The Krukenberg procedure, also known as the Krukenberg operation, is a surgical technique that converts a forearm stump into a

pincer Pincer may refer to: * Pincers (tool) *Pincer (biology), part of an animal *Pincer ligand In chemistry, a transition metal pincer complex is a type of coordination complex with a pincer ligand. Pincer ligands are chelating agents that binds tig ...

. It was first described in 1917 by the German army surgeon

Hermann Krukenberg Hermann Krukenberg (21 June 1863 – 3 October 1935) was a German surgeon who was a native of Calbe, Province of Saxony, Kingdom of Prussia. He was the brother of pathologist Friedrich Ernst Krukenberg (1871–1946). Krukenberg studied medicine at ...

. It remains in use today for certain special cases but is considered controversial and some surgeons refuse to perform it.Freire J, Schiappacasse C, Heredia A, Martina JD, Geertzen JH. (2005)
Functional results after a Krukenberg amputation
Prosthet Orthot Int. 29(1):87-92.

Procedure

The procedure involves separating the

ulna The ulna (''pl''. ulnae or ulnas) is a long bone found in the forearm that stretches from the elbow to the smallest finger, and when in anatomical position, is found on the medial side of the forearm. That is, the ulna is on the same side of t ...

and

radius In classical geometry, a radius ( : radii) of a circle or sphere is any of the line segments from its center to its perimeter, and in more modern usage, it is also their length. The name comes from the latin ''radius'', meaning ray but also the ...

for below-elbow

amputation Amputation is the removal of a limb by trauma, medical illness, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on indi ...

s, and in cases of

congenital absence A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities can r ...

of the hand, to provide a pincerlike grasp that is motored by the

pronator teres muscle The pronator teres is a muscle (located mainly in the forearm) that, along with the pronator quadratus, serves to pronate the forearm (turning it so that the palm faces posteriorly when from the anatomical position). It has two attachments, to t ...

. The prerequisites for the operation are a stump over 10 cm long from the tip of the

olecranon The olecranon (, ), is a large, thick, curved bony eminence of the ulna, a long bone in the forearm that projects behind the elbow. It forms the most pointed portion of the elbow and is opposite to the cubital fossa or elbow pit. The olecranon ...

, no elbow contracture, and good psychological preparation and acceptance. Garst, R.J. (1991)
The Krukenberg Hand
''The Journal of Bone and Joint Surgery'' 385(3) The success of the Krukenberg procedure depends directly on the strength of the pronator teres, the sensibility of the skin surrounding both ulna and radius, elbow mobility, and mobility of the ulna and radius at the

proximal radioulnar joint The proximal radioulnar articulation, also known as the proximal radioulnar joint (PRUJ), is a synovial pivot joint between the circumference of the head of the radius and the ring formed by the radial notch of the ulna and the annular ligament. ...

. Individual patient expectations and motivations, although more difficult to assess, probably play a major role in outcomes as well.

Advantages

The procedure is, in this time and age, mostly performed on patients in developing countries who lack the means to obtain expensive prostheses. It has been extensively used in the context of deliberate amputations as seen in the atrocities

Sierra Leone Sierra Leone,)]. officially the Republic of Sierra Leone, is a country on the southwest coast of West Africa. It is bordered by Liberia to the southeast and Guinea surrounds the northern half of the nation. Covering a total area of , Sierra ...

civil war. In the Western world, the Krukenberg procedure is usually reserved for blind patients with bilateral amputations, because it can provide the patient with tactile sensation.Swanson AB. (1964)
THE Krukenberg procedure in the juvenile amputee
J Bone Joint Surg Am. 46:1540-8. While the Krukenberg procedure's poor

cosmesis Cosmesis is the preservation, restoration, or bestowing of bodily beauty.''Dorland's Medical Dictionary''. 25th ed. Philadelphia: W.B. Saunders Co.; 1995 In the medical context, it usually refers to the surgical correction of a disfiguring defect, o ...

makes it very rare, it does preserve

proprioception Proprioception ( ), also referred to as kinaesthesia (or kinesthesia), is the sense of self-movement, force, and body position. It is sometimes described as the "sixth sense". Proprioception is mediated by proprioceptors, mechanosensory neurons ...

and

stereognosis Stereognosis (also known as haptic perception or tactile gnosis) is the ability to perceive and recognize the form of an object in the absence of visual and auditory information, by using tactile information to provide cues from texture, size, spat ...

in the functional stump and so allows for effective maneuvering. Once this procedure is performed, it does not preclude the use of a functional prosthesis giving the patient the option to use either functional strategy. While the operation is rarely performed in the modern age, patients can prefer it to sophisticated prosthetics, as in one case study of a Dutch woman, reported in 2002.

Initially after traumatic bilateral forearm amputation he patientwas provided with mechanical prostheses. Eventually she stopped using them because she chose to use her bare stumps as pincers. She explained that being able to feel helped her a lot in her tasks... an excellent functional result was obtained, from both the surgical and the rehabilitation point of view. The patient lives with her family, takes care of the household, and does art and crafts, which she is currently selling, and is very happy with the procedure. A year and a half has gone by and she is still gaining dexterity and strength. The patient in question also requested the procedure be completed on her other arm.

Notable patient

The German physicist

Burkhard Heim Burkhard Heim (; 9 February 1925 – 14 January 2001) was a German theoretical physicist. He devoted a large portion of his life to the pursuit of his unified field theory, Heim theory. One of his childhood ambitions was to develop a method of s ...

had two Krukenberg hands as a result of a laboratory accident.

References

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External links

Wrist and Forearm Amputations
emedicine
Digital Amputations
emedicine

Orthopedic surgical procedures Surgical removal procedures Types of amputations