Krukenberg procedure
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The Krukenberg procedure, first described in 1917 by surgeon Hermann von Krukenberg, is a surgical technique that converts a forearm stump into a pincer. The procedure involves separating the ulna and radius for below-elbow amputations to provide a pincerlike grasp that is motored by the pronator teres muscle[1]. The prerequisites for the operation are a stump over 10 cm long from the tip of the olecranon, no elbow contracture, and good psychological preparation and acceptance [2].
Today, the procedure is mostly performed on patients in developing countries who lack the means to obtain expensive prostheses. In most cases, patients in developing countries actually prefer the pincers to prostheses.[2] In the Western world, the Krukenberg procedure is reserved for blind patients with bilateral amputations, because it can provide the patient with tactile sensation.[3]
The procedure preserves proprioception and stereognosis in the functional stump to allow for effective maneuvering. Once this procedure is performed, it does not preclude the use of a functional prosthesis. Therefore, the patient is afforded the option to use either functional strategy.[1]
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. Individual patient expectations and motivations, although more difficult to assess, probably play a major role in outcomes as well.[1]
The German phycisist Burkhard Heim had two Krukenberg hands as a result of a laboratory accident.
