A 55-year-old diabetic man undergoes below-knee (transtibial) amputation for ischemic gangrene. The ideal residual limb (stump) length for optimal prosthetic fitting is:

• A As short as possible to minimize phantom pain
• B 12–15 cm below the tibial tuberosity (from tibial plateau) ✓
• C At the musculotendinous junction of the gastrocnemius (5 cm below knee)
• D At the junction of middle and distal third of tibia

Explanation

For below-knee (transtibial) amputation, the optimal tibial stump length is 12–15 cm measured from the tibial plateau (approximately 10–14 cm below the tibial tuberosity). This length provides sufficient lever arm for prosthetic control, adequate muscle cuff for padding the bone end, and room for the prosthetic socket. Stumps shorter than 10 cm may be functionally end-bearing problematic and harder to fit; stumps in the distal third of the tibia have poor tissue coverage and delayed healing (particularly in vascular disease). The myofasciocutaneous flap (Burgess posterior flap technique) is standard for vascular amputations.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.