Commentary on Troedsson's 1964 article "Stump arterial circulation and its relationship to the prescription of a prosthesis for the geriatric patient".

T he primary purpose of the Research Program in Pros-thetics, inaugurated by the Surgeon General of the Army in 1945 and now supported by the Veterans Administration and other agencies, has been to improve or construct artificial limbs that would enable the amputee to assume his place in society with a minimum loss of function. Although research has been mainly devoted to fitting the young, vigorous soldier, fitting the geriatric ampu-tee has become an ever-increasing problem. Recognizing this fact, the National Academy of the Sciences authorized a special conference on The Geriatric Amputee, which was held in Washington, D.C. in 1961. At that conference, the Panel on Medical Management (1) chaired by Dr. George T. Aitken, recommended that the geriatric amputee be defined as a person over 55 years of age, and that the terms " old amputee " and " new amputee " be used to designated two subclasses. The panel recognized this terms as somewhat arbitrary since age is a matter not only of chronology by also of physiological fitness. In my experience, the statement credited to Dr. Osler of The Johns Hopkins University, " You are as old as your arteries, " is true in the majority of cases; statistics also bear out the adage. Since arteries may be obstructed in the young as well as in the old, the term geriatric am-putee should probably be abolished, and the title, " Amputations and pros-theses in case of decreased arterial supply in the extremities and in the stump " be used instead. This all-embracing title would also have subgroups, such as nondiabetic and diabetic, and would include consideration of amputation sites and technics. Statistics indicate that vascular diseases, particularly atheroscle-rosis, cause more deaths than the next five causes, which include cancer. Certainly in most cases, the degree of lower-extremity function is directly related to arterial condition, such as degree of obstruction. With increasing obstruction, there is a corresponding decrease in function and an " aging " of the limb, which may lead to gangrene, resulting in death. The same symptoms associated with gradually increasing obstruction in the arteries of a limb may also be presented by the stump, i.e., the stump may get tired or develop claudication after a brief walk with the prosthesis; stump abrasions may develop after socket contact during a short walk, and the abrasions may be slow-healing or nonhealing, depending upon the degree of …