Krukenberg procedure: Difference between revisions

Latest revision as of 11:05, 15 February 2025

Surgical procedure to convert a forearm stump into a pincer

Krukenberg Procedure[edit]

The Krukenberg procedure is a surgical technique designed to convert a forearm stump into a functional pincer, allowing individuals with forearm amputations to gain improved grip and dexterity. This procedure is particularly beneficial for bilateral amputees who require enhanced manual dexterity for daily activities.

History[edit]

The Krukenberg procedure was first described by the German surgeon Hermann Krukenberg in 1917. It was initially developed to assist World War I veterans who had lost their hands in combat. The procedure gained popularity due to its ability to provide a functional alternative to prosthetic limbs, especially in resource-limited settings.

Indications[edit]

The Krukenberg procedure is indicated for patients with:

Bilateral forearm amputations
Intact radius and ulna
Adequate soft tissue coverage
Motivation and ability to undergo rehabilitation

Surgical Technique[edit]

The procedure involves the following steps:

1. Incision and Exposure: A longitudinal incision is made along the forearm stump to expose the radius and ulna. 2. Separation of Bones: The radius and ulna are carefully separated, creating a space between them. 3. Formation of Pincer: The separated bones are shaped to form a pincer-like structure, with the radius acting as the thumb and the ulna as the fingers. 4. Soft Tissue Adjustment: Soft tissues are adjusted to ensure adequate coverage and mobility of the newly formed pincer. 5. Closure: The incision is closed, and the patient is placed in a splint to allow for healing.

Rehabilitation[edit]

Postoperative rehabilitation is crucial for the success of the Krukenberg procedure. Patients undergo extensive physical therapy to learn how to use their new pincer effectively. This includes exercises to improve strength, range of motion, and coordination.

Advantages[edit]

Provides a functional grip without the need for external prosthetics
Allows for sensory feedback through the skin
Can be performed in settings with limited access to advanced prosthetic technology

Disadvantages[edit]

Aesthetic concerns due to the appearance of the forearm
Requires significant rehabilitation and patient motivation
Limited to patients with specific anatomical conditions

Related pages[edit]

