The Krukenberg procedure: a surgical option for the treatment of double hand amputees in Sierra Leone

Lancet. 2000 Sep 23;356(9235):1072-5. doi: 10.1016/S0140-6736(00)02731-8.


Background: For the past 9 years, Sierra Leone has struggled with a cruel civil war in which the civilian population has been the principal target. The International Committee of the Red Cross established a surgical mission in Netland Hospital, Freetown, and during this surgical mission, we treated crippled individuals who had had one or both hands amputated. We assessed the benefit of the Krukenberg procedure to restore manual dexterity in this group. In this operation, radius and ulna are separated and a pincer-like grasp is created.

Methods: From July 15, 1998, to Sept 9, 1998, we carried out the Krukenberg procedure on a group of double and single hand amputees. The main target group was double hand amputees, however, the procedure was initially done on three single hand amputees to assess the functional result. Between the original trauma and the operation, there had been an interval of 3 months or longer in all patients. Patients were followed up for 3 months after the procedure to assess gripping strength and self-sufficiency (feeding, personal hygiene, dressing, and manual dexterity).

Findings: 15 Krukenberg procedures were done on 11 patients: eight men and three women (mean age 42 years). Three had single hand amputation and eight had double hand amputation. In only two patients had sufficient time passed for the stumps to heal. Of ten patients who were followed up at 3 months, all could eat and drink by themselves. The simple dressing test was passed by all patients and 75% of the patients had recovered some dexterity.

Interpretation: The Krukenberg procedure is a surgical option to achieve some manual dexterity in double hand amputees, where resources for sophisticated hand prostheses are lacking.

MeSH terms

  • Activities of Daily Living
  • Adolescent
  • Adult
  • Amputation Stumps / surgery*
  • Amputees / rehabilitation
  • Arm
  • Female
  • Humans
  • Male
  • Middle Aged
  • Sierra Leone