DGAFMS MEMORANDUM NO (165)
ARTIFICIAL LIMBS
Introduction:
1. Although many consider amputation to be the ultimate surgical failure, in
actuality, it is a well planned and executed reconstructive procedure. It is aimed at
removal of a painful dysfunctional limb (or limb segment) and fashioning of a sensate
‘end organ’ i.e. stump, for fitting of a prosthesis (artificial limb), leading to a functional
and pain-free rehabilitative outcome.
2. Amputation not only causes physical disablement but also leads to
psychological, social and economic handicap which can be overcome to some extent by
provision of an Artificial Limbs. A successful rehabilitation programme for amputees
consists of the following stages: -
Stages of rehabilitation :-
• Pre-amputation counselling
• Amputation Surgery
• Post amputation care
• Psychotherapy
• Pre-prosthetic training
• Prosthetic fitting
• Training with prosthesis
• Vocational training
• Reintegration in community
• Periodic follow up
Provision of prosthesis or artificial limb is an important and vital step in the overall
rehabilitation of the amputee.
History
3. Amputation is one of the oldest problems of the mankind. In 1975 Smithsonian
Scientists found a skeletal of a caveman, in Iraq and testified that the caveman had
Above Elbow Amputation 45,000 years ago. Therefore it can be said that problem of
amputation is as old as the mankind itself. Artificial limb of some kind like a forked-
stick must have been in use since the dawn of mankind. Rig Veda mentions of a female
warrior, who having lost her foot in a battle was fitted with a prosthetic foot by the
celestial twin-physicians. Earliest mention of artificial limb in literature is by Herodotus
(484 BC) who described a Persian soldier Hegosistratus using an artificial foot.
Artificial limbs were also known to be in use in the medieval Europe. However it was
Ambroise Pare who laid the true scientific basis of amputation and prosthesis during
the Napoleonic era. Armed conflicts and warfare periodically infused fresh impetus to
this science particularly post World War I & World War II. It can be said that Armed
Forces throughout the world contributed not only to the increase in amputee population
but also in improving their rehabilitation care. In India too, Artificial Limb Centre,
Pune is the pioneer in this discipline, working since 1944, an era when concepts of
medical rehabilitation was non-existent in the rest of the country.
Definition
4. Prosthesis may be defined as ‘ a man made device used to compensate for an
anatomical loss’. It may be internal like IOL, Prosthetic Heart Valve, Prosthetic Hip
1
, Joint etc. or external i.e. worn outside the body like Spectacles (for aphakic eye) or a
Denture. An externally applied device to replace a limb or limbs segment is called an
artificial limbs (WHO).
5. Artificial limbs are of two types namely Exoskeletal (Crustacean) and
Endoskeletal (modular). In the former the shape as well as the weight transmission is
the through the walls of the prosthesis and hence has a hard rigid shell. In the later the
weight is transmitted through a central shaft, which is covered externally by a cosmetic
covering.
Nomenclature
6. The nomenclatures of artificial limb are similar to that of the level of
amputation. Previously the amputations were named in relation to the major joint in
the vicinity (e.g. above knee amputation, below elbow amputation etc). Now a days the
level of amputation is named in relation to the major bone through which amputation
has taken place (e.g. trans-femoral, trans-tibial, trans-humeral, trans-radial). If an
amputation is done through the joint it is called disarticulation (e.g. shoulder
disarticulation, knee disatriculation). Consequently the nomenclature of artificial limb
have also changed from former to latter i.e. below knee prosthesis is now called trans-
tibial prosthesis and so on. The use of names of individuals are not encouraged with the
exception of Syme’s and Chopart’s amputation as they have made a place for
themselves due to their uniqueness and popularity. Other amputations, which go by the
individual’s names like Gritti-Stroke’s, Boyde’s, Pyrogoff’s etc, are not accepted any
longer. Thus the various levels of amputations and their corresponding prostheses are
as follows: -
UPPER LIMB
AMPUTATION PROSTHESIS
Fore Quarter Amputation Shoulder Disarticulation prosthesis
Shoulder Disarticulation
Trans-humeral Amputation Trans-humeral prosthesis
Elbow Disartriculation Elbow Disartriculation prosthesis
Trans-radial Amputation Trans-radial prosthesis
Wrist Disarticulation Wrist Disarticulation prosthesis
Partially mutilated hand (PMH) Partially mutilated hand (PMH) prosthesis
LOWER LIMB
AMPUTATION PROSTHESIS
Hind Quarter Amputation Hip Disarticulation prosthesis
Hip Disarticulation Hip Disarticulation proshesis
Trans-Femoral Amputation Trans-Femoral prosthesis
Knee Disartriculation Knee Disartriculation prosthesis
Trans-tibial Amputation Trans-tibial prosthesis
Syme’s Amputation Syme’s prosthesis
Trans-metatarsal(Chopart’s) Amp. Surgical footwear
Partially mutilated foot (PMF) -do-
2
ARTIFICIAL LIMBS
Introduction:
1. Although many consider amputation to be the ultimate surgical failure, in
actuality, it is a well planned and executed reconstructive procedure. It is aimed at
removal of a painful dysfunctional limb (or limb segment) and fashioning of a sensate
‘end organ’ i.e. stump, for fitting of a prosthesis (artificial limb), leading to a functional
and pain-free rehabilitative outcome.
