Friday 31 August 2018

2018-Amputations in Malvinas

Amputations in Malvinas

                             Eduardo C. Gerding 


Amputation is a surgical act that causes an ireversible change in the person subjected to it.  14  The amputation of a limb is a dilemma to which a doctor is submitted to under certain critical situations. Unsuccessful attempts to save an unrecoverable limb are associated with high morbidity and often result lethal to the patient.39

Military personnel are at grave risk for landmine and shrapnel injuries, amputation (occurring in 10%–16% of wounded soldiers) Roughly 3500 traumatic amputations are performed each year on soldiers, despite multiple preventive programs instituted by the military and other agencies.( Starnes BW, Beekley AC, and Sebesta JH. et al. Extremity vascular injuries on the battlefield: tips for surgeons deploying to war. J Trauma. 2006 60:432–442.)

In England and Wales there are more than 80,000 people who have lost one or more members: 27,000 due to wars and 60,000 due to injuries or illnesses. Approximately 3,500 new cases are sent to the 21 national prosthetic centers each year. 28

War injuries  have caused many disabled men, making Cambodia the country with the largest number of amputees per capita in the world. 28

This article delineates, in relatively simple terms, the experience in amputations among Argentine and British military  during the Malvinas conflict.

Without further digging into technical details, which are the responsibility of the orthopedic surgeon, this paper tries to contribute to a better knowledge for both the Argentine Association of Wounded in Malvinas and for the Subdirectorate of War Veterans through the Prosthesis Area of ​​the Special Benefits Department of the National Institute of Social Services for Retirees and Pensioners (INSSJP).

Historical background 2,41

There are references of Neolithic amputations of fingers which have been dated to about 5000 B.C. Amputations of hands were sometimes done as a mean of verifying numbers of prisoners taken in battle. 41
Artificial hands made of iron were used by knights in the 15th .An example of this is the Alt-Ruppin iron hand  found in 1863 in the River Rhine and that, endowed with a rigid thumb, allowed to flex the remaining fingers, in pairs, on the palm.28
Evidence of foot amputations performed in Peru in 300 BC has also been found. 41
Perhaps the first use of a limb prosthesis is that of a Persian soldier, Hegesistratus, who was reported by Herodotus to have escaped about 484 B.C. from stocks by cutting off one of his feet and replacing it with a wooden one. 2 . The oldest known artificial limb in existence was a copper-and-wood leg unearthed at Capri, Italy, in 1858, which was supposedly made about 300 B.C. 2,41
Verduin (1696) devised the first prosthesis with free knee joint. In 1800 James Pott, began the construction of wooden prosthesis, against the general opinion of manufacturing them in iron, as their weight prevented any effective function. Pott added to his wooden prosthesis, knee joints in steel and an articulated foot provided with tendons that provided a dorsal elevation when flexing the knee (this prosthesis was used and disclosed by the Marquis of Anglesey, and is known as the "Anglesey leg").28

Hippocrates described the use of ligatures, but this technique was lost during the Middle Ages. It was reintroduced in 1529 by Ambroise Paré, a French military surgeon. As a result, amputations were increasingly used as a salvage measure since the survival rate was much higher when ligatures were used. 2
In 1674, William Richard Morel introduced the tourniquet, which gave another impetus to amputation surgery. Paré  carried out the first procedure of disarticulation of the elbow in 1536. Sir James Syme described in 1843 a procedure for the amputation of the ankle.
The introduction of the antiseptic technique in 1867 by Lord Lister, a student and son-in-law of Syme, contributed greatly to the overall success of amputation surgery, as did the use of chloroform and ether at almost the same time.2
In 1898 Dr. Robert Rieder of the University of Bonn went to Istanbul to reform Turkish medical education and, while there, fell down fracturing his hip and leg. The treasurer of II. Abdűlhamit broke his leg and suffered 3 amputations.
 For this reason four army officers were sent to Paris to study prosthetics. The Turkish naval officer Hűseyin Rifat returned from Europe and established the first prosthetic workshop called Tersane-i Alati Nazikiye.
During the First World War, Ottoman Empire´s  naval officer Kazim Elgűn was sent to Vienna for 4 years to learn prosthetics and on his return he worked with Professor Dr. Besim Őmer Akaim. 4
The concept of kinematics to push upper extremity prostheses directly by muscle contraction was introduced by Giuliano Vanghetti in 1898. This last attempt thus to improve the function of the Italian soldiers to whom the Abyssinians amputated their hands. Vanghetti's partner, Antonio Ceci, performed the first such operation on humans in 1900.
 In Germany, Ferdinand Sauerbruch (1916) developed the skin-lined muscle tunnel. In Argentina, in the 1920s. Guillermo Bosch Arana carried out clinical studies of this procedure .2
In Great Britain, the Limb Fitting Centre at Queen Mary's Hospital, Roehampton, expanded its research effort shortly after the end of World War II and became known as the Biomechanical Research and Development Unit. 2


