Leg stump

“ If the leg stump is ten centimetres long, if the knee joint is freely mobile and capable of complete, or almost complete, active extension, and if there are no adherent scars around the tuberosities of the tibia, the American apparatus with free knee joint should be adopted. ”

“ Almost always when the will is exerted to move the toes, actual contraction may be perceived in the muscles of the stump. One might, therefore, expect that where the toe-moving muscles were cut off, the sense of the toes being moved might disappear. But this is not the case. I have cases of thigh amputation, in which all the foot-moving muscles are gone, and yet in which the feet or toes seem to move at will. And I have cases of lower-leg amputation in which, though the foot-moving muscles contract in the stump, the toes or feet feel motionless. ”

“ Where the leg, for instance, has been lost, they feel as if the foot was present, but as though the leg were shortened. If the thigh has been taken off, there seems to them to be a foot at the knee; if the arm, a hand seems to be at the elbow, or attached to the stump itself. ”

“ My one eye aches when I read for too long, and the stump below the knee is too tender still to fit the false leg on to, and I cannot, because of my shoulder, use my crutch overmuch, so walking is out of the question. ”

“ For stumps that become swollen in hot weather, or that require extra covering in cool weather, or for such as have never used an artificial leg, with the consequent probability of the stump rapidly reducing, this inner socket may be made adjustable by lacing. ”

“ Many patients tell how they met with accidents, by rising suddenly and starting to walk as if their leg were still there, or by getting out of bed in the same way. Others tell how they have involuntarily put down their hand to scratch their departed foot. One man writes that he found himself preparing with scissors to cut its nails, so distinctly did he feel them. Generally the position of the lost leg follows that of the stump and artificial leg. If one is flexed the other seems flexed; if one is extended so is the other; if one swings in walking the other swings with it. ”

“ In walking, when the weight of the body rests on the ball of the foot, the spring in the back part of the leg (heel spring) is firmly compressed, and when the weight of the body is thrown forward [38] on to the other foot the spring rises and carries the foot forward to its place with very little effort of the wearer, assisting greatly in carrying the weight of the leg.
The prices for legs described in this part, for amputation at any point above the ankle, are, including suspenders, stump socks, etc., complete:
$50, warranted for one year. ”

“ When children have been deprived, by accident or disease, of one or both lower limbs, artificial legs should be applied as soon as the condition of the stump will safely permit. It is too generally presumed that an outgrown limb is of no further use, and that the purchase of an artificial leg before full growth is assured means a foolish expenditure. ”

“ Many surgeons strongly urge that an artificial leg cannot be safely fitted for several months after cicatrization occurs, while, on the other hand, some manufacturers of artificial limbs claim that a leg can be satisfactorily fitted just as soon as the stump has healed, no matter if it be but five or six weeks after the amputation. ”

“ At the places where the amputation is apt to be made, the nerves which supply the foot are all buried deeply in the tissues. Superficial contact with the stump never excites, therefore, the sensibility of the foot-nerves. All ordinary contacts of the stump, thus failing to awaken the foot-feeling in any noticeable way, that feeling fails to grow associated with the stump's experiences ”

“ In order to attain this, the higher classes bind tight bandages round the feet of female infants, so that none but the great toe is suffered to retain its natural position. This compression is continued until the foot ceases to grow. It is then a misshapen little stump, four or five inches long, with all the smaller toes adhering firmly to the sole. The growth thus cruelly checked in its proper place, increases the ankle to such a clumsy size, that it almost entirely conceals the foot. ”

“ To sit close astride, and claw up the rock by means of the thighs, elbows and hands, is customary, and seemingly safe; but the really safer method, because it admits of uninterrupted progress, is to keep the body away, and to grip with the sole and flexed ankle, or with the knees and sides of the feet, on either side of the rib, or to lock one leg diagonally across the edge so that the foot and knee press against its opposing facets. ”

“ The back of the foot will rub the knee if that be attacked, whilst if the foot be cut away, the stump will make ineffectual movements, and then, in many frogs, a pause will come, as if for deliberation, succeeded by a rapid passage of the opposite unmutilated foot to the acidulated spot. ”

“ The limb is first tied tight above the joint with a piece of cord, and the hand or foot is taken out of the socket of the wrist or ankle joint. The stump is then dipped into hot pitch, and the sufferer is permitted to go away with his friends ”

“ In amputation of the thigh, the same method of incision is followed as in amputation of the arm. But, according to the point of removal, the direction of the flaps varies. If in operating high in the limb the flaps be made laterally, there will be imminent risk of the bone protruding through the upper part of the wound; for the patient uniformly raises the stump towards his abdomen. No antagonist muscular power is left to oppose the action of the muscles inserted into the trochanter minor, and the elevation of the stump is involuntary: it always occurs to a remarkable extent in young persons. ”

“ There is intense pain and abnormal position in the injured part, besides deformity produced by the swelling. The foot of the injured limb is turned over to one side or the other, [Pg 107] owing to a rolling over of the portion of the limb below the break. With both lower limbs in line with the body, and the patient lying on the back, measurements are made from each hip-bone to the prominence on the inside of either ankle joint. Shortening of the injured leg will be found, varying from one to over two inches, according to the overlapping and displacement of the fragments. ”

“ Certain limb makers consider these operations are bad for the same two reasons that we have already refuted in connection with amputation through the condyles of the femur, viz.—
(1) The stump being enlarged at its lower end will not fit into a wooden bucket.
(2) The stump is too long to allow an artificial foot to be fixed below it.
From this it simply follows: 1. That complete enclosure of the stump in a wooden bucket is impossible; 2. That pressure must be placed directly and exclusively upon the end of the stump. ”

