverside Ave., Suite 101, Adrian 517-263-3310
CHAPTER VIII - Thigh Or Femoral Stumps
DEFINITIONS. - Thigh or femoral stumps are those that reach to any point above the knee joint; they are designed upper-, middle-, or lower-third thigh stumps, according to their lengths, in relation to the three divisions of the thigh.

LONG OR LOWER-THIRD STUMPS. - When a stump reaches to a point in the region of the lower third, it is commonly termed a long thigh stump, a few of which are illustrated in Cuts H 1 to H 4.

Artificial legs suitable for such are illustrated in Cuts H 5 and H 6.

In cases of long and flabby stumps the number G 7 leg, see page 82, can be applied to advantage.

STUMPS OUT OF LINE. - Persons walking on crutches for a considerable length of time permit their stumps to incline forward. The flexors in the groin become contracted and the extensors yield to the influence, and the stump assuming the position, when hanging at ease, of that shown in Cut H 1, and occasionally that shown in Cut H 3. This condition should not cause anxiety on the part of the wearer, as it can be controlled and corrected by a suitably attached artificial leg.

CONSTRUCTION OF LEGS. - The thigh and leg sections of H 5 are constructed of wood of choice character. The socket is hollowed out to receive the stump properly, and to receive the weight of the wearer where it can be tolerated.

The outside dimensions both above and below the knee are dressed down to the curves and dimensions of the natural leg as far as conditions will admit. The lower part excavated to minimize weight, both sections are covered with rawhide and enameled, the foot is of sponge rubber with spring mattress as heretofore described. The manner in which the knee joint is constructed is substantially the same as shown in Cut F 6, and described on page 74.

VARIETY OF MIDDLE-THIRD THIGH STUMPS. - Thigh amputations through or above the middle thirds produce stumps that admit of the simplest form of knee-joint mechanism, called the T joint, explained further on.

Cut H 7 to H 14 show thigh stumps of a variety of lengths with flaps and cicatrices of many characters.

END AND NON-END-BEARING. - As a rule thigh stumps are incapable of taking weight on their extremities, and as there is but little advantage in putting pressure on that point, and as the risk of doing so is very great, we rarely consent to construct limbs in that way and only do so when we are positive that the ends of the stumps will not be injured. Cut H 15 shows the usual type of artificial leg for a thigh stump. The thigh and leg sections are made of tough, light, bass or willow wood, shaped to the size and contours of the natural leg so far as conditions will permit. The thigh is excavated to receive the stump in the best way, permitting pressure only at admissible places. The end of the stump, together with a few inches of the thigh, are, as a rule, required to hang in space, all the weight being applied to the upper borders of the thigh socket and along the sides of the stump immediately adjacent to the body. When weight can be prudently applied to the end a cushion is provided for that purpose. The lower section of the leg is excavated to reduce weight. The whole is covered with rawhide and elegantly finished with a flesh-tinted enamel.

A rubber foot with spring mattress as heretofore described, is properly attached at the ankle. Cut H 16 represents the rear view showing the knee mechanism with parts together, and Cut H 17 represents the working parts of the knee separated. Cut H 18 shows the T joint, the spring, and their connections; a is the T joint which is secured to the knee block located at the lower end of the stump socket. The two arms work in journals made in the leg section; bb are the cap screws that hold the T joint to its place; cc the caps; d the spring piston; e the spiral spring; f the cylinder; g spring cover, and parts of the spring together; iii represent the steel screws used to hold the T joint firmly to thigh. The joint a has the shape of an inverted T, hence its name, T joint. It is made of gun metal forged from one piece, turned, drilled, and finished on the lathe. When the leg and thigh sections are placed together the arms of the T joint rest in boxes and are held by two hardwood caps, cc, which are secured by long steel screws, bb, which depend for their security on steel nuts, imbedded in the front part of the leg.

THOROUGH CONTROL. - The wearer has thorough command over this joint; the pressure of the caps on the joints can be regulated by the screws, and thus any desired tension on the articulation be made.

KNEE SPRING. - The small steel lever with ball on the end, projecting from the back of the joint, operates in the cavity of the hardwood piston d; the piston is inserted in one end of the steel spring, e, which has its lower part encased with leather g, and then placed in a drawn metal cylinder f. The lower convexed end of the cylinder is received on a bridge placed in the interior of the leg in the region of the calf.

