Krukenberg amputation & its

management
Poly Ghosh
NILD, Kolkata
 Introduction
• The Krukenberg procedure separates
the forearm bones in a manner similar
to a syndactyly release to provide
sensate grasp for a child who lacks
one or both functioning hands.
• It is particularly useful in regions of
the world where the availability of
prosthetic devices is limited and costs
are prohibitive.
 Advantages
• Patient in addition to being able to grasp objects without using a
prosthesis, has the ability to feel objects that are being grasped
 Indication

1. Vision impairment:
blind children because it results in a sensate limb, which allows the child tactile
exploration, interaction, and feedback from his or her environment
• Sighted children with unilateral or bilateral deletions also derive functional
benefits from the procedure
• reconstructive alternative for children with congenital absence of the hand,
particularly in those with profound contralateral abnormalities, associated
blindness, or a lack of access to prosthetic care
2. Forearm length: In children 5 to 6 years old, the residual limb
length should be at the transcarpal or wrist level. In older
children, deletions at the midforearm level or longer can be
functional
3. Age:-
• developmentally 4 years of age or older a
• Children should have sufficient psychological development to
understand and cooperate with the postoperative exercise
program
4. Cultural and Geographical Considera tion:
• Children with upper limb injuries caused by land mine explosions
. In countries where explosive remnants of war are an important
problem, there is often substantial social disorder and poverty, and
prosthetic facilities are rare
5. Anatomical Consideration: The skin of the forearm must have good
sensation. Residual limb lengths of at least 5 cm are recommended.
 Contraindication

• if there is a radioulnar synostosis or

substantial elbow abnormality
 Cosmetic appearances vs. function
• The extraordinary dexterity provided by a Krukenberg limb allows
more natural motion than that achieved using a prosthesis
 Surgical technique
• The forearm incisions are designed to provide as much skin coverage
to the distal residual limbs as possible.
• Any skin distal to the wrist is preserved for use in covering the distal
pincers.
• The forearm bones are separated by incising the interosseus
membrane to its proximal extent.
• preserve two musculocutaneous flaps
• One flap includes the brachioradialis and the extensor carpi radialis
muscles. This flap should not be separated from the radius.
• ulnar flap and includes the flexor carpi ulnaris and the extensor carpi
ulnaris. This flap should not be separated from the ulna.
• Sensory nerves should be preserved.
• The integrity of Pronator teres should be maintained at all costs, as it is
the prime motor for the pincer (the other stabilizer is supinator)
• Sufficient debulking of finger flexor (flexor digitorum superficialis and
FDP) and extensors should be done in order to get maximum full
thickness cover of pincers
• The most important muscles to preserve are the flexor carpi ulnaris, the
extensor carpi ulnaris, the brachioradialis, and the pronator teres.
• separating the forearm bones, as much separation as possible should
be obtained without injuring the capsules of the proximal radioulnar
joint or the radiocapitellar joint.
• The length of the pincers is determined by the distance between the
attachment of the pronator teres to the radius and the end of the radius.
• The forearm bones should be of equal length.
• It is desirable to have 6 to 8 cm, but a shorter distance can be tolerated,
especially when distal growth is anticipated. In older children, the
forearm bones can be shortened for better closure.
• Longer pincers have less strength
at the tips, but they have a larger
grasping potential.
• Active exercise can begin in 2 to 3
weeks and should be focused on
grasp and release rather than
pronation and supination
 Failed to use krukenberg
amputation
• Funstional or cosmetic prosthesis can be
used.