[Pubic disarticulation].
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In this article is presented the 20-years experience of surgical preparation and prosthetics of 62 invalids with the femur stumps after knee joint exarticulation at the age of 5-65 years in the clinic of LNIIP. New methods of distal epiphysis transposition with muscle connection preservation instead of diaphysial femur amputations were applied to the patients with the integument defects. There have been broadened and made more accurate indications for knee joint exarticulation as a consequence of a trauma as well as in case of vascular diseases. Prosthetic appliances are made with utilization of modified monocentric knee units, polycentric modules and frame-type full-contact sockets of new design.
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Patients can be provided with a functional above-knee amputation stump when the tumor is not resectable. In order to do this and still remove the entire upper end of the femur a small Austin-Moore prosthesis with drill holes is inserted and enclosed in long anterior and posterior flaps. Muscle attachments are sutured into the distal stem to obtain the balance between abduction and extension of a functional stump.
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A 36-year-old man with posttraumatic transarticular knee (TK) amputation illustrates the difficulties of prosthetic fitting. The excessively long and deformed stump was successfully overcome by an unusual surgical technique consisting of the shortening of the femoral bone by an osteotomy and plate fixation with preservation of the integrity of the condyles to correct the deformity. A short review of the literature concerning the advantages and limitations of TK amputations demonstrates some of the previously-reported surgical techniques.
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