HELPS KNEE MOTION WHEN WALKING. - The operation of the spring is twofold; it urges the lower leg forward in walking, and holds it at full flexion when sitting. This is done in the following manner: When the leg is extended, the point at which the spring pressure is applied is on the end of a steel lever projecting an inch back of the center of motion in the knee. This urges further extension, as shown in Cut H 19, the lever revolves with the joint; and when the leg is partly flexed, as shown in Cut H 20, it has been carried to a neutral point where the spring neither urges flexion nor extension; but when the knee is further flexed, as shown in Cut H 21, the lever has passed forward of the neutral line and the spring forces the ball upward, urging greater flexion; and when the flexion is at its limit the leg is kept in that position by the spring. Thus the objection to the usual spring knee articulation is removed, that of the tendency of the leg to fly out when the wearer is sitting and unguarded.

SPRING STRENGTH CAN BE REGULATED. - The power of the spring in the knee can be increased or diminished. If it is desired to increase it, a little packing can be tamped in the cylinder, or a longer spring can be substituted, and if it is desired to diminish it, a coil or two of the spring can be cut off or a shorter one substituted. If the wearer does not want the spring he can take it out and discard it. When the leg is together and in working order, the knee movement is arrested by the striking of the vertical shaft of the T joint against a pad placed in the knee, which can be increased or diminished by the wearer, and the range of articulation in the knee made less or greater, as may be desired.

The center of motion of this knee is placed considerably back of the center of gravity of the leg in order to secure the knee against treacherous bending.

KNEE LOCK. - The knee lock is a device placed in the knees of artificial legs to keep them from flexing, or from flexing beyond a fixed limit. When the wearer wishes to sit the knee can readily be unlocked. It is not very often that knee locks are required, therefore they are only placed in artificial limbs when conditions demand.

Cut H 22 shows an artificial leg with knee lock for thigh stump; a is a sliding bar that can be moved upwardly or downwardly. When down the leg is incapable of moving at the knee, or is permitted to move only through a limited angle, as shown in Cut H 23. When the sliding bar is pulled up, the lock is out of action, and the knee can be bent at right ankles as represented in Cut H 24.

This device is found to be of value to those who have short, weak, or deflected stumps, and is also used to advantage by equestrians. We have a patron, a baptist clergyman, who finds the knee lock indispensable when performing the rites of immersion; because of the buoyancy of the lower leg the knee without the lock would flex the moment he enters the baptismal font. Knee locks are used to advantage by persons who are required to walk through obstructions, such as underbrush, heavy grass, snow, etc.; without the locks these obstructions are likely to flex the knees inopportunely. Hip joints and waist belts are occasionally attached to the thighs of these legs.

HIP JOINTS. - The knee lock, hip joint, and waist belt can be combined to advantage in legs applied to stumps that are deflected, abducted, or that in any way incline out of the normal lines. The knee lock places the knee beyond the influence of the partly flexed stump, and the hip joint places the leg beyond the influence of the abducted stump. As these auxiliary parts complicate the construction of the leg, add weight, and more or less hamper graceful and natural walking, it is not considered desirable to add them unless the conditions of the stump or the occupation of the wearer demand.

WATERPROOF AND BATHING LEGS. - Persons wearing artificial legs on thigh stumps frequently find it desirable to use their artificial legs while they are bathing or swimming in salt or fresh water. It is embarrassing to those who have but one leg to be viewed with curiosity while hopping or walking with crutches or hitching on hands and knees on the shore. This embarrassment often prevents them from indulging in the exhilarating and health-giving river, lake, or ocean bath.

An artificial leg especially designed for swimming and bathing purposes is constructed practically the same as those heretofore described, differing only in the fact that they are absolutely waterproof, the knee to articulate or not, as the wearer may elect. As the wearing parts of waterproof legs are made of composition instead of steel, they are not as durable as those made for ordinary purposes; they are therefore only made when especially ordered.

LEGS WITHOUT KNEE JOINTS. - We have on a number of occasions been required to construct artificial legs for thigh stumps without knee joints. Cut H 25 shows an artificial leg of this type. The entire structure, including the foot core, is carved from a single piece of wood, slightly curved at the knee so as to represent the natural leg when partly flexed, for better accommodation when sitting. The foot is of rubber with spring mattress as described. The leg is covered in the usual way and enameled or waterproofed if it is to be used in watery places.

PEG LEGS. - Peg legs are occasionally used on thigh stumps. They are practically artificial legs without feet. As already stated we do not advocate the use of peg legs, as they are of limited efficiency. The foot is a very important part of an artificial leg. It assists in balancing, aids in walking, and restores the appearance.

Years ago before artificial legs with rubber feet and spring mattresses were so generally used, the peg leg was more in evidence, but lately it is worn more as a means of disciplining the stump or as a makeshift to bridge an impecunious period.

