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The Krukenberg Procedure in the Pediatric Patient: A Case Series
JoAnna Nguyen, MD1; Katherine Au, MD2; John Lawrence, MD3
1University of Southern California Keck School of Medicine, Los Angeles, CA; 2Shriners Hospitals for Children, Los Angeles, Los Angeles, CA; 3Ronald Regan UCLA Medical Center, Los Angeles, CA

Background: The loss of a hand has devastating consequences on one's functional independence, and reconstruction after hand amputation is limited, especially in the pediatric population. Commonly, pediatric hand amputees are limited to prosthetic use, but these are difficult to use due to the lack of proprioception and need for frequent adjustments. Because of this, many unilateral amputees choose to forgo prosthetic wear. The Krukenberg operation provides children with hand absence a useful and sensate pincer mechanism that is helpful for activities of daily living. Authors have described the technique of separating the radius and ulna through the interosseous membrane to the level of the pronator teres to create this sensate pincer grasp. Historically, this procedure has been reserved for blind bilateral amputee patients or in areas where prosthetic devices are unavailable. In this series, we present the long-term follow up of pediatric patients who have undergone the Krukenberg procedure for either congenital or traumatic hand deficiencies.
Methods: We performed a retrospective chart review of patients who underwent the Krukenberg procedure at a single institution. Patient demographic, pre-operative, operative and post-operative data were examined.
Results: From 1987 to 2013, we identified 7 consecutive pediatric patients who underwent the Krukenberg procedure for hand amputation. Indications for surgery included congenital transverse limb deficiency (n=4) and traumatic amputation (n=3). Average follow up was 4.4 years (range: 2 to 10 years), and all patients (n=7) were male. None of the patients were blind. Complications included skin breakdown (n=2) and heterotopic ossification (n=1). Overall, the patients did well and were able to use the Krukenberg to perform activities of daily living.
Conclusion: In this series, we demonstrate the feasibility and safety of performing the Krukenberg procedure in pediatric patients. In certain populations where there are limited resources for prostheses, this procedure offers the patient functional independence with a sensate upper extremity capable of prehension. The biggest disadvantage of this operation is its appearance.

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