Indications 5

1. Extremities with severe compromise of skin, muscle, bones and irreparable nerve injuries.
2. Severe local infection which, despite adequate surgical measures and antibiotic treatment, endangers life.
3. Death of the limb, vascular gangrene when the vascular repair fails or is impracticable.
4. Massive septic gangrene. Cellulitis or anaerobic myositis confined to a single muscle group can be treated with resection and hyperbaric chamber.

Objectives of the Primary Amputation 5

1. Resect all dead, contaminated and blunt tissue.
2. Allow primary deferred closing
3. Leave a stump acceptable for later equipment

Note: Method of urgency. This amputation, also called  ¨in sausage¨, has its precise indications in emergency surgery; it is proposed, above all things, to save the patient´s . It is performed when a severe trauma has destroyed part of a limb and presents a large, bloody surface that has been in contact with septic bodies; it is also indicated in cases of severe septic processes, particularly due to anaerobes.

Primary Deferred Closure 5

The experience of the Service of Traumatology of the Malvinas Military Hospital in 1982 confirms the validity of the concept of primary deferred closure in serious limbs wounds , open fractures and stumps. 6

Characteristics of a good stump 28
The most suitable length of a stump is that which best preserves comfort, function and aesthetics. The ideal length for amputations below the knee is 12 cm and never more than 15 cm.
All surgically good stumps must meet the following three conditions:

􀂃 Softly conical shape.
􀂃 Normal sensitivity.
􀂃 Scar properly located and mobile.

Morbidity and mortality among civilians 36

In Argentina, 48% of amputations are due to diabetes.13

The greatest frequency of amputations due to trauma is found in the decade from 41 to 50 years; due to illness, between 61 and 70 and, due to tumors, between 11 and 20 years.28

Of the 146 patients with traumatic lower limb amputations attended at the Trauma Center of the University of Maryland (USA) 9% died during admission and 3.5% died after being discharged. 67% of the patients were men and 75% were white. 60% of the amputations were in patients under 40 years of age. The most frequent location of amputations is in the lower extremities (10: 3 in relation to the upper extremity).

A study conducted in the Surgical Department of the Municipal Hospital of Arhus (Denmark) on 109 amputee patients revealed that two thirds of them could walk with a prosthesis but only half of them could do it with full capacity. The ability to walk and not suffer pain was better in the infrapatellar than in the suprapatellar amputees. (Acta orthop. scand. 45. 97-104,1974)

Cause of disability due to amputations

Studies reveal that the most frequent causes of disability after a traumatic amputation of lower limbs are: 1) Psychological illness, 2) Decrease in physical and vocational functionality, 3) Increase in cardiovascular morbidity and mortality. 29,33,35

The psychological damage 17

Traumatic amputations are often linked with intense fear, horror, images of others being injured, and startling sounds that resurface during rehabilitation (even in the absence of full criteria for PTSD).        (  Parkes CM.. Psychosocial transitions: comparison between reactions to loss of a limb and loss of a spouse. Br J Psychiatry. 1975;127:204–210. ) (Bhuvaneswar, Chaya et al-Reactions to Amputation: Recognition and Treatment-Prim Care Companion J Clin Psychiatry 2007;9(4):303-308)

A review in India of men with lower limb amputations due to traumatic causes revealed a prevalence of psychiatric disorders in 32% to 84%, including depression (10.4 to 63%), PST (3.3 to 56.3). %) and Phantom Limb phenomenon (14 to 92%) .40

Prostheses only become a substantial help in the treatment of these psychic alterations when they manage to adapt to the body schema in a dynamic sense. 28

IRegarding this,  Argentine war veterans have the support of the Islas Malvinas Armed Forces ´Health Center

Complications of  BKA amputations

The possible complications of  BKA are due to: 1) Anesthesia, 2) Infections, 3) Vascular and nervous lesions, and 4) Bleeding and blood clots.

