Introduction to Amputation and Traumatic Cases

Amputation Definition and Overview

• Amputation is the removal of a limb or body part, usually surgical.

Transtibial Amputation

• One of the challenges in a transtibial amputation is the need to balance the soft tissue and bony components to achieve a functional residual limb.
• The end of the residual limb remains exposed and sensitive despite reconstructive techniques.
• Soft tissue from the back and sides can be brought over the end of the residual limb to provide coverage.

Anatomy and Nerve Supply

• The tibial nerve supplies the deep group of muscles including popliteus, flexor digitorum longus, flexor hallucis longus, and tibialis posterior.
• The anterior tibial artery is one of the terminal branches of the popliteal artery.
• The main blood supply to the anterior fascial compartment in the lower leg is from the anterior tibial artery.

Surgical Techniques

• A bone graft can be used to build a bone bridge connecting the tibia and fibula in some surgical techniques.
• Reconstructive surgical techniques in transtibial amputation focus on restoring the function of the residual limb.

Amputation Types and Characteristics

• The preferred fascial compartment in transtibial amputations for providing padding is the anterior compartment.
• Forequarter amputation usually occurs when the tumor or infection is extensive and involves the scapula or proximal humerus.
• A 'long above elbow' amputation typically has a range of length of 15-20 cm.
• In a shoulder disarticulation amputation, the scapula remains mobile but with limited range of motion.
• BKA stands for Below Knee Amputation in the context of amputations.
• The peroneal nerve supplies the muscles in the lateral fascial compartment of the lower leg.

Ankle and Foot Complex

• The main blood supply to the posterior fascial compartment in the lower leg is from the posterior tibial artery.
• The talus bone serves as the proximal surface of the talocrural joint and bears 90% of the body’s weight.
• The main function of the ankle and foot complex during push-off is to transfer forces from the leg to the foot.
• The fibula bone forms an articulation with the condyle of the femur and the head of the fibula above and articulates with the talus and the distal end of the fibula below.
• The medial malleolus serves as an attachment site for the medial collateral ligament (MCL) and acts as an anatomic pulley for the flexors of the foot.
• The ankle and foot complex has 26 bones and 3 joints.
• The tibia bone serves as the primary weight-bearing bone in the leg.
• The fibula bone serves primarily as a site for muscle and ligamentous attachment in the leg.
• The calcaneus bone, also known as os calcis, bears the body's weight and transmits forces to the ground.
• The talus bone receives all of the body’s weight during single limb weight-bearing.
• The resting position of the distal tibiofibular joint is in a neutral position.
• The cuboid bone acts as a spacer between the navicular and bases of the three medial metatarsal bones and contributes to the transverse arch of the foot.
• The distal tibiofibular joint is commonly referred to as the syndesmosis.
• The cuboid bone serves as the anatomical pulley of the peroneals, articulating with the talus.
• The calcaneus bone serves as the attachment site for gastrocsoleus in the foot.
• The talus bone articulates above at the ankle joint, below with the calcaneus, and in front with the navicular joint.