Amputation Levels: Classification of Limb Removal Types

Summary

This document classifies amputations by the anatomical level at which a limb is removed, separately for the upper and lower limbs. It covers partial hand and foot amputations, disarticulations, and transhumeral and transtibial amputations, with brief notes on how each level affects prosthetic fitting, mobility and function.

Key points

Amputations are classified by the anatomical level at which the limb is removed, following anatomical regions.
Upper limb levels include partial hand, wrist disarticulation, transradial, elbow disarticulation, transhumeral, shoulder disarticulation and forequarter amputation.
Lower limb levels include partial foot (toe, ray, transmetatarsal, Lisfranc, Chopart), Syme's ankle disarticulation, transtibial, knee disarticulation, transfemoral, hip disarticulation, hemipelvectomy and hemicorporectomy.
A disarticulation removes a limb at a joint and preserves the joint function, which makes prosthetic fitting easier than higher-level amputations.
Higher-level amputations usually cause greater functional loss and need more complex prosthetics, while lower-level amputations offer better mobility with proper rehabilitation.

Test yourself

Amputations are classified based on the specific level at which a limb is removed. This classification typically follows anatomical regions and varies depending on whether it involves the upper or lower limb. This document provides a detailed breakdown by anatomical region:

Upper Limb Amputation Levels

Partial Hand Amputations (Transphalangeal)

Finger Amputation: Removal of one or more fingers at the distal, middle, or proximal phalanx level.
Thumb Amputation: Particularly significant due to its importance in grip function.
Metacarpal Amputation: Loss of part or all of the hand while preserving the wrist.

Wrist Disarticulation

Wrist Disarticulation: Amputation through the wrist joint, preserving the forearm bones.

Below Elbow Amputation (Transradial)

Short Transradial: Amputation close to the elbow, reducing leverage.
Long Transradial: Amputation closer to the wrist, allowing for better prosthetic control.

Elbow Disarticulation

Elbow Disarticulation: Removal of the forearm at the elbow joint, preserving the humerus.

Above Elbow Amputation (Transhumeral)

Short Transhumeral: Amputation closer to the shoulder, limiting leverage.
Long Transhumeral: Amputation closer to the elbow, allowing for better prosthetic attachment.

Shoulder Disarticulation

Shoulder Disarticulation: Amputation at the shoulder joint, removing the entire arm.

Forequarter Amputation (Interscapulothoracic)

Forequarter Amputation: Removal of the entire arm, shoulder girdle, and part of the scapula and clavicle.

Lower Limb Amputation Levels

Partial Foot Amputations

Toe Amputation: Removal of one or more toes.
Ray Resection: Removal of a toe and its associated metatarsal bone.
Transmetatarsal Amputation: Amputation through the metatarsal bones.
Lisfranc Amputation: Amputation at the tarsometatarsal joint.
Chopart Amputation: Amputation at the midtarsal joint (between talus/navicular and calcaneus/cuboid).

Ankle Disarticulation (Syme's Amputation)

Syme's Amputation: Removal of the foot at the ankle joint while preserving the heel pad.

Below Knee Amputation (Transtibial)

Short Transtibial: Amputation close to the knee, reducing leverage.
Long Transtibial: Amputation closer to the ankle, allowing for better prosthetic control.

Knee Disarticulation

Knee Disarticulation: Removal of the lower leg at the knee joint, preserving the femur.

Above Knee Amputation (Transfemoral)

Short Transfemoral: Amputation near the hip, reducing prosthetic control.
Long Transfemoral: Amputation closer to the knee, allowing for better leverage.

Hip Disarticulation

Hip Disarticulation: Removal of the entire leg at the hip joint while preserving the pelvis.

Hemipelvectomy (Transpelvic Amputation)

Hemipelvectomy: Removal of the entire leg along with part of the pelvis.

Hemicorporectomy (Translumbar Amputation)

Hemicorporectomy: Removal of both lower limbs along with the pelvis and lower abdominal structures.

Clinical and Functional Considerations for Amputations

Higher-level amputations (e.g., above elbow or above knee) typically result in greater functional loss and require more complex prosthetic solutions.
Lower-level amputations (e.g., partial foot, transtibial, transradial) offer better mobility and function with proper rehabilitation.
Disarticulations (e.g., knee or elbow disarticulation) preserve joint function, making prosthetic fitting easier compared to higher-level amputations.

FAQ

What is a disarticulation?

A disarticulation is an amputation made through a joint, such as the wrist, elbow, shoulder, knee or hip. The joint is removed rather than cut through the bone, which preserves the bone above it.

Why is a transtibial amputation easier to fit with a prosthesis than a transfemoral one?

The text states that lower-level amputations, such as transtibial, offer better mobility and function with proper rehabilitation. Higher-level amputations, such as above knee, typically result in greater functional loss and require more complex prosthetic solutions.

What is Syme's amputation?

Syme's amputation removes the foot at the ankle joint while preserving the heel pad. It is one of the ankle disarticulations listed in the lower limb levels.