Possible post-amputation disorders 37

1. Continuous nervous pain
2. Phantom limb
3. Bone spur (heterotopic ossification)

Note: A study conducted at the University of Maryland Trauma Center on 146 amputees revealed that a quarter of them had disorders with the residual limb including Phantom Limb Syndrome.36

Phantom Limb  32

A phantom limb is the sensation that an amputated or missing limb  still attached. Despite a great deal of research on the underlying neural mechanisms of phantom limb pain there is still no clear consensus as to its cause.

Note: According to Bosman et al, the protective factors of the Phantom Limb are: 1) Being a male, 2) Amputation of the lower limb and 3) Interval of time since the amputation.3

Experience of the Argentine Military Health Service 7
Ceballos et al published a review of 439 medical records of  surgical patients injured during the Malvinas war . It was necessary to perform 40 amputations and half of them where at the toes level.

Surgical pathology of limbs caused by combat actions-Cases admitted at the Military   Puerto Argentino (April 12nd to June 15th, 1982). Data represents 22% of the 1990 patients admitted to the hospital in the same period.

                                                                                          No              %
Combat injries:
            Sharpnel                                                       183             41.7
            Bullets                                                                    76              17,3
            Explosions                                                               7               1,6

Combat related conditions
            Trench foot                                                    173             39.4
           Total                                                                      439            100,0

Note: It is suspected that some of the bullet wounds were self inflicted

                                                                         Shrapnel injury


Location of wounds by projectiles and anti-personnel explosives admitted at  the Military Hospital of Puerto Argentino. Those wounded in the limbs represent 73.7% of 361 cases of casualties war admitted in the same period.
                                                                                              No              %
Limbs                                                                           266              73.7
Thorax                                                                                   23                6,4
Abdomen                                                                              13                3,6
Head and neck                                                                     8                 2,2
Multiple wounds and others                                             51              14,1
Total                                                                                    361              100,0

Wounded by weapons of war admitted at the Military Hospital of Puerto Argentino, discriminated  by agent.
                                                                                         No              %
Sharpnel                                                                     256            70,9
Bullets                                                                                  83            23
Blast                                                                                      15             4,2
Mine                                                                                       5             1,4
Granade                                                                                2             0.5
Total                                                                                  361           100.0

Note: 90% of gun shot injuries were in the limbs and 48% in hands and feet.

Open fractures  fractures caused by war weapons admitted at the Military Hospital of Puerto Argentino. Injuries by anti-personnel explosives (foot of mine and hand granade) are not included

                                                            Shrapnel      Bullet                  Total
                                                                                                           No        %
Femur                                                      3              -                      3         4.6
Shin bone                                                4               2                     6         9.1
Fibula                                                       1               1                     2         3.0
Foot bones                                              2              21                  23      34.8
Humerus                                                 7               -                      7       10.6
Radius and ulna                                     1               2                     3         4.6
Radius                                                      2              -                      2         3.0
Hand bones                                            1              19                  20       20.3
Total                                                      21              45                  66     100.0

                              (Kindly submitted by War Veteran Silvia Barrera)
 British Army war veteran Col (Ret) James Michael Ryan and on his left the Argentine Sergeant War Veteran Juan  Gualberto Vallejos, a native of Corrientes who belonged to the  Company A of Regiment 3 who lost his right leg at Wireless Ridge towards the end of the war. He fought 67 days.  As he says "I was 25 years old when the conflict happened, and  thanks to my family I read the gospel and the message that  God had for me. This last  allowed me to overcome the   psychic, social and emotional problems, set aside the  resentment and preach the Word of the Lord. " The veteran is   pastor of an evangelical church and since 2006 provides material and spiritual assistance at the Heroes Generation Foundation.  (El Litoral.com.ar)

Amputations per trench foot made at the Puerto Belgrano Naval Hospital 24

11 patients were amputated. In all cases, emergency were performed, leaving the stump open.
The amputees were treated in the hyperbaric chamber in the pre- and post-operative stages. In all cases the amputation was indicated by suppuration of the lesions.
The level of amputation was as follows:

