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Surgical, Prosthetic, and Rehabilitation Principles

Fourth Edition

Volume 1

General Topics Upper Limb

Editors

Joseph Ivan Krajbich, MD Michael S. Pinzur, MD LTC Benjamin K. Potter, MD Phillip M. Stevens, MEd, CPO

Surgical, Prosthetic, and Rehabilitation Principles

Fourth Edition

Atlas of

Amputations and

Limb Deficiencies

Atlas of

Amputations and

Limb Deficiencies

Surgical, Prosthetic, and Rehabilitation Principles

Fourth Edition

Volume 1

General Topics

Upper Limb

Editors

Joseph Ivan Krajbich, MD

Michael S. Pinzur, MD

LTC Benjamin K. Potter, MD

Phillip M. Stevens, MEd, CPO

American Academy of Orthopaedic Surgeons Board of Directors, 2015-2016

David D. Teuscher, MD

President

Gerald R. Williams Jr, MD

First Vice President

William J. Maloney, MD

Second Vice President

Frederick M. Azar, MD

Treasurer

Frederick M. Azar, MD

Past President

Lisa K. Cannada, MD Howard R. Epps, MD Daniel C. Farber, MD Daniel K. Guy, MD Lawrence S. Halperin, MD David A. Halsey, MD David J. Mansﬁeld, MD Raj D. Rao, MD Brian G. Smith, MD Ken Sowards, MBA Jennifer M. Weiss, MD Karen L. Hackett, FACHE, CAE (ex-ofﬁcio)

The material presented in the fourth edition of the Atlas

of Amputations and Limb Deﬁciencies: Surgical, Prosthetic, and Rehabilitation Principles has been made available

by the American Academy of Orthopaedic Surgeons for educational purposes only. This material is not intended to present the only, or necessarily best, methods or procedures for the medical situations discussed, but rather is intended to represent an approach, view, statement, or opinion of the author(s) or producer(s), which may be helpful to others who face similar situations.

Some drugs or medical devices demonstrated in Academy courses or described in Academy print or electronic publications have not been cleared by the Food and Drug Administration (FDA) or have been cleared for speciﬁc uses only. The FDA has stated that it is the responsibility of the physician to determine the FDA clearance status of each drug or device he or she wishes to use in clinical practice.

Furthermore, any statements about commercial products are solely the opinion(s) of the author(s) and do not represent an Academy endorsement or evaluation of these products. These statements may not be used in advertising or for any commercial purpose.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form, or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

Staff

Ellen C. Moore, Chief Education Ofﬁcer Hans Koelsch, PhD, Director, Department of Publications Lisa Claxton Moore, Senior Manager, Book Program Kathleen Anderson, Senior Editor Steven Kellert, Senior Editor Michelle Wild, Associate Senior Editor Courtney Dunker, Editorial Production Manager Abram Fassler, Publishing Systems Manager Suzanne O’Reilly, Graphic Designer Susan Morritz Baim, Production Coordinator Karen Danca, Permissions Coordinator Charlie Baldwin, Digital and Print Production Specialist Hollie Muir, Digital and Print Production Specialist Emily Nickel, Page Production Assistant Genevieve Charet, Editorial Coordinator

Published 2016 by the American Academy of Orthopaedic Surgeons 9400 West Higgins Road Rosemont, IL 60018

Library of Congress Control Number: 2015959857

ISBN 978-1-62552-437-9

Printed in Canada

Editors

American Academy of Orthopaedic Surgeons Atlas of Amputations and Limb Deﬁciencies: Surgical, Prosthetic, and Rehabilitation Principles Fourth Edition

Joseph Ivan Krajbich, MD, FRCS(C)

Staff Orthopaedic Surgeon Shriners Hospital for Children Portland, Oregon

Michael S. Pinzur, MD

Professor of Orthopaedic Surgery and Rehabilitation Department of Orthopaedic Surgery and Rehabilitation Loyola University Health System Maywood, Illinois

