When Are Elbow and Above-Elbow Amputations Performed?

Elbow and above-elbow amputations aim to preserve as much of the function of the elbow as possible. 

Amputation is the removal of a body part due to a pathological condition. This may include a limb or extremity such as an arm, leg, foot, hand, toe, or finger. It is usually due to an injury, disease, or surgery.

A prosthesis is an artificial limb used to help replace the loss of function from amputations. When deciding on a suitable prosthesis, the patient will normally have to choose between a functional and cosmetic prosthesis.

The surgical removal of an elbow or the arm above the elbow joint is called elbow amputation. Elbow and above-elbow amputations may be performed for the following reasons:

• Peripheral vascular disease (PVD): The risk factors include diabetes and blood clots.
• Osteomyelitis (an infection in the bones)
• Severe injury or accidents
• Surgery to remove tumors or infected area from bones and muscles

The levels of elbow amputations can be separated into three categories:

• High amputation near the metaphyseal (shoulder joint)
• Diaphyseal (mid-upper arm)
• Supracondylar (near the elbow joint)

Following are the major goals of an upper-extremity amputation surgery:

• Maximum preservation of function
• Durable coverage
• Preservation of sensation
• Prevention of damage to the important nerves
• Minimization of short- and long-term risks
• Early prosthetic fitting, when applicable
• Early return of the patient to work and daily routine

General anesthesia is considered for elbow and above-elbow amputations. The level of the elbow amputation will be determined by the surgeon by a thorough assessment. 

Often, the cause of the amputation will decide the level of the required amputation. For example, if the amputation is due to a severe injury or infection, the amount of arm that can be preserved will depend on the location of the injury. 

The surgeon will aim to preserve the arm length but will also require to be able to appropriately pad the remaining area to optimize the prosthetic (artificial) fitting.

• After the anesthesia is administered, the surgeon will monitor the patient’s vitals throughout the procedure. The surgeon will also start an intravenous line for pain and antibiotics.
• During the amputation, the surgeon will smoothen the end of the exposed bone to try and prevent any soft tissue injury from bony edges.
• The surgeon will separate the nerves and remove them from the site of amputation and place them in healthy soft tissues to reduce irritation from the prosthetic socket or any other unwanted sources of contact from the wound healing.
• The surgeon will then perform either a myoplasty or myodesis to stabilize the bone and soft tissues.
  • A myoplasty is a procedure in which the opposing muscles in the residual limb are stitched together to stabilize the arm.
  • A myodesis is a procedure in which the muscles are stitched to the bone.
• Both processes will work well to pad the remaining area and facilitate the use of prosthesis. The surgeon may also consider the functional limitations of amputation levels and prosthetic designs. Other factors that need to be considered are the individual’s occupation and their physical and emotional well-being.

After amputation, the patient would be on antibiotics and pain management for several days. After the surgery, the patient will be offered physiotherapy to assist in learning new skills, which will help the patient adjust to life with a missing part. 

The patient may wish to be fitted with a prosthesis that can help them carry out daily functions with minimal effort. Usually, the patient may take 12 to 18 months to recover from the surgery and learn to live without the amputated part. 

During this time, rehabilitation can be performed by a physiotherapist or occupational therapist. The physiotherapist will help the patient learn how to use the prosthesis and adaptive skills to compensate for the missing arm. 

Treatment will start when the individual is still in the hospital. Moreover, the physiotherapist will focus on maintaining and improving overall body strength and fitness levels. While the individual is still in the hospital, the physiotherapist will work with them to reduce muscle weakness and also to assist with recovery from the surgery.

Those who have amputations that are performed at the appropriate level and with proper surgical technique do very well. The complications are generally prevented or successfully managed. 

A patient’s attitude, motivation and desire before amputation strongly influence the overall outcome after the procedure. However, if proper follow-up care and rehabilitation are not coordinated with a multispecialty team of surgeons, physical therapists, physiatrists, prosthetists, and psychologists, then the recovery may be delayed.