Middle third of leg                                                     2
Upper ankle joint                                                       2
Tarsus metatarsal                                                8
Metatarsal-phalanx                                                      2
Partial amputation of fingers both feet                    3
Big toe                                                                               1

Antibiotic therapy: Antibiotic treatment was performed in 30 patients. 52% of the cases. In mild injuries (stage 1) antibiotics were not administered. In severe injuries (stage 5) antibiotic therapy was performed according to the antibiogram

Experience of the British Military Health Service 19,26

Amputations in the British Armed Forces in Malvinas
Two years after the end of the Malvinas conflict, the British had 38 amputations (32 major and 6 minor amputations), of which 23 corresponded to the Army.
At least 51 British soldiers have suffered amputations due to injuries suffered in Afghanistan, surpassing the Malvinas figures.21

Note: Captain Harry Parker, son of Lieutenant General Sir Nick Parker, the third officer in seniority of the British Army lost his leg by a bomb while patrolling in Afghanistan and, although the doctors struggled two weeks to save his limb ,they were unsuccesful.


Complete traumatic amputation                   13
Gross disruption                                                           7
Primary vascular damage                                           2
Secondary vascular insufficiency                              1

Note: A typical example is the case of Parachutist Eric Baker (71) years of Doncaster, South Yorkshire who suffered a fracture in the Malvinas between the 4th and 5th finger. The fracture became infected. He was admitted and his leg had a BKA. He had to be re-admitted for gangrene and a new cut  7.5 cm above the knee was made.31

Distribution of Amputation

Above knee                                                7(2)
Through knee                                            1
BKA                                                       11 (7)
Above elbow                                              2
Below elbow                                              2(2)
Total                                                           23(11)

Note: The figures in parentheses are  cases that occurred after the cease-fire. 48% (11) of the amputations occurred after the cease-fire. Amputations of fingers secondary to burns are not included. If we exclude the 11 cases, the amputation index was approximately 2.5%. None of the patients who arrived at primary surgical care died. There were no cases of amputations as a result of clostridia.

                   Land mines


Wounding agent

Anti personnel   mine                            9(5)
Mortar/Artillery                                             3
Gun shot                                                          3
Bomb                                                                2
Sidewinder                                                      -(4)
Booby trap                                                      -(1)
High Explosives                                             -(1)


Note: United Nations personnel suffered 174 incidents with antipersonnel mines, anti-tank mines and booby traps in Yugoslavia between September 1992 and June 1995. There were 204 injuries and 20 deaths. 32.4% were outside the minefield demarcation zones, 17.1% in seemingly demined fields, 13.9% were non-avoidable and 6.9% were mines lost in time. 5

Antibiotic administration first 24hs

Benzyl Penicillin                                               9
Benzyl Penicillin with other Penicillins               5
Benzyl Penicillin with Metronidazole                   1
Triplopen with Metronidazole                               1
Other Penicillins alone                                            5
Ampicillin and Metronidazole                               1
Tetracyclin/Erythromicine with                            1

The Malvinas War medics who had to amputate limbs with a Swiss Army penknife - and no anaesthetic .30,34

On May 28, 1982, during the combat of Goose Green, British soldier Dave 'Chopsey' Gray received a mortar hit that ripped his right leg, tearing left full with shrapnel. Gray was in a crater flooded with his own blood.
Corporal Lancer Bill Bentley from Manchester came to assist him and realized that he had to have his right leg amputated. He took out the only thing he had: his Swiss Army penknife and, without anesthesia cut the tissue from which the leg still hung. Then applied a tourniquet on the stump.
Gray was carried on a stretcher under heavy fire to the aid station where Captain Steven Hughes paramedic was to assist him. Gray reacted only with the third liter of blood transfused. Hughes was to attend 34 Paras and twelve Argentines.
Bentley, who joined the Army in 1970, and served for 17 years, received four medals including the Military Medal for Courage and the South Atlantic Medal with Rosette. Bentley subsequently sold his medals which were auctioned at more than 30,000 pounds.