LTC Benjamin K. Potter, MD

Chief Orthopaedic Surgeon, Amputee Care Program Deputy Chief, Orthopaedic Surgery Vice Chair (Research) and Associate Professor Uniformed Services University-Walter Reed Department of Surgery Bethesda, Maryland

Phillip M. Stevens, MEd, CPO, FAAOP

Prosthetist/Orthotist Hanger Clinic Adjunct Assistant Professor Division of Physical Medicine and Rehabilitation University of Utah Salt Lake City, Utah

Explore the full portfolio of AAOS educational programs and publications across the orthopaedic spectrum for every stage of an orthopaedic surgeon’s career, at www.aaos.org/store. The AAOS, in partnership with Jones & Bartlett Learning, also offers a comprehensive collection of educational and training resources for emergency medical providers, from ﬁrst responders to critical care transport paramedics. Learn more at www.aaos.org/ems.

Contributors

Joseph F. Alderete Jr, MD

Chief, Orthopaedic Oncology Section Associate Program Director, Orthopaedic Residency Department of Orthopaedic Surgery San Antonio Military Medical Center (formerly Brooke Army Medical Center) San Antonio, Texas

Motasem A. Al Maaieh, MD

Instructor Department of Orthopaedic Surgery University of Miami Miami, Florida

Edward A. Athanasian, MD

Associate Professor of Clinical Orthopedics Chief, Hand Surgery Service Hospital for Special Surgery New York, New York

M. David Beachler, CP

Lead Clinical Prosthetist Orthotic and Prosthetic Services Walter Reed National Military Medical Center Bethesda, Maryland

Christopher Bibbo, DO, FACS

Department of Surgery Division of Plastic and Reconstructive Surgery Hospital of the University of Pennsylvania Philadelphia, Pennsylvania

John H. Bowker, MD

Professor Emeritus Department of Orthopaedics Miller School of Medicine University of Miami Miami, Florida

Mihai Bragaru, PhD

Chelmsford, United Kingdom

Rickard Brånemark, MD, MSc, PhD

Orthopaedic Surgeon Department of Orthopaedics Sahlgrenska University Hospital Gothenburg, Sweden

Joseph Karl Brenner, BSc/Biology, CP, FAAOP

Director of Clinical Prosthetics Hanger Clinic Michigan Institute for Electronic Limb Development Livonia, Michigan

John T. Brinkmann, MA, CPO/L, FAAOP

Assistant Professor and Research Prosthetist Department of Physical Medicine and Rehabilitation Northwestern University Chicago, Illinois

Helena Burger, MD, PhD

Medical Director University Rehabilitation Institute Ljubljana, Slovenia

Greg Bush, BA, CP(C)

Research Prosthetist Institute of Biomedical Engineering University of New Brunswick Fredericton, New Brunswick, Canada

Federico Canavese, MD, PhD

Head, Department of Pediatric Surgery University Hospital Estaing Clermont-Ferrand, France

Kevin Carroll, MS, CP, FAAOP

Vice President, Prosthetics Department of Prosthetics Hanger Clinic Orlando, Florida

Min Ho Chang, MD

Staff Physician Interdisciplinary Pain Management Center Womack Army Medical Center Fort Bragg, North Carolina Assistant Professor, Department of Physical Medicine and Rehabilitation Uniformed Services University of the Health Sciences Bethesda, Maryland

Ee Ming Chew, MBBS

Consultant Department of Hand Surgery Singapore General Hospital Singapore

Benjamin B. Chi, MD

Orthopaedic Surgery Resident Department of Orthopaedic Surgery Walter Reed National Military Medical Center Bethesda, Maryland

W. Lee Childers, PhD, MSPO, CP

Assistant Professor Department of Prosthetics and Orthotics Alabama State University Montgomery, Alabama

Mickey S. Cho, MD

Attending Hand Surgeon Department of Orthopaedics and Rehabilitation San Antonio Military Medical Center (formerly Brooke Army Medical Center) San Antonio, Texas

