Abstract
The below-knee stump proves to be far superior to the stumps produced by above-knee amputation and even knee disarticulation. Therefore, the orthopaedic surgeon must make every effort to save the knee joint including the insertions of its extensor and flexor muscles. This is particularly important in vascular patients who all are candidates for bilateral leg amputation. Modem below-knee prostheses with total surface contact and without knee hinges or thigh corset have now been available for almost 20 years. The PTB-principle has been improved and now definitely offers much better function and cosmesis for the amputee. Late complications, particularly circulation problems can be avoided. Still, too many prosthetists prefer to fit their patients with conventional below-knee prostheses. This issue tries to encourage surgeons to prescribe and prosthetists to use this modern technique, the age of the steam engine also being over for at least a couple of years. Temporary and final fitting practices are presented with all the details useful to prevent failure.
Report on results with 1180 PTB prostheses. Over 90% of new amputees and 75% of old amputees are fitted with this modified type of PTB below-knee prosthesis. Details of construction and results even in extremely short or long stumps are discussed.
Temporary prostheses with sockets made from low pressure polyethylene give excellent results in early and even final fitting of amputees. The material is easy to handle and can be combined with polyethylene closed-cell foam products. Cosmesis, comfort and weight are most acceptable compared to other types of temporary sockets.
A method of temporary prosthetic fitting of below-knee amputees is presented. It permits constant supervision of the wound, total immobilisation of the stump, easy adaptation to changes of volume and early gait training. The prosthesis is light-weight and easy to handle. 17 patients have been fitted so far.
Early fitting of below-knee amputees is particularly difficult if stump conditions are not ideal. The paper presents a temporary prosthesis which provides total contact and full stability and thus accelerates stump maturation.