Persons are able to stand, stump about, and perform a limited amount of labor on peg legs, which are unquestionably better than crutches, but their restoration is not complete until they are wearing artificial legs with spring mattress rubber feet. Cut H 26 shows a peg leg for a thigh stump. It is made of suitable wood, excavated to receive the stump and reduce weight. The outside has the contours of nature as closely as the conditions will admit, the end terminating in a metal ferrule and rubber tip, as illustrated on page 71, Cuts E 57-58-59. Cut H 27 shows a peg leg with knee joint, for a thigh stump. It is constructed in all parts the same as H 15, heretofore described. The absence of the foot and the substitution of a rubber tip is the only difference.

SUSPENDERS. - Suspenders suitable for legs for thigh amputations, as well as for amputations in the knee joint are of various kinds to suit the habits and demands of the wearers. The style of suspender which is most generally adopted is that illustrated in Cut H 28, termed the roller suspender.

While it has excellent features it has limited application. It can be used to advantage on stumps reaching to any point from the middle of the thigh to the knee, but for shorter stumps and for hip-joint amputations a method that will hold the limb to the body more firmly is necessary. The roller suspender is the product of many experiments and years of experience, assisted by the kindly suggestions of our patrons.

The shoulder straps are usually of two-inch non-elastic webbing. A strip of webbing is attached to the right strap, and forms a loop through which the left strap passes. A piece of webbing stitched to the back of both straps holds them together. The front lower ends of the shoulder straps are received into buckles, and the back lower ends are terminated by snaps; each hooks into the ends of the leather roller cords which pass around rollers attached to either side of the leg. Any degree of pressure upon the shoulders can be obtained by means of the clamp buckles, and when obtained, the buckles are clamped and are never disturbed, unless the pressure on the shoulders needs further adjustment. When it is desired to remove the limb, the suspenders are detached by unsnapping both front and back.

Cut H 29 shows a front view of a person wearing a pair of roller suspenders.

Cut H 30 gives the back view, and Cuts H 31, H 32, and H 33 side views.

These cuts show the relative positions of the rollers, as well as the effect of the loops in holding the shoulder straps in place and in directing the leg. Elasticity is obtained by two pieces of elastic webbing attached to the backs of the shoulder straps a little below the shoulder blades.

The operation of the suspenders is illustrated in Cuts H 29-30-31-32-33. All the traveling of the suspenders due to changes of position takes place about the rollers on the sides of the thigh, instead of on the shoulders of the wearer, whether the person is standing, stooping, walking, or sitting.

STRAIGHT SHOULDER STRAPS. - Cut H 34 shows a style of suspender especially adapted to an artificial leg for a short thigh stump. It is the style very generally used before roller suspenders were devised. The shoulder straps are of fine elastic webbing, 2 inches wide.

The front straps are of two-inch non-elastic webbing; each front strap passes through a metal link attached to the lower end of the elastic shoulder strap. After passing through the metal link the front straps are received into a two-prong buckle. The suspenders are attached to the leg by means of leather tags and metal Dís screwed to the back and front. The metal D admits of side motion, thereby insuring direct pull.

BELT ATTACHMENT. - Cut H 35 represents a belt and suspender combined. The shoulder straps and belt are preferably of non-elastic webbing. The straps running from the belt to the leg are made of elastic webbing, 2 inches wide or less, as the case may demand.

VEST METHOD. - Cut H 36 illustrates the vest method. It is made of strong muslin, fitted to the person and worn under the shirt. Elastic straps are attached to the lower border and buckled into straps that are secured to the leg. In order to obtain the best results, the vest must be made and fitted by a tailor. Persons who desire to have their artificial limbs constructed from measurements, and choose the vest suspender, are required to have vests made at home, and if sent to us, we will attach the straps and make the proper connections with the leg without additional charge.

SUSPENDERS FOR WOMEN. - For obvious reasons the means of suspending artificial limbs to women differ from those employed with men. When shoulder straps are used they must pass over the shoulders and not press upon the breasts. Yokes, girths, or bands must pass around the waists so as to place the burden all or in part on the hips.

YOKE METHOD. - Cut H 37 shows a combination of the roller straps with the yoke; rollers or pulleys are secured to the sides of the thigh, and leather cords pass around them. The yoke is made to fit the loins and hips, adjustable by lacing in front or on the sides, as may be preferred; the shoulder and roller straps are also adjustable, so as to bring the proportionate weight about the shoulders and hips without displacing the yoke.

CORSET METHOD. - As many women pride themselves on their trim waists and neat-fitting garments, it is especially desirable that means of leg suspension should be light and neat. Straps securely sewed to the corset, extending downward and connected with the artificial limb, admit of the neatest adjustment. Cut H 38 shows the corset method, which can be easily adjusted by the wearer.

Comment from follow-up survey
I would very much recommend any one to you.