Helen Cochrane, CPO(c), MSc

Project Director College of Allied Rehabilitation Sciences University of the East Ramon Magsaysay Memorial Center Manila, Philippines

Sheila A. Conway, MD

Associate Professor Department of Orthopaedic Surgery University of Miami Miller School of Medicine Miami, Florida

Colleen P. Coulter, PT, DPT, PhD, PCS

Physical Therapist IV Department of Orthotics and Prosthetics Children’s Healthcare of Atlanta Atlanta, Georgia

Robin C. Crandall, MD

Orthopaedic Surgeon Limb Deﬁciency Clinic Twin Cities Shriners Hospitals for Children Minneapolis, Minnesota

Donald R. Cummings, CP, LP

Director Department of Prosthetics Texas Scottish Rite Hospital for Children Dallas, Texas

Anna Cuomo, MD

Pediatric Orthopaedic Surgeon Department of Orthopaedics University of North Carolina Chapel Hill, North Carolina

Charles d’Amato, MD, FRCSC

Orthopaedic Surgeon Shriners Hospital for Children Portland, Oregon

Todd DeWees, BS, CPO

Prosthetist/Orthotist Pediatric Orthotic and Prosthetic Services Shriners Hospital for Children Portland, Oregon

Michael P. Dillon, PhD

Senior Lecturer in Prosthetics and Orthotics Department of Prosthetics and Orthotics La Trobe University Bundoora, Victoria, Australia

Kim Doolan, BA, CPV

Clinical Coordinator Allen Orthotics and Prosthetics Midland, Texas

Paul J. Dougherty, MD

Professor Department of Orthopaedic Surgery Wayne State University Detroit, Michigan

Gregory A. Dumanian, MD, FACS

Chief, Division of Plastic and Reconstructive Surgery Northwestern University, Feinberg School of Medicine Chicago, Illinois

Tobin T. Eckel, MD

Orthopaedic Foot and Ankle Surgeon Department of Orthopaedic Surgery Walter Reed National Military Medical Center Bethesda, Maryland

Mark Edwards, MHPE, CP

Director Professional and Clinical Services Ottobock Austin, Texas

Jorge A. Fabregas, MD

Residency Director Department of Orthopaedics Children’s Orthopaedics of Atlanta Atlanta, Georgia

Stefania Fatone, BPO(Hons), PhD

Associate Professor Northwestern University Prosthetics-Orthotics Center Northwestern University Chicago, Illinois

Brian J. Giavedoni, MBA, CP, LP

Senior Prosthetist Department of Orthotics and Prosthetics Children’s Healthcare of Atlanta Atlanta, Georgia

James R. Ficke, MD

Chairman and Professor Department of Orthopaedic Surgery Johns Hopkins Hospital Baltimore, Maryland

Sandra Fletchall OTR/L, CHT, MPA, FAOTA

Manager, Department of Burn Rehabilitation Fireﬁghters’ Regional Burn Center Memphis, Tennessee

Michael J. Forness, DO

Director, Limb Differences Clinic Department of Pediatric Orthopaedics Helen Devos Children’s Hospital/Spectrum Health Grand Rapids, Michigan

Johnathan A. Forsberg, MD, PhD

Orthopaedic Oncologist National Institutes of Health and John P. Murtha Cancer Center Naval Medical Research Center Silver Spring, Maryland

Robert S. Gailey, PhD, PT

Professor Department of Physical Therapy University of Miami Miller School of Medicine Coral Gables, Florida

Donald A. Gajewski, MD

Director Center for the Intrepid San Antonio Military Medical Center (formerly Brooke Army Medical Center) San Antonio, Texas

Ignacio A. Gaunaurd, PhD, MSPT

Research Physical Therapist Department of Research Miami Veterans Affairs Healthcare System Miami, Florida

Frank A. Gottschalk, MD

Professor Department of Orthopaedic Surgery University of Texas Southwestern Medical Center Dallas, Texas