2. Amputation not only causes physical disablement but also leads to
psychological, social and economic handicap which can be overcome to some extent by
provision of an Artificial Limbs. A successful rehabilitation programme for amputees
consists of the following stages: -
Stages of rehabilitation :-
• Pre-amputation counselling
• Amputation Surgery
• Post amputation care
• Psychotherapy
• Pre-prosthetic training
• Prosthetic fitting
• Training with prosthesis
• Vocational training
• Reintegration in community
• Periodic follow up
Provision of prosthesis or artificial limb is an important and vital step in the overall
rehabilitation of the amputee.
History
3. Amputation is one of the oldest problems of the mankind. In 1975 Smithsonian
Scientists found a skeletal of a caveman, in Iraq and testified that the caveman had
Above Elbow Amputation 45,000 years ago. Therefore it can be said that problem of
amputation is as old as the mankind itself. Artificial limb of some kind like a forked-
stick must have been in use since the dawn of mankind. Rig Veda mentions of a female
warrior, who having lost her foot in a battle was fitted with a prosthetic foot by the
celestial twin-physicians. Earliest mention of artificial limb in literature is by Herodotus
(484 BC) who described a Persian soldier Hegosistratus using an artificial foot.
Artificial limbs were also known to be in use in the medieval Europe. However it was
Ambroise Pare who laid the true scientific basis of amputation and prosthesis during
the Napoleonic era. Armed conflicts and warfare periodically infused fresh impetus to
this science particularly post World War I & World War II. It can be said that Armed
Forces throughout the world contributed not only to the increase in amputee population
but also in improving their rehabilitation care. In India too, Artificial Limb Centre,
Pune is the pioneer in this discipline, working since 1944, an era when concepts of
medical rehabilitation was non-existent in the rest of the country.
Definition
4. Prosthesis may be defined as ‘ a man made device used to compensate for an
anatomical loss’. It may be internal like IOL, Prosthetic Heart Valve, Prosthetic Hip
1
, Joint etc. or external i.e. worn outside the body like Spectacles (for aphakic eye) or a
Denture. An externally applied device to replace a limb or limbs segment is called an
artificial limbs (WHO).
5. Artificial limbs are of two types namely Exoskeletal (Crustacean) and
Endoskeletal (modular). In the former the shape as well as the weight transmission is
the through the walls of the prosthesis and hence has a hard rigid shell. In the later the
weight is transmitted through a central shaft, which is covered externally by a cosmetic
covering.
Nomenclature
6. The nomenclatures of artificial limb are similar to that of the level of
amputation. Previously the amputations were named in relation to the major joint in
the vicinity (e.g. above knee amputation, below elbow amputation etc). Now a days the
level of amputation is named in relation to the major bone through which amputation
has taken place (e.g. trans-femoral, trans-tibial, trans-humeral, trans-radial). If an
amputation is done through the joint it is called disarticulation (e.g. shoulder
disarticulation, knee disatriculation). Consequently the nomenclature of artificial limb
have also changed from former to latter i.e. below knee prosthesis is now called trans-
tibial prosthesis and so on. The use of names of individuals are not encouraged with the
exception of Syme’s and Chopart’s amputation as they have made a place for
themselves due to their uniqueness and popularity. Other amputations, which go by the
individual’s names like Gritti-Stroke’s, Boyde’s, Pyrogoff’s etc, are not accepted any
longer. Thus the various levels of amputations and their corresponding prostheses are
as follows: -
UPPER LIMB
AMPUTATION PROSTHESIS
Fore Quarter Amputation Shoulder Disarticulation prosthesis
Shoulder Disarticulation
Trans-humeral Amputation Trans-humeral prosthesis
Elbow Disartriculation Elbow Disartriculation prosthesis
Trans-radial Amputation Trans-radial prosthesis
Wrist Disarticulation Wrist Disarticulation prosthesis
Partially mutilated hand (PMH) Partially mutilated hand (PMH) prosthesis
LOWER LIMB
AMPUTATION PROSTHESIS
Hind Quarter Amputation Hip Disarticulation prosthesis
Hip Disarticulation Hip Disarticulation proshesis
Trans-Femoral Amputation Trans-Femoral prosthesis
Knee Disartriculation Knee Disartriculation prosthesis
Trans-tibial Amputation Trans-tibial prosthesis
Syme’s Amputation Syme’s prosthesis
Trans-metatarsal(Chopart’s) Amp. Surgical footwear
Partially mutilated foot (PMF) -do-
2