“ If the fracture be simple, a bandage of strips previously applied round the limb from the ancle to the knee is highly useful. It secures the fragments more effectually from lateral displacement, and prevents the swelling of the leg. A simple roller applied with a moderate degree of tightness round the foot, is also of service in preventing a swelling in that part, as well as in removing it if it has already occurred. ”

“ They are rather a diminutive race, generally below five feet five inches, with crooked legs and thick ankles—a deformity caused by their passing so much of their time sitting or squatting upon the calves of their legs and their heels, in the bottom of their canoes—a favorite position, which they retain, even when on shore. The women increase the deformity by wearing tight bandages round the ankles, which prevent the circulation of the blood, and cause a swelling of the muscles of the leg. ”

“ The man softly, yet awkwardly, lifted the robe, folded it back, and slowly uncovered the knee. The leg was worn away almost to skin and bone, but the knee itself was swollen with inflammation. He bathed it with some water, mixed with vinegar and herbs, then drew down the deer-skin shirt, and did the same with the child's shoulder. Both shoulder and knee bore the marks of teeth,—where a huge wildcat had made havoc—and the body had long red scratches. ”

“ For if the accident be recent and the patient young, we may sometimes succeed in reducing the limb by grasping and rotating the thigh this way and that. When the dislocation is inwards we may sometimes accomplish our purpose by bending the limb at the groin inwards frequently and strongly. If the dislocation does not yield to these means we must have recourse to extension, first with the hands, certain assistants grasping the thigh and leg and pulling the limb downwards, while others grasp the body at the armpits and pull upwards. ”

“ This done, he returned to the cabin, and he and I “set” Mr. Trufant’s broken leg—and a deuce of a “set” we made of it. I had read “anatomy” in my time, and fancied I knew something of surgery and the general construction of the human frame; but, tossing about as the ship was at that time, the most skillful surgeon could scarcely have done justice to the case.
Only the tibia—that is, the large bone of the leg—was broken, and we applied three splints to it, bound it too tightly, with too much bandage, and fancied we had “reduced the fracture,” in a scientific manner. ”

“ So many men come to us with terrific bedsores to add to the distress of their shattered legs it takes much ingenuity to take care of them. We have one man who is practically slung in hammocks which are attached with counter{69} weights to the frame over the bed. These small hammocks, or slings, go, one under his shoulders, one under his lower back, and then his leg is in a frame with weights attached to the foot. Rubber tubes are run in and out of his thigh, and knee, and his wounds are irrigated through these tubes which are perforated. ”

“ The wound is generally lacerated and contused and the mouths of the vessels do not gape, but are twisted and crushed. The skin usually separates at the highest point and the muscles protrude, appearing to be tightly embraced and almost strangulated by the skin, and also by the tendons, vessels, and nerves which, crushed and twisted with the fragments of bone, form a conical stump. ”

“ On examining the removed stump, all the nerves, particularly the musculo-spiral, were found greatly enlarged in their extremities, and intimately adherent to the cicatrix and the ligamentous covering of the rounded extremity of the humerus. More desperate operations have even been performed to free patients from irritable stump. The lower limb has been hacked off bit by bit, even to the coxo-femoral articulation, without much, if any, relief. Such operations are hardly warrantable.
Amputation at the shoulder-joint is more frequently required for accident than for disease. ”

“ Thin splints of wood are bound to the limb to hold the bones in position and after the break has healed, full use of the member is often regained. A fracture of the upper arm or leg is seldom treated with success for the powerful muscles pull the bones out of the position and, if the victim survives, a crippled limb results. Over in the north end of the town lives a young lady of nineteen who suffered an accident of this type. Returning from the spring one day with a heavy jar of water on her head, she missed her step and fell over a low cliff. ”

“ Dressing of the Stump.—From its peculiar shape and position, the escape of any blood into the stump is much{80} to be deprecated, for as it cannot easily get out, on the one hand it gives pain, and may cause sloughing from its pressure, and on the other it is sure eventually to cause suppuration, and delay union. To avoid such results care must be taken to secure every vessel that can be seen; if there is any general oozing it is best merely to pass the sutures through the edges of the flaps, but not bring them together, thus leaving the stump open for some hours ”

“ Beach speaks of an individual who suffered fracture of both thighs, and compound comminuted fracture of the tibia, fibula, and tarsal bones into the ankle-joint, necessitating amputation of the leg. The patient not only survived the operation, but recovered with good union in both thighs. As illustrative of the numerous fractures a person may sustain at one time, the London Medical Gazette mentions an injury to a girl of fourteen, which resulted in 31 fractures. ”

“ No stump-cap is to be applied; the stump is to be raised a little on a proper pillow from the bed, in which the patient lies on his back; and if the bone appear to press too much against the upper flap, the body may be a little raised, which will relieve it.
In secondary amputation of the thigh, the integuments may not be sound, and will not retract, in which case they must be dissected back to an equal distance all round. If [86] the muscles are much diminished in size, or flabby, they should be left even longer than may appear necessary for the formation of a good stump ”

“ Many patients with thigh amputation feel, more or less distinctly, their knee, or their calf. But even where they do not, the foot may seem separate from the stump, though possibly located nearer it than natural. ”

“ Luxation of the Bones of the Leg.—separation of them from the end of the femur—seldom occurs. It can be the effect only of great violence and great laceration. Most frequently fracture is concomitant, perhaps with wound; and such accidents require amputation, either primarily or secondarily. Subluxation, from laceration of the internal lateral ligament, is not so unfrequent. It is most common in females, the natural conformation of their thigh-bones disposing them to bend inwards; and from falling awkwardly, particularly if carrying a weight, the ligament is apt to give way. ”