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1407 E. Michigan Ave., Jackson 517-784-1142 770 Riverside Ave., Suite 101, Adrian 517-263-3310
CHAPTER VII - Disarticulated Knee Stumps
END-BEARING AND NON-END-BEARING STUMPS. - Amputations through the articulations of the knees call for careful prothetical consideration. Stumps resulting from such amputations may be end-bearing or not; when they are covered with tissue flaps, free from cicatrices and nervous complications, they are end-bearing; if they are cicatrized, and sensitive, pressure must be applied elsewhere; if they are tapering to the ends or are broadened at the extremities they must be treated accordingly. The presence of the patella, securely united in the intercondylar space, will improve the character of the stump, but if it is not united it is doubtful if the end will tolerate any weight whatever.

FITTINGS. - Artificial legs for knee-joint amputations must admit of placing pressure only on parts capable of enduring it. Tender, delicate, sensitive, and irritable spots must be guarded, and non-end-bearing stumps must be provided with limbs that will take the weight at the ischial and perineal regions; if the sides of the stumps are sloping a share of the weight can be distributed over those parts. Sensitive condyles, bony prominences, and fascia must be properly cared for.

PECULIARITIES OF STUMPS. - Cut G 1 shows a type of stump resulting from knee-joint amputations; the nodulous extremity due to the presence of condyles, together with ample coverings, provide desirable conditions. An artificial leg suitable for this stump is so fitted that the weight is carried on the end, which rests on a padded surface at the lower end of the socket, and held securely in place by the leather lacing. The shoulder suspension is greatly simplified when condyles are present in the stump. Cut G 2 shows a side view of a stump favorable for end pressure.

Cut G 3 shows a stump reaching to the knee, patella present and without cicatrices, thus admitting of end pressure.

Cut G 4 shows a thigh stump reaching to the knee and extremely well protected, with cicatrices at the rear and well away from the end; bunches of sensitive tissue hanging from the extremity prevent the application of weight at that point. Cut G 5 shows a thigh stump reaching to the knee with an end incapable of bearing pressure; the condyles and all the natural coverings of the bone were removed in the operation. Bunches of tissue and ganglia were gathered at the end back of the stump. The muscle tissue puckered considerably and the presence of cicatrices on and about the end prevents the application of weight there. Cut G 6 shows a stump reaching to the knee, condyles present, the extremity covered with integumentary folds, deep fissures and cicatrices, preventing the application of weight upon the extremity.

MOST FAVORABLE CONDITIONS. - These examples develop the following points: Stumps extending to the knee with nodulous extremities, capable of bearing weight, are the most favorable of all knee-joint stumps. They result from amputations through the knee articulations, the condyles remaining untrimmed, or, if trimmed, the ends protected by bone and muscle flaps; the natural coverings to the bones permitted to remain on the articulating surfaces; the patellas, if present, firmly united to the end of the femur; flaps well carried to the posterior and the cicatrices some distance from the ends. Stumps possessing these favorable conditions can be efficiently accommodated with artificial legs that will minimize the pressure about their upper borders and simplify the mode of suspension.

A stump reaching to the knee, with a nodulous extremity and incapable of bearing weight on the end, is capable of operating an artificial leg, but the means of attachment are necessarily more extensive and more severe than when the weight can be borne on the ends.

Inability to bear weight on the extremities of knee-joint stumps is not always due to surgery.

Sloughing, bone degeneration, hyperęthesia, etc., frequently occur despite the most careful precautions of the operator.

SUITABLE ARTIFICIAL LEGS. - The foregoing cuts illustrate stumps that can be advantageously fitted with artificial legs constructed upon plans of those shown in Cuts G 7 or G 8, according as the stump is tapering or straight, or whether the end can endure weight or not. The thigh of either leg is made partly of wood and partly of leather. The rear section is of wood, excavated to receive the stump in the most comfortable way. The front portion is of leather arranged for lacing as shown. If the stump is tapering to the end there will be no advantage in having the front laced, the entire socket can be better constructed of wood.

Cut G 7 illustrates a leg made to place a large amount of the weight of the wearer directly on the extremity of the stump. Cut G 8 shows a leg with annular top designed to hold the end of the stump away from the bottom of the socket, all the weight being distributed over the sides, above the knees and about the top borders of the socket. In both these styles every requirement for the comfort of the wearer and the efficiency of the leg is considered.

The stump socket of either leg is of proper size and shaped to receive the stump and carry the weight of the wearer.

Both upper and lower sections are made of selected kiln-dried wood, carved to the shape of the stump with external proportions as near those of the natural leg as the conditions will admit. The lower leg is excavated to reduce weight. The foot is of rubber as heretofore described, and both leg and thigh are covered with suitable material properly enameled. The knee mechanism is the same as that illustrated in Cuts F 6 and F 7.

Suspenders for legs for knee-joint amputations are the same as those applied to thigh amputations, and are fully treated in the following chapter.

We point with pride to many thousand persons who walk on artificial legs of either the above type with efficiency and naturalness and who voluntarily bear witness to the excellence of the manner in which they have been fitted out, and their increased capabilities to perform their full share of work.

Comment from follow-up survey
I am able to go walking now without any pain. I appreciate how you worked with my Medicaid on this for me. Thank you so much. They feel good on my feet.