In transtibial (below-knee) amputation for vascular disease, which residual limb length provides the best prosthetic fit and energy efficiency?

• A Very short below-knee stump (< 5 cm from tibial tuberosity)
• B Syme's amputation (distal tibia) regardless of vascular status
• C Through-knee (distal femoral) amputation for optimal prosthetic fitting
• D Long residual limb at the junction of middle and distal thirds of the tibia (approximately 12–15 cm from the tibial tuberosity) ✓

Explanation

The ideal transtibial stump length for prosthetic fitting is approximately 12–15 cm from the tibial tuberosity (junction of middle and distal thirds), preserving the maximum lever arm for prosthetic control. Very short stumps have inadequate lever arm; very long stumps have marginal blood supply distally in vascular disease. The tibia is bevelled anteriorly ('sagittal saw' technique) and covered with the posterior myocutaneous flap for durable weight-bearing tissue.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.