Resusitation-Intravenous fluid administration.
                                                              Cases    Average            Range
Hartmann´s solution (litre)                 23                 1,5              0.3-3
Blood(Units)                                            15                 3.4              2-7
Polygeline (Haemaccel)500ml            13                  1.7              1-3


1. Analgesia: All British patients were administered a dose of Omnopon in the field through a syringe containing 30 mg of the drug. In those cases in which a delay in the evacuation was anticipated, two doses were administered. However in two cases the analgesia was totally ineffective. Jackson et al suggest that administration of sublingual Buprenorphine would have been better.26
2. Tetanus immunization: The 23 cases received 0.5 ml IM of antitetanus toxoid in the resuscitation phase.
3. Evacuation: Under very risky situations stretchers, a Volvo BV202 vehicle and helicopters were used.

Note: Omnopon 10 contains 6.72 mg / ml of Morphine HCL, 0.6 mg / ml of Papaverine HCl and 0.52 mg / ml of Codeine HCl. The Omnopol 20 is equivalent to 10-15 mg of Morphine.

Rehabilitation of British patients

When returning to UK all amputees were referred to Limb Fitting Center. They received their protheses within 24hours. Only 1 of the 12 BKA and 5 of the 8 above the knee had stumps of a conventional accepted length. In some cases the rehabilitation was remarkable. 3 of 12 BKA passed the physical fitness tsts. It is expected that 3 more will do it as well. One of them is employed as a physical training instructor . Four of the BKA group, including those with doublé amputation were discharged. Of the 8 amputees above the knee, the rehabilitation was less striking and onbiously none can run. 6 have been discharged.With regard to upper limb amputees, one was discharged. In this type of amputee the anual test of aptitude in the use of personal weapons is a problem. Of the three patients who continue in service, two approved this test.


The British Army has received many criticisms regarding the compensations offered to the personnel. The British Legion noted in 2007 that a RAF civilian stenographer who had lost his thumb got 484,000 pounds while a 23-year-old paratrooper Ben Parkinson who required lifelong support for stepping on an antipersonnel mine received 152,150 pounds. 9

The American program of comrade and mentor for the amputated war  veteran.

The US Veterans Administration Amputee Assistance System works in conjunction with the Amputee Coalition providing a successful Amputee Veteran Companions Program that acts as mentors. Contact is established among veterans who have suffered the same type (and cause) of amputation and parallels in sex and age.38

Return to active service

A study conducted by Kisbaugh (1995) found that only 11 of the 469 (2.3%) of the amputated American soldiers re-entered the service in 1980. They presented partial amputations of foot, hand and infrapatelares.18
Nonetheless, and due to new technologies according to the US Army. At least 167 soldiers with major amputations have remained in active service since the beginning of the war in Afghanistan and Iraq.27
The factors that limit the re-entry of amputees to active service are:
1. Complications in the healing of the limb.
2. Loss of multiple limbs
3. Phantom Member Syndrome
4. Disturbances that limit the use of the prosthesis
5. Decrease in functional capacity
6. Traumatic brain injury
7. Delayed psychological adaptation to amputation
8. Loss of self-confidence to reintegrate.


Approximately 600 US war veterans participate in Orlando's Wheelchairs Competition, stimulating them to have healthier and more active lives.44

In 2017 the Chaqueña Selection for Amputees made a demonstration of discipline in Villa Ángela.

Inability and Disability

Inability in the workplace is the situation in which a worker is not qualified to perform a job or any job, depending on the degree of inability. In Argentina, 12.9% of the population has a permanent difficulty or limitation.12
The most common inability is the visual one (in Argentina, 264 thousand people suffer it), then the motor one (110 thousand); the auditory follows (72 thousand) and finally the cognitive one (55 thousand) .21
A worker can be disabled and have no inability or vice versa.
Example: A person with hemophilia has a 33% disability but is perfectly capable of working. A worker with chronic depression may have a total permanent inability for his or her usual job as a truck driver but does not have any degree of disability.11

Valuation table for permanent inabilities 43

By amputation of the muscle, between the hip and the knee, from 70 to 80%.
By amputation of the leg, between the knee and the neck of the foot, from 55 to 65%
For the total loss of the foot, from 50 to 55%
For the mutilation of a foot with heel conservation, from 35 to 45%
For the tarsal-metatarsal disarticulation, from 25 to 30%

In Argentina there is the National Rehabilitation Service (SNR) located in Ramsay 2250 (0800-555-3472) that extends the Single Certificate for Disability. This last is a public document determined by a medical board, which is granted to any person who requests it and who has a functional, permanent, transient or prolonged physical, sensory or mental impairment. That in relation to their age and social environment imply considerable disadvantages for their adequate family, social or work integration. This certificate allows access a series of rights and benefits given by laws 22.431 and 24901. The procedure is free.