James A. Harder, BSc, MD, FRCS(C)

Pediatric Orthopaedic Surgeon Department of Pediatric Orthopaedics Alberta Children’s Hospital Calgary, Alberta, Canada

Carson Harte, CEO

Exceed Lisburn, Northern Ireland

Bradford D. Hendershot, PhD

Lead Scientist Center for Rehabilitation Sciences Research Uniformed Services University of the Health Sciences Bethesda, Maryland

Andrea Hess, CP

Upper Limb Clinical Specialist Ottobock Healthcare San Jose, California

James T. Highsmith, MD, MS

Dermatologist Fellowship, Private Practice Total Skin and Beauty Dermatology Center Birmingham, Alabama

M. Jason Highsmith, PhD, DPT, CP, FAAOP

Associate Professor University of Southern Florida School of Physical Therapy and Rehabilitation Sciences Tampa, Florida

Wendy Hill, BScOT

Occupational Therapist Atlantic Clinic for Upper Limb Prosthetics University of New Brunswick Fredericton, New Brunswick, Canada

Ali Hussaini, BASc, MScE

Engineer Institute of Biomedical Engineering University of New Brunswick Fredericton, New Brunswick, Canada

Justin Z. Laferrier, PT, PhD, OCS, SCS, ATP, CSCS

Assistant Professor Department of Physical Therapy University of Connecticut Storrs, Connecticut

Sabrina Jakobson Huston, CPO

Prosthetist/Orthotist Department of Pediatric Orthotic Prosthetic Services Shriners Hospital for Children Portland, Oregon

Brad M. Isaacson, PhD, MBA, MSF

Program Manager/Lead Scientist Center for Rehabilitation Sciences Research The Henry M. Jackson Foundation for the Advancement of Military Medicine Bethesda, Maryland

Michelle A. James, MD

Chief of Orthopaedic Surgery Shriners Hospital for Children, Northern California Sacramento, California

Brian Kaluf, BSE, CP

Clinical Outcome and Research Director Ability Prosthetics and Orthotics Greenville, South Carolina

JoAnne L. Kanas, PT, CPO, DPT

Corporate Director of Orthotics and Prosthetics Department of Orthotics and Prosthetics Shriners Hospital for Children Tampa, Florida

Stephen J. Kovach III, MD

Assistant Professor of Surgery, Division of Plastic Surgery Department of Orthopaedic Surgery University of Pennsylvania Health System Philadelphia, Pennsylvania

Joseph Ivan Krajbich, MD, FRCS(C)

Staff Orthopaedic Surgeon Shriners Hospital for Children Portland, Oregon

Peter Kyberd, BSc, MSc, PhD

Vice President’s Research Chair in Rehabilitation Cybernetics Institute of Biomedical Engineering University of New Brunswick Fredericton, New Brunswick, Canada

Chris Lake, L/CPO, FAAOP

Owner, Clinical Director Department of Upper Limb Prosthetics Lake Prosthetics and Research Euless, Texas

Jakub Stuart Langer, MD

Orthopaedic and Hand Surgeon Shriners Hospital for Children – Consultant Hand Surgeon Portland, Oregon

John F. Lawrence, MD

Senior Physician Department of Orthopaedic Surgery University of California, Los Angeles Los Angeles, California

L. Scott Levin, MD, FACS

Chair, Department of Orthopaedic Surgery Penn Medicine Philadelphia, Pennsylvania

Robert D. Lipschutz, CP, BSME

Assistant Professor Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine Northwestern University Clinical Practice Leader Department of Prosthetics and Orthotics Rehabilitation Institute of Chicago Chicago, Illinois

Ellen J. MacKenzie, MSc, PhD

Professor and Chair Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland

Samir Mehta, MD

Chief, Orthopaedic Trauma and Fracture Service Department of Orthopaedic Surgery University of Pennsylvania Philadelphia, Pennsylvania

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