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Krukenberg Amputation & Its Management

The Krukenberg amputation separates the forearm bones to provide a sensate grasp for children lacking functioning hands. It allows tactile feedback and interaction with the environment for blind children or those without access to prosthetics. The procedure is indicated for children aged 4+ with a forearm length of at least 5cm who can participate in postoperative exercises. The forearm muscles and nerves are preserved to form pinchers for grasping while separating the bones. Postoperative rehabilitation focuses on grasp, release, and sensory feedback.

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246 views

Krukenberg Amputation & Its Management

The Krukenberg amputation separates the forearm bones to provide a sensate grasp for children lacking functioning hands. It allows tactile feedback and interaction with the environment for blind children or those without access to prosthetics. The procedure is indicated for children aged 4+ with a forearm length of at least 5cm who can participate in postoperative exercises. The forearm muscles and nerves are preserved to form pinchers for grasping while separating the bones. Postoperative rehabilitation focuses on grasp, release, and sensory feedback.

Uploaded by

SIBASIS PATTANAYAK
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Krukenberg amputation & its

management
Poly Ghosh
NILD, Kolkata
Introduction
• The Krukenberg procedure separates
the forearm bones in a manner similar
to a syndactyly release to provide
sensate grasp for a child who lacks
one or both functioning hands.
• It is particularly useful in regions of
the world where the availability of
prosthetic devices is limited and costs
are prohibitive.
Advantages
• Patient in addition to being able to grasp objects without using a
prosthesis, has the ability to feel objects that are being grasped
Indication

1. Vision impairment:
blind children because it results in a sensate limb, which allows the child tactile
exploration, interaction, and feedback from his or her environment
• Sighted children with unilateral or bilateral deletions also derive functional
benefits from the procedure
• reconstructive alternative for children with congenital absence of the hand,
particularly in those with profound contralateral abnormalities, associated
blindness, or a lack of access to prosthetic care
2. Forearm length: In children 5 to 6 years old, the residual limb
length should be at the transcarpal or wrist level. In older
children, deletions at the midforearm level or longer can be
functional
3. Age:-
• developmentally 4 years of age or older a
• Children should have sufficient psychological development to
understand and cooperate with the postoperative exercise
program
4. Cultural and Geographical Considera tion:
• Children with upper limb injuries caused by land mine explosions
. In countries where explosive remnants of war are an important
problem, there is often substantial social disorder and poverty, and
prosthetic facilities are rare
5. Anatomical Consideration: The skin of the forearm must have good
sensation. Residual limb lengths of at least 5 cm are recommended.
Contraindication

• if there is a radioulnar synostosis or


substantial elbow abnormality
Cosmetic appearances vs. function
• The extraordinary dexterity provided by a Krukenberg limb allows
more natural motion than that achieved using a prosthesis
Surgical technique
• The forearm incisions are designed to provide as much skin coverage
to the distal residual limbs as possible.
• Any skin distal to the wrist is preserved for use in covering the distal
pincers.
• The forearm bones are separated by incising the interosseus
membrane to its proximal extent.
• preserve two musculocutaneous flaps
• One flap includes the brachioradialis and the extensor carpi radialis
muscles. This flap should not be separated from the radius.
• ulnar flap and includes the flexor carpi ulnaris and the extensor carpi
ulnaris. This flap should not be separated from the ulna.
• Sensory nerves should be preserved.
• The integrity of Pronator teres should be maintained at all costs, as it is
the prime motor for the pincer (the other stabilizer is supinator)
• Sufficient debulking of finger flexor (flexor digitorum superficialis and
FDP) and extensors should be done in order to get maximum full
thickness cover of pincers
• The most important muscles to preserve are the flexor carpi ulnaris, the
extensor carpi ulnaris, the brachioradialis, and the pronator teres.
• separating the forearm bones, as much separation as possible should
be obtained without injuring the capsules of the proximal radioulnar
joint or the radiocapitellar joint.
• The length of the pincers is determined by the distance between the
attachment of the pronator teres to the radius and the end of the radius.
• The forearm bones should be of equal length.
• It is desirable to have 6 to 8 cm, but a shorter distance can be tolerated,
especially when distal growth is anticipated. In older children, the
forearm bones can be shortened for better closure.
• Longer pincers have less strength
at the tips, but they have a larger
grasping potential.
• Active exercise can begin in 2 to 3
weeks and should be focused on
grasp and release rather than
pronation and supination
Failed to use krukenberg
amputation
• Funstional or cosmetic prosthesis can be
used.

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