In medicine a prosthesis  is an artificial device that replaces a missing body part, which may be lost through trauma, disease, or congenital conditions.


An orthopedic appliance or apparatus used to support, align, prevent, or correct deformities or to improve function of movable parts of the body.e.g. splints. The orthosis complements but never replaces.

Parts of a prosthesis

  • The internal frame, or skeleton, of a prosthetic limb is called the pylon.  
  • The socket is the part of the prosthetic device that connects to the patient's residual limb or limb stump.  
  • The suspension system keeps the prosthetic limb attached to the body.


Microprocessor is an integrated circuit that contains all the functions of a central processing unit of a computer.
The C-Leg is the first prosthesis that has a hydraulic system in the world controlled by a microchip. With the use of the unique C-Leg technology, a new level of comfort, safety and mobility has been established for transfemoral amputees.
The Smart Adaptive has a microchip control. Its sensors analyze speed, slope, stairs and other parameters.

Amputation levels

1.      Hemipelvectomy
2.    Hip disarticulation
3.    Transfemoral (Above the knee)
4.    Transrotuliana
5.     Transtibial( BKA)
6.    Ankle disarticulation
7.     Fingers partial amputation

Leg amputation

1.Transfemoral (above the knee)


Socket systems

1.     Conical
2.   Quadrangular
3.   Cat Cam 16

2.Transtibial (BKA )
Socket systems for BKA                                                                                                                                                                               
 Non health profesional may skip this section.  

Basically they are: 1) SSWB (Specific Surface Weight Bearing): a) Type PTB (Patellar Tendon Bearing), b) Type PTS (Patellar Tendon Suspension), c) Type KBM (Kondylen Bettung Munster) and 2) TSWB (Socket with system of discharge and total contact): a) Lace to Suction and b) Harmony System (polyurethane liner).
In the PTB, the stump relies mainly on the Subrotulian zone.
The most frequent error observed with the PTB socket is an excessive adjustment in the popliteal area of the stump. 15. The KTB improves the knee lateral stability.


KBM tibial prosthesis with adjustable foot in equine for underwater activities such as snorkeling.

Nota: In U.S.A. The Hanger Clinic manufactures the ComfortFlex® socket that accommodates bone, muscles, vessels, tendons and nerve structures to the residual stump of each patient. It uses a three-dimensional laser system called Insignia ™ Laser Scanning.


Knee prosthesis

They are made of titanium, steel or aluminum. There are more than 50 models.

1. Single axis knee: As a hinge.
2. Polycentric knee: It has a more natural twist
3. Intelligent knee: Controlled by microprocessor.


 Foot amputations

1. Chopart: The foot with an amputation at the level of the Chopart joint can be difficult to fit, since there is a remarkable muscular imbalance that tends to place it progressively in equine and varus.
2. Lisfranc (Tarsometatarsal)
3. Trans-metatarsal

They are made of titanium, steel or aluminum. There are more than 50 models.

1. Single axis knee: As a hinge.
2. Polycentric knee: It has a more natural twist
3. Intelligent knee: Controlled by microprocessor.

Note: Syme or Transmaleolar type amputation: Developed in 1842 by James Syme, Scottish surgeon, this amputation is done leaving the tibia and fibula practically intact. It consists of a transmaleolar section 0.6 cm above the articular surface of the tibia and talus. The tissues of the heel are preserved to cover the stump, which allows the patient to lean directly on it and support its weight, facilitating walking without prosthesis inside the house. It is indicated in lesions of the foot with loss of tissues in the vicinity of the tarsometatarsal joints.

Foot prosthesis:
There are more tan 200 foot prosthesis types.

