Anatomical Classification of Limb Amputation Levels

Amputations are classified according to the anatomical level where the limb is removed. This classification is important for surgical planning, prosthetic fitting, rehabilitation, and functional outcomes.

Upper Limb Amputation Levels

Partial Hand Amputations

• Finger Amputation: Removal of one or more fingers.
• Ray Amputation: Removal of finger(s) including the metacarpal bone.
• Transmetacarpal Amputation: Amputation through the palm, across the metacarpals.

Wrist Disarticulation

The entire hand is removed at the wrist joint. This procedure preserves full forearm length but results in limited space for prosthetic fitting.

Forearm (Transradial) Amputation

Amputation performed through the radius and ulna. It is classified based on the percentage of forearm length preserved:

• Long Transradial: More than 55% of forearm length preserved.
• Medium Transradial: 30–55% preserved.
• Short Transradial: Less than 30% preserved.

Elbow Disarticulation

Amputation performed through the elbow joint. This retains full humerus length, providing better leverage, but often requires a bulky prosthetic fitting.

Above Elbow (Transhumeral) Amputation

Amputation performed through the humerus. It is classified based on the percentage of humerus length preserved:

• Long Transhumeral: More than 60% preserved.
• Medium Transhumeral: 30–60% preserved.
• Short Transhumeral: Less than 30% preserved.

Shoulder Disarticulation

The entire upper limb is removed at the shoulder joint.

Forequarter Amputation (Interscapulothoracic)

Removal of the entire upper limb, including the scapula and clavicle. This procedure is typically performed for malignant tumors or severe trauma.

Lower Limb Amputation Levels

Partial Foot Amputations

• Toe Amputation: Removal of one or more toes.
• Ray Amputation: Removal of the toe plus the corresponding metatarsal.
• Transmetatarsal Amputation: Amputation across the forefoot.
• Lisfranc’s Disarticulation: Amputation at the tarsometatarsal joint.
• Chopart’s Disarticulation: Amputation at the midtarsal joint (involving the talonavicular and calcaneocuboid joints).

Ankle Disarticulation (Syme’s Amputation)

Removal at the ankle joint, with the heel pad preserved for weight bearing.

Below Knee (Transtibial) Amputation

Amputation performed through the tibia and fibula. It is classified based on the percentage of tibial length preserved:

• Long Transtibial: More than 50% of tibial length preserved.
• Standard Transtibial: 20–50% preserved.
• Short Transtibial: Less than 20% preserved.

Knee Disarticulation

Amputation performed through the knee joint, with the femur preserved. This level allows for end weight bearing but often requires a bulky prosthesis.

Above Knee (Transfemoral) Amputation

Amputation performed through the femur. It is classified based on the percentage of femur length preserved:

• Long Transfemoral: More than 60% of femur preserved.
• Medium Transfemoral: 35–60% preserved.
• Short Transfemoral: Less than 35% preserved.

Hip Disarticulation

The entire lower limb is removed at the hip joint, while the pelvis is preserved.

Hemipelvectomy (Transpelvic Amputation)

Removal of the lower limb along with part of the pelvis. This is usually performed for malignant tumors or severe trauma.

Special Amputation Procedures

• Van Nes Rotationplasty: Used primarily in cases of malignant bone tumors. The ankle joint is rotated 180 degrees to function as a knee joint.
• Hindquarter Amputation: Similar to a hemipelvectomy, but sometimes includes removal of part of the sacrum.

Clinical Importance of Amputation Classification

The classification level determines prosthetic design and functional prognosis:

• More Distal Amputation: Generally results in better function and prosthetic control.
• More Proximal Amputation: Leads to higher energy expenditure and greater disability.