Atlas of Amputations and Limb Deficiencies: Surgical, Prosthetic, and Rehabilitation Principles, ed 3 Smith DG, Michael JW, Bowker JH, eds. Rosemont, IL 60018, American Academy of Orthopaedic Surgeons,2004, hardcover, 965 pp, illus, ISBN: 0-89203-313-4, $215.
The third edition of the Atlas of Amputations and Limb Deficiencies is intended to “present the major advances of the past decade” for all members of the rehabilitation team. Many of the chapters of this book do meet that intention. Several chapters, however, are extremely brief in content and lack research published in the past decade. In this newest edition, contributors were recruited in the areas of care of people with wartime amputations, the role of the Krukenberg procedure in developing countries, the rise of the consumer movement for people with amputations, and the rapidly expanding role of sports and recreation, as well as osseointegration and transplantation.
This atlas is organized into 5 sections and 1 appendix. The appendix, titled “Terminology in Acquired Limb Loss,” is disappointing. It directs the reader to the Web site for the International Organization for Standardization and lists the organization's mailing address in Switzerland.
Section I, “Introduction,” includes 7 chapters on the history of amputations and prosthetics, the causes of amputations, and care of people with wartime amputations. A connection is made between armed conflicts and the improvements in prosthetics, including the increase in education for doctors, therapists, and patients, and the materials used to create prosthetics. Although repetitive at times, chapters 2 through 6 explore the causes of amputation and surgical techniques, including limb salvage techniques, the long-term concerns and complications associated with these surgical techniques, and postoperative management. Chapter 7 is devoted to the care of people with wartime amputations, tracing the history from the Civil War to the Vietnam War, including the management issues associated with land mine injuries.
Section II, “The Upper Limb,” consists of 21 chapters. As with section I, many chapters are repetitious. Chapter 8 provides an excellent review of the kinesiology and functional characteristics of the upper limb. Chapters 9 through 12 describe the body-powered components and the electric-powered systems for the upper limb, including their uses, comparison to physiological joints, durability, and financial concerns. The issues of hybridpowered and control systems, artificial reflexes, the role of surgery in creating control sites, cineplasty, and osseointegration are included in chapter 12. Physical therapists, occupational therapists, recreational therapists, and students will benefit from the content of these chapters, which explain these devices and the improvement that the devices can make in the quality of life of the person with an amputation.
The remaining chapters cover amputations of the upper limb—from the surgical and prosthetic perspectives—for people with unilateral or bilateral amputations, including recent and future developments. A new chapter on the Krukenberg procedure is an excellent addition to the atlas. Physical therapists will benefit from understanding the use of the muscles of the upper limb in controlling the pincerlike extremity that results from this procedure. Chapter 22 will be of particular interest to physical therapists, because it covers the pre- and postprosthetic training of the patient in vocational and avocational activities. Many examples are provided in all the chapters.
Section III covers the lower limb. Twentyfour chapters provide the reader with information on normal gait and gait with an amputation, energy expenditure issues associated with people with amputations, surgical and prosthetic management, sports and recreation possibilities, and research in lower-limb prosthetics. Chapters 29 through 32 provide an excellent review of the kinematics and kinetics of normal gait and gait for people with transtibial and transfemoral amputation and the energy expenditure of walking for people with an amputation. Prosthetic components and their muscular control are considered within each phase of the gait cycle. The lack of details in the studies of energy expenditure in people with a unilateral amputation (no distinction of the age of the subjects, causes of amputation, use of assistive devices, prosthetic fit, and experience) reinforce the need for more research addressing these issues.
Reference charts and tables in many of the chapters will be beneficial resources for students, new graduates, and experienced practitioners. Chapter 48, centering on physical therapy, provides the reader with a wealth of exercises and activities for the rehabilitation process. There are several excellent figures that cover exercises and activities and wrapping techniques with elastic bandages for people with transtibial and transfemoral amputations. Both recent graduates and seasoned clinicians will find these figures helpful as quick references when developing rehabilitation programs for patients with lower-limb amputations.
Physical therapists will also be attracted to chapter 51 on sports and recreation. It contains a table outlining the 5 basic steps of running with an amputation and a table with specific instructions for the golfer. Although the focus of this chapter is swimming, golfing, and cycling, there is valuable information for preparing people with amputations for recreational and competitive sports, including a table with tips for coaching the novice athlete. The last chapter in this section, chapter 52, “Research in Lower Limb Prosthetics,” is lacking in recent studies on prosthetic development and use. There are only a few references from the past 10 years. All other references were published before 1995. This chapter leaves the reader wanting more current information than is provided.
Section IV considers management issues, such as osseointegration in transfemoral amputees, musculoskeletal complications, chronic pain issues, and psychological adaptation to amputation. Chapter 53, “Future Developments: Osseointegration in Transfemoral Amputees,” includes reports on both the positive and negative outcomes of various clinical trials in this field.
The final section of this atlas is devoted to pediatrics. The reader is reminded that the child is not a small adult, but has particular issues that need to be addressed, including growth management and tolerance for gadgets. Developmental kinesiology and general prosthetic considerations are thoroughly covered. Chapter 63 includes a useful reference figure with the normal developmental milestones in infants and young children.
The final chapter in this section explores the need for surgical modification of residual limbs for fitting prostheses, for self-suspension, and for end-weight bearing; issues associated with terminal overgrowth; and the potential advantages of lengthening residual limbs for function.
Physical therapists who see patients with amputations and limb deficiencies will find valuable information in this atlas on pre- and postoperative care, prosthetic components and designs, and prosthetic training. The multidisciplinary approach provides valuable information on developmental, physiological, psychosocial, pharmacological, and surgical aspects of treatment. The chapters on prosthetic components and management and occupational therapy and physical therapy are particularly pertinent. The case studies provided in several chapters are an excellent adjunct to applying the content in a clinical context. The book liberally uses photographs and illustrations of patients before and after their amputation and prosthetics. The chapters with tables and figures provide quick reference points for both the novice and experienced clinician. Overall, I would recommend this atlas as a reference source for occupational therapists and physical therapists and students.
- Physical Therapy