1.     SACH (Solid Ankle Cushion Heel): The cushion of the heel absorbs the impact much like the plantar flexion of a conventional ankle. 42

2. Dynamic
3. Articulated
4. Energy Vector Optimization EVO. LP Vari-Flex with EVO Ossur.20

The partial foot amputation has a very limited range of prostheses available to use as a treatment, with most options seeming to concentrate on the appearance of the foot rather than the functionality.23

(Kindly submitted by Ally Lou-Nobel China Limited, Liaobu, Dongguan, Guangdong, China-www.nobel.hk )

Energy saving prostheses

-Hafner,Brian, BS; Joan E. Sanders, PhD; Joseph M. Czerniecki, MD; John Fergason, CPO Department of Bioengineering, Department of Rehabilitation Medicine, University of Washington, Seattle- Transtibial energy-storage-and-return prosthetic devices: A review of energy concepts and a proposed nomenclature- Journal of Rehabilitation Research and Development Vol. 39 No. 1, January/February 2002 Pages 1–11

Flex-Foot Cheetah

Created by 22 years old Van L.Phillips (who lost his foot in a wáter skiing accident)in collaboaration with an aerospace company. It´s the only foot prothesis which took part in an Olympic game. In UK it costs about   £ 3700 the pair. 23

                                                       Prosthesis for finger amputation
See  The Evolution of the Robotic Hands -The New York Times Agosto 1,2018: https://www.nytimes.com/es/interactive/robots-manos-avances/?rref=collection%2Fsectioncollection%2Fnyt-es

The Bionic hand


Around 600 people in Britain lose upper limbs each year. Current prosthetic hands work by picking up electrical signals from the stump, but controlling them requires practice and concentration. A bionic hand sees an object and reaches for it automatically without thought.The prosthetic is fitted with a camera which takes a picture of the object in front of it, assesses its shape and size then triggers an appropriate grasping movement.The device is ten times faster than current bionic limbs, and uses artificial intelligence to continually improve its detection and picking-up skills. For the first time in a century, they had developed an ‘intuitive’ hand that can react without thinking. The computer isn’t just matching an image, it’s learning to recognise objects and group them according to the grasp type the hand has to perform to successfully pick it up. (Sara Knapton-Bionic hand which see and reaches for objects automatically to be trialled by British amputees –The Telegraph 3 May 2017).

Scientists in Rome have unveiled the first bionic hand with a sense of touch that can be worn outside a laboratory. The prosthetic hand has sensors that detect information about whether an object is soft or hard.These messages are linked to a computer in a rucksack that converts these signals into a language the brain will understand. (Fergus Walsh-Woman receives bionic hand with sense of touch-BBC News 3 January 2018)

It took less than a year since that first hand prosthesis that the innovators Gino Tubaro and Rodrigo Pérez Weiss printed in 3D for Felipe Miranda, an eleven-year-old boy. Tubaro won a History Channel award and began working at the Technological Innovation Center. It was set as an example by the President of the United States. Barack Obama. (Clarin, 3/23/16)
Nicolás Bantar, is one of the ambassadors in Paraná, together with Matías Agüero, of the NGO AtomicLab, a non-profit non-governmental organization that prints prostheses of hands and arms in 3D and gives them free of charge to those who need it.

nodaltec.am /2015/05/jovenes-disenan-una-protesis-de-mano-3d-hiperrealista-y-economica/

Prostheses used in the United Kingdom

The The Limbless Veterans (Blesma ), founded in 1930, is a British charity that helps all men and women in service and out of duty who have lost limbs or eyes. They follow the guidelines of prosthesis dictated by the National Health Service (NHS)8,45
For most primary amputations below the knee (BKA), they use a PTB (Patellar Tendon Bearing) socket with an internal lining and some type of suspension with silicones. 10
In the case of foot amputations, the British usually indicate the Pro-Flex ®XC. Not only is it useful for walking normally but it is also suitable for those who run or take long walks.
For transfemoral amputations, they use an internal lining called Iceross® Seal-In® liners. 10
The NHS provides prostheses with microprocessors in the cases in which it is indicated.8

                                       Pro-Flex ®XC

Argentine engineer Matías Menghini designed and built a functional prosthesis of knee and foot flexible prosthesis that will allow, in the near future, to replace successfully the expensive prosthesis of imported origin that now dominate the local market .(Diario Jornada-16 / 3/15) and (Argentina Investiga 13/4/15)


Osseointegration, a process that links the prosthesis directly to the skeleton, can improve the comfort and mobility of amputees
Commander Jonathan A. Forsberg, orthopedic oncologist at Walter Reed National Military Medical Center in Bethesda, Maryland, and a researcher at the Naval Medical Research Center, treats patients who have suffered recent injuries and those who have been living with amputations for many years.
"The development of osseointegration, as a capacity within the Department of Defense, satisfies our commitment to provide advanced solutions for the entire spectrum of combat casualty care," said Forsberg. Although clinical trials have been conducted for osseointegration in other parts of the world, the Walter Reed clinical trial is the first of its kind to be conducted in the United States.
The first patient of the program was former Sergeant Michael Frazier. In May 2011, Frazier stepped on an improvised explosive device in Trek Nawa, Afghanistan, losing both legs from the explosion. This patient received another type of osteointegrated implant from Potter and Forsberg: the Compress® Transdermal Implant funded by the Department of Defense.


