Krukenberg procedure
Encyclopedia
The Krukenberg procedure also known as the Krukenberg operation is a surgical technique that converts a forearm stump into a pincer
. It was first described in 1917 by the German army surgeon Hermann Krukenberg
.
and radius
for below-elbow amputation
s, and in cases of congenital absence of the hand, to provide a pincerlike grasp that is motored by the pronator teres muscle
. The prerequisites for the operation are a stump over 10 cm long from the tip of the olecranon
, no elbow contracture, and good psychological preparation and acceptance
The success of the Krukenberg procedure depends directly on the strength of the pronator teres, the sensibility of the skin surrounding both ulna and radius, elbow mobility, and mobility of the ulna and radius at the proximal radioulnar joint. Individual patient expectations and motivations, although more difficult to assess, probably play a major role in outcomes as well.
The procedure preserves proprioception
and stereognosis
in the functional stump and so allows for effective maneuvering. Once this procedure is performed, it does not preclude the use of a functional prosthesis giving the patient is afforded the option to use either functional strategy.
Objections are usually cosmetic, and indeed for this reason and for cultural reasons, in South America it is usually not done. While in developed countries the operation is rarely done, patients can prefer it to sophisticated prosethetics. In one case of a Dutch woman reported in 2002.
The patient "After this first procedure the patient also asked for the Krukenberg procedure for her left arm."
had two Krukenberg hands as a result of a laboratory accident.
Pincer
Pincer may refer to:*Pincer *Pincer , part of an animal*Pincer ligand, a terdentate, often planar molecule that tightly binds a variety of metal ions.*Pingas...
. It was first described in 1917 by the German army surgeon Hermann Krukenberg
Hermann Krukenberg
Hermann Krukenberg was a German surgeon who was a native of Calbe, Province of Saxony, Germany. He was the brother of pathologist Friedrich Ernst Krukenberg ....
.
Procedure
The procedure involves separating the ulnaUlna
The ulna is one of the two long bones in the forearm, the other being the radius. It is prismatic in form and runs parallel to the radius, which is shorter and smaller. In anatomical position The ulna is one of the two long bones in the forearm, the other being the radius. It is prismatic in form...
and radius
Radius (bone)
The radius is one of the two large bones of the forearm, the other being the ulna. It extends from the lateral side of the elbow to the thumb side of the wrist and runs parallel to the ulna, which exceeds it in length and size. It is a long bone, prism-shaped and slightly curved longitudinally...
for below-elbow amputation
Amputation
Amputation is the removal of a body extremity by trauma, prolonged constriction, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for...
s, and in cases of congenital absence of the hand, to provide a pincerlike grasp that is motored by the pronator teres muscle
Pronator teres muscle
The pronator teres is a muscle of the human body that, along with the pronator quadratus muscle, serves to pronate the forearm .-Structure:...
. The prerequisites for the operation are a stump over 10 cm long from the tip of the olecranon
Olecranon
The olecranon is a large, thick, curved bony eminence of the forearm that projects behind the elbow.It is situated at the upper end of the ulna, one of the two bones in the forearm...
, no elbow contracture, and good psychological preparation and acceptance
The success of the Krukenberg procedure depends directly on the strength of the pronator teres, the sensibility of the skin surrounding both ulna and radius, elbow mobility, and mobility of the ulna and radius at the proximal radioulnar joint. Individual patient expectations and motivations, although more difficult to assess, probably play a major role in outcomes as well.
Advantages
The procedure is, in this time and age, mostly performed on patients in developing countries who lack the means to obtain expensive prostheses. In the Western world, the Krukenberg procedure is usually reserved for blind patients with bilateral amputations, because it can provide the patient with tactile sensation.The procedure preserves proprioception
Proprioception
Proprioception , from Latin proprius, meaning "one's own" and perception, is the sense of the relative position of neighbouring parts of the body and strength of effort being employed in movement...
and stereognosis
Stereognosis
Stereognosis is the ability to perceive and recognize the form of an object using cues from texture, size, spatial properties, and temperature...
in the functional stump and so allows for effective maneuvering. Once this procedure is performed, it does not preclude the use of a functional prosthesis giving the patient is afforded the option to use either functional strategy.
Objections are usually cosmetic, and indeed for this reason and for cultural reasons, in South America it is usually not done. While in developed countries the operation is rarely done, patients can prefer it to sophisticated prosethetics. In one case of a Dutch woman reported in 2002.
Initially after traumatic bilateral forearm amputation she was provided with mechanical prostheses. Eventually she stopped using them because she chose to use her bare stumps as pincers. She explained that being able to feel helped her a lot in her tasks... an excellent functional result was obtained, from both the surgical and the rehabilitation point of view. The patient lives with her family, takes care of the household, and does art and crafts, which she is currently selling, and is very happy with the procedure. A year and a half has gone by and she is still gaining dexterity and strength.
The patient "After this first procedure the patient also asked for the Krukenberg procedure for her left arm."
Noted patients
The German physicist Burkhard HeimBurkhard Heim
Burkhard Heim was a German theoretical physicist. He devoted a large portion of his life to the pursuit of his unified field theory, Heim theory. One of his childhood ambitions was to develop a method of space travel, which contributed to his motivation to find such a theory.During World War II,...
had two Krukenberg hands as a result of a laboratory accident.
External links
- Wrist and Forearm Amputations. emedicine
- Digital Amputations. emedicine
- Picture showing the completed procedure