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-'''Krukenberg Procedure'''
+{{Short description|Surgical procedure to convert a forearm stump into a pincer}}
+{{Use dmy dates|date=October 2023}}
-The '''Krukenberg procedure''' is a surgical technique primarily used in the management of certain types of [[hand injuries]] and [[amputations]], where a functional grasp is created from an otherwise non-functional forearm. This procedure is named after the German surgeon, Friedrich Krukenberg, who first described it in 1917. It is most commonly indicated in patients who have lost their hand but retain an intact and functional forearm, allowing them to achieve a pincer-like action between the ulna and the radius.
+== Krukenberg Procedure ==
+The '''Krukenberg procedure''' is a surgical technique designed to convert a forearm stump into a functional pincer, allowing individuals with [[forearm amputation]]s to gain improved [[grip]] and [[dexterity]]. This procedure is particularly beneficial for [[bilateral amputees]] who require enhanced [[manual dexterity]] for daily activities.
-==Indications==
+[[File:Krukenburg.svg|thumb|right|Diagram of the Krukenberg procedure]]
-The Krukenberg procedure is typically indicated for patients with [[Forearm Amputation|forearm amputations]] who require improved function for activities of daily living, and who are not candidates for or have refused [[Prosthetics|prosthetic]] devices. It is particularly useful in settings where sophisticated prosthetics are not available or are too expensive. The procedure is also considered in cases of severe hand trauma where the hand cannot be salvaged, and in certain congenital limb deficiencies.
-==Procedure==
+== History ==
-The Krukenberg procedure involves the separation of the radius and ulna for a portion of the forearm, creating a bifurcated structure that can be controlled by the remaining forearm muscles. This separation allows the patient to use the pronator and supinator muscles to achieve a pincer action, providing them with the ability to grasp and manipulate objects. The surgery is complex and requires careful consideration of the soft tissue coverage, as well as the preservation of the nerves and blood supply to the separated bones.
+The Krukenberg procedure was first described by the German surgeon [[Hermann Krukenberg]] in 1917. It was initially developed to assist [[World War I]] veterans who had lost their hands in combat. The procedure gained popularity due to its ability to provide a functional alternative to [[prosthetic limbs]], especially in resource-limited settings.
-==Outcomes==
+== Indications ==
-Patients undergoing the Krukenberg procedure can achieve a significant improvement in the functionality of their forearm, allowing them to perform tasks that would otherwise be impossible. The success of the procedure depends on several factors, including the level of the amputation, the condition of the remaining forearm muscles, and the patient's motivation and ability to undergo rehabilitation. Postoperative rehabilitation is crucial and involves extensive physiotherapy to learn how to control the newly formed pincer grasp effectively.
+The Krukenberg procedure is indicated for patients with:
+* Bilateral forearm amputations
+* Intact [[radius]] and [[ulna]]
+* Adequate [[soft tissue]] coverage
+* Motivation and ability to undergo [[rehabilitation]]
-==Complications==
+== Surgical Technique ==
-As with any surgical procedure, the Krukenberg procedure carries risks and potential complications. These may include infection, bleeding, nerve damage, and issues with bone healing. Additionally, there can be psychological impacts associated with the altered body image, and some patients may struggle with the appearance of their forearm post-surgery.
+The procedure involves the following steps:
-==Ethical Considerations==
+. '''Incision and Exposure''': A longitudinal incision is made along the forearm stump to expose the radius and ulna.
-The Krukenberg procedure raises several ethical considerations, particularly regarding patient selection and informed consent. It is essential that patients are fully informed about the nature of the surgery, its potential outcomes, and the long-term implications for their body image and function. The decision to proceed with the Krukenberg procedure should be made collaboratively by the patient, their family, and the surgical team, taking into account the patient's lifestyle, goals, and preferences.
+. '''Separation of Bones''': The radius and ulna are carefully separated, creating a space between them.
+. '''Formation of Pincer''': The separated bones are shaped to form a pincer-like structure, with the radius acting as the thumb and the ulna as the fingers.
+. '''Soft Tissue Adjustment''': Soft tissues are adjusted to ensure adequate coverage and mobility of the newly formed pincer.
+. '''Closure''': The incision is closed, and the patient is placed in a [[splint]] to allow for healing.
-==Conclusion==
+== Rehabilitation ==
-The Krukenberg procedure remains a valuable surgical option for certain patients with forearm amputations or severe hand injuries. While it is not the first choice for all patients, it can provide significant improvements in function and quality of life for those who are appropriate candidates. Ongoing research and advancements in surgical techniques continue to improve the outcomes for patients undergoing this unique procedure.
+Postoperative rehabilitation is crucial for the success of the Krukenberg procedure. Patients undergo extensive [[physical therapy]] to learn how to use their new pincer effectively. This includes exercises to improve [[strength]], [[range of motion]], and [[coordination]].
-[[Category:Orthopedic Surgical Procedures]]
+== Advantages ==
-[[Category:Amputations]]
+* Provides a functional grip without the need for external [[prosthetics]]
-[[Category:Hand Surgery]]
+* Allows for [[sensory feedback]] through the skin
+* Can be performed in settings with limited access to advanced prosthetic technology
-{{Medicine-stub}}
+== Disadvantages ==
+* Aesthetic concerns due to the appearance of the forearm
+* Requires significant rehabilitation and patient motivation
+* Limited to patients with specific anatomical conditions
+== Related pages ==
+* [[Amputation]]
+* [[Prosthetics]]
+* [[Rehabilitation (neuropsychology)]]
+[[Category:Surgical procedures]]
+[[Category:Orthopedic surgery]]
+[[Category:Amputation]]