A person who does not receive a prosthetic within 2 years of amputation has a greater likelihood of social welfare.
For patients without health insurance, a prosthetic leg typically costs less than $10,000 for a basic prosthetic leg up to $70,000.A  computer-assisted prosthetic leg which controlls muscle movements costs $20,000 or more.
The C-Leg computerized prosthetic leg by Otto-Bock, for above-the-knee amputees, can cost as much as $50,000, or up to $70,000 or more, including the prosthetic foot.
RSL Steeper, creator of the Bebionic artificial hand, has just announced that the hand will be offered at a price of $11,000 (€9000) around the world. Amputees control the prosthetic limb using my-oelectric sensors that read signals on the surface of the skin from residual muscle.

Skinning, poem of  Colombian writer Darío Jaramillo 46

Without foot my body keeps loving the same and my soul goes out to the place that I no longer occupy, outside me: No, there are no symbols here, the body adapts to the passion and passion to the body that loses its fragments and continues intact , untouched without mysteries .
Against death I have the look and the laughter, I am the owner of my fríend´s  hug  and of the dull beat of an anxious heart.
Against death I have pain in a foot that I no longer have, a pain as real as death itself and a huge desire for caresses, kisses, to know the proper name of a tree that overlooks me, to aspire a lost perfume that I pursue , to hear certain songs whose fragments I remember , to caress my dog, to ring the phone at six in the morning, to follow this game.

Note: Darío Jaramillo, author of Memories of a Happy Man, lost one of his legs as a result of a mine that was not destined for him in Bogotá in 1982.


Questions are always more important than answers. There is no unified registry of the amputations carried out in the Malvinas and many files are still in the process of being digitized. It would be interesting to know how many amputees (and other disabilities) exist per province, how they evolved and if they have sports activities that imply reviewing the type of prosthesis.


-Chenier, Brian-Support Officer Prosthetics-British Limbless Ex Service Men´s Association (Blesma)- www.blesma.org.  UK
- Clasper, Jon CBE DSc DPhil DM FRCSEd(Orth), Col L/RAMC,
Emeritus Professor & Consultant Orthopaedic Surgeon,Military Clinical Director DMG (SE), Visiting Professor in Bioengineering, Imperial College London, Clinical Lead, The Royal British Legion Centre for Blast Injury Studies-UK
-Dra. Diaz Rolon, Gabriela-Chief of Physiatry -Instituto Nacional de Servicios Sociales para Jubilados y Pensionados (INSSJP).Argentina.
- Henson, Dave MBE, Department of Bioengineering, Imperial College London, South Kensington Campus. UK
-López, Marcela-Librarian-Library of the Argentine Medical Association. Argentina
-Iglesias, Carlos Col.-Medical Director of the Argentine Army Central Hospital  Cirujano Dr. Cosme Argerich. H Gral 601.Argentina.
-Lou, Ally-Nobel China Limited- Bohui industrial park, Panlong Road,    Yaole 523428, Liaobu, Dongguan, Guangdong, China.
- Ryan, James Michael  Cnel War Veteran OBE, OStJ . 
MB, BCh, BAO(NUI), MCh (NUI) (University College Dublin), FRCS(Royal College of Surgeons of England),Hon FRCEM (CEM)         ( Fellow of the College of Emergency Medicine ),DMCC (SoA)(Society of Apothecaries of London).UK
-Tyler, David-National Health Service(NHS). UK
- Szymczak, Marcos- Captain Medicine Doctor (Ret)War Veteran  -Former surgeon of the Puerto Argentino Military Hospital- Author of A surgeon in Malvinas published by the Instituto de Publicaciones Navales. Argentina

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43-Tabla de Valuacion de Incapacidades Permanentes


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