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Upper Extremity Amputations

- See:
      - Amputation of the Finger and Hand:
      - Above-Elbow Amputation
      - Below-Elbow Amputation
      - Upper Extremity Prosthetics:
      - Wrist Disarticulations

- General Considerations:
    - Disability:
         - loss of one upper extremity   = 50%
         - loss of one hand                     = 45%
         - thumb amputations                 = 23% (50% of one hand)

- Complications:
neuroma formation:
        - A new operation for the prevention and treatment of amputation neuromas.

- Considerations w/ Brachial Plexus Injuries:
    - w/ fully flail arm, w/o scapulothoracic control, is a candidate for AE amputation;
    - this disencumbers the patient and the reduction of wt reduces the subluxation of the shoulder;
    - w/ one normal arm, the patient will not use a 2 joint AE prosthesis, therefore recommend shoulder fusion, with pectoral muscle transfer to control elbow and BE amputation;
    - there must be scapulothoracic control, not a completely flail extremity;
    - if remaining arm is the dominant arm, and the invovled arm has no scapulo-thoracic contnrol, the patient is not likely to use any prosthesis;
          - AE amputataion relieves shoulder distraction;
          - fusion is pointless if there will be no forward hand placement;

- Upper Extremity Amputations in Children:
    - most children with shoulder level or above-elbow amputations function very well w/o a prosthesis if they have normal contralateral upper extremity;
    - transverse absences of forearm:
         - usually do not mandate excision of nubbins for prosthetic fit;
         - bilateral amputees may be candidates for Krukenberg procedure, where radius & ulna are separated to serve as pincers;
    - children with a below elbow amputation may or may not choose to wear a prosthesis;
         - it used to be taught that early fit of a passive mitten or hand at 6 months of age would encourage integration of the prosthesis into activities of
               daily living, however, this is not seen clinically;
         - these children may note that the prosthesis may be hot and sweaty in the summer and have a negative effect on proprioception;
    - at approximately 2 years of age, a functional terminal device can be added if it is requested by the child or parent

Myoelectric prostheses. A long-term follow-up and a study of the use of alternate prostheses.

The surgery of arm and forearm amputations.  

A new approach to the use of the Krukenberg procedure in unilateral wrist amputations. An original functional-cosmetic prosthesis.

Upper limb amputations and prostheses.

The rational selection of treatment for upper extremity amputations.    

Grabbing Gracefully, With Replacement Fingers