A Primer on Limb Prosthetics

A PRIMER ON LIMB PROSTHETICS. A. Bennett Wilson, Jr. 151 pp. Illust. Charles C Thomas, Publisher, Springfield, Ill. 1998. Can$38.95 (clothbound), Can$25.95 (paperbound). ISBN 0-398-06900-X (clothbound), 0-398-06807-6 (paperbound)

The days are probably over when a surgeon will write a prescription for a patient’s prosthesis. Few amputation surgeons can pretend to embrace the art of prosthetic selection and fitting or be cognizant of modern appliance options. Even our fellowship candidates in orthopedic surgery approach multiple choice questions on limb prosthetics with justifiable trepidation. Yet the amputation surgeon’s skill and care ultimately have a major influence on the success of prosthetic selection, fitting, comfort and utility. Some measure of understanding would therefore seem reasonable.

This small textbook is designed to provide entry level surgeons, therapists, prosthetists and even administrators with a basic knowledge of the current state of prosthetic art. It focuses on a broad overview of the components of a successful limb prosthesis, while nicely introducing and explaining the principles of basic engineering and terminology. The information presented is current to 1998. The book introduces mainstream thinking and avoids reference to fringe or fad treatments.

The book contains 65 pages devoted to lower extremity prostheses and 44 pages devoted to upper extremity prostheses. Within these few pages, 93 line drawings expand and illustrate mechanical principles and modern appliances. For the neophyte surgeon or therapist, the bewildering array of joint substitutions and terminal appliances are presented in outline and selection criteria summarized. Thus, in a single evening, the new member of an amputation clinic team can get a quick overview of the main issues in limb prosthetics.

Of particular note in the section on the lower extremity, a well-organized and illustrated review of stance phase control and swing phase control devices is presented. In the section on the upper extremity, standard body-powered articulations and terminal devices are emphasized. The subject of externally-powered upper limb prostheses is unfortunately given meagre attention. Given that most upper limb amputees are extremely interested in myoelectric controlled devices, a more extensive explanation of the systems required for signal detection, amplification and application of motor control, as well as the current limitations, would have been appropriate.

The book is clearly written, well illustrated and of broad interest to those requiring at least superficial familiarity with limb prosthetics. This book will not allow the reader to solve most fitting problems or analyse malalignment during gait, but it will teach the reader to ask the right questions.