A 55-year-old diabetic undergoes below-knee amputation for dry gangrene. Which is the MOST appropriate level of below-knee amputation for optimal prosthetic fitting?
- A Very short below-knee (< 5 cm below tibial tuberosity)
- B Syme's ankle disarticulation
- C Knee disarticulation
- D Standard below-knee at junction of middle and distal thirds of the tibia (approximately 12-18 cm) ✓
Explanation
The optimal transtibial (below-knee) amputation level is at the junction of the upper and middle thirds of the tibia — approximately 12-18 cm below the knee joint (tibial tuberosity). This provides: adequate residual limb length for prosthetic socket suspension and lever arm, adequate soft tissue for tension-free closure, and preserved knee joint for maximal function. Very short stumps (<5 cm) are difficult to fit with prostheses; stumps >20 cm create prosthetic fitting challenges and poor cosmesis. The fibula is beveled 1-2 cm shorter than the tibia to prevent distal fibular prominence.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.