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Review Question - QID 1340

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QID 1340 (Type "1340" in App Search)
A 25-year-old male presents to the emergency department with a mangled lower extremity that is not salvageable. He undergoes transfemoral amputation. Three months later the patient presents to the office with the limb sitting in an abducted position. What important step was forgotten during the amputation?

Beveling the distal femur

1%

10/1622

Saving the patella

0%

2/1622

Allowing the sciatic nerve to retract deep into the soft tissue

1%

12/1622

Myodesis of the adductors

97%

1578/1622

Timely fitting of orthosis

1%

10/1622

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Prior to the late 80’s, techniques for transfemoral amputation sacrificed the hip adductor muscles resulting in unopposed abductor forces. Amputation with an abducted femur leads to an increase in side lurch and higher energy consumption. Gottschalk in ’99 showed that myodesis of the adductor magnus through drill holes in the lateral femur preserved maximum muscle force and provided a mechanical advantage for the adductors of the thigh. This resulted in maintenance of the normal anatomic alignment of the femur and a balance between the abductor and adductor mechanisms of the hip, thus providing patients with improved control and easier prosthesis fit.

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