Optimizing Transhumeral Amputations

• Published in: Operative techniques in orthopaedics 2023-09, Vol.33 (3), p.101057, Article 101057
• Main Authors: Larsen, Christopher G., Griffis, Martin, Tanner, Natalie, Tedesco, Liana J., Ayalon, Omri B.
• Format: Article
• Language: English
• Subjects: amputation; considerations; neuroma; prosthesis; surgical technique; targeted muscle reinnervation; upper extremity
• ISSN: 1048-6666; 1558-3848
• DOI: 10.1016/j.oto.2023.101057

Transhumeral amputations have historically been plagued by high rates of neuroma formation, neuropathic pain, poor prosthetic fitting, and low prosthesis use rates. Recent advances in adjunct surgical techniques are promising for excellent reconstructive and functional outcomes for these patients. A surgical approach addressing all aspects of the residual extremity, including bone, soft tissues, and nerves, will result in superior outcomes and fewer complications. Humeral osteotomy techniques shorten the residual extremity to create a lever arm, which improves prosthetic fit and functionality. Use of myodesis and myoplasty provides a stable soft tissue envelope around the residual bone ends to minimize tissue redundancy. Nerve interface procedures, such as targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI), reduce the likelihood of neuroma formation and rates of phantom limb pain while increasing the number of electromyographic signals that can be detected by a myoelectric prosthesis. Osseointegration, a promising new bone-anchored prosthesis technology, may further improve functional outcomes for transhumeral amputees. A multidisciplinary team, including orthopedic surgeons, mental health professionals, occupational therapists, and physical therapists, can improve patient quality of life and functional outcome postoperatively.