From 1966 to 1971, Fitzsimons General Hospital [1] in Aurora, Colorado, averaged roughly one-hundred amputees per year, [2] which represented 10 percent of the orthopedic population at any given time. [3] The average Vietnam amputee was 21.7 years old [4], had "17 percent body fat, and reasonable cardiovascular fitness, heat acclimated and 10 percent dehydrated." [5] During American involvement in the Vietnam war, there were 5,283 amputations, with over a thousand comprising multiple amputations. [6] The average Vietnam amputee spent nine to eleven months [7] in hospital rehabilitation.  This duration may have been longer at Fitzsimons as there existed an unofficial policy of actively resisting the release of their patients to the Veterans Administration until full rehabilitation was deemed achieved. [8,9] Averages tell an incomplete story; in 1968 the orthopedic cases at Fitzsimons tripled. [9] Therapeutic skiing* and horseback riding* programs were improvised because of the influx of amputees during 1968. These were not officially sanctioned Army activities, at least not initially, and received consternation and threats of letters of reprimand from the Army's Surgeon General's office. In total, more than 600 amputees were treated from 1966 to 1971 at Fitzsimons, "of which eighty-five percent were lower extremity amputees." [2]

*[Surviving films of these therapeutic activities can be viewed in the Reference section of this library.]

In March of 1974, the newly renamed Fitzsimons Army Medical Center began taking X-rays of above-knee limbs under weight-bearing conditions.  X-rays were taken during the manufacture of the prosthesis, [3,10] as part of an adopted comprehensive checkout of the above-knee limb.  The aims of the X-ray checkout are probably best introduced in the restored narrated slideshow.  The slideshow was a part of an Armed Forces Institute of Pathology constructed exhibit detailing FAMC's use of checkout X-rays.

The above image shows a Fitzsimons' patient positioned in front of a 14" x 36" cassette for radiographic evaluation of his prosthesis. Prior to X-ray, radiographically opaque solder is affixed to the prosthetic socket so that the contours of the prosthetic socket can be imaged on the X-ray and established checkout points evaluated.  The specific X-ray room protocols adopted by Fitzsimons Army Medical Center can be found in the Supplement to Standard Check-out, under the subheading "Procedure," and are also referenced in Dr. Mayfield's recovered research paper, under the subheading "Method."

After adoption of the X-ray checkout at FAMC, above-knee limbs began to be produced with a manifestly different shape.  X-rays provided verification of the established design goals of the quadrilateral limb, [11] yet resulted in adoption of a new alignment protocol [12] and ultimately, in time, a unique above-knee socket design. [13, 14]

The above image has been scanned from 16mm film, taken on May 14, 1974, by Fitzsimons Medical Illustrations and Audio Visual Activity (MIAVA). On the left, a standard quadrilateral prosthesis is pictured; on the right, a described "revised alignment" [15] replacement limb is depicted, employing Ivan Long's bench alignment, which became known as Long's Line.  Mayfield's recovered research paper contains the individual femoral remnant angle measurements of 73 weight-bearing X-rays taken of 51 patients at Fitzsimons Army Medical Center.  Given the scarcity of weight bearing prosthetic X-rays and the unique patient population (mostly Vietnam War casualties), this is a uniquely valuable dataset.

The purpose of this peer reviewed section of the O&P library is to reintroduce to the body of prosthetic scientific knowledge unpublished documents related to Fitzsimons Army Medical Center's X-ray checkout of the above-knee limb.  Signed letters have been collected from former Fitzsimons physicians detailing Fitzsimons' clinical use of checkout X-rays.  In this research — and history — section of the O&P library, patient identifiers have been removed from all documents, faces have been obscured in gait films and photographs, and each document has been subject to peer review.  Digital republishing and digital re-imaging of the recovered documents have been undertaken with supervision and approval of the original and/or surviving authors and links to the original source documents are provided.  The objective of this special section of the O&P library is to present unique, decades-old research and portray it in its contextual historic background under current standards of patient confidentiality.  It is sincerely hoped that this data and history may be of value and use to modern researchers in future research.

01/06/2010

NOTES

¹ In 1974, Fitzsimons General Hospital was renamed Fitzsimons Army Medical Center, according to Engineer Update (see Ref. 1) [curiously, other references state the year as 1973].

² Recorded interview, Colonel Paul W. Brown, MC, USA (Ret.): 05/09/09

³ Personal communication, Colonel Paul W. Brown, MC, USA (Ret.): 12/06/07

REFERENCES

1. Bickford LA.  Fitzsimons Hospital Begins New Civilian Life. Engineer Update September 2000; 24 (9): 5.
2. Brown PW. Avocational Rehabilitation of Amputees. Proceedings of the First International Congress on Prosthetics Techniques and Functional Rehabilitation. Vienna, Austria, March 19-24, 1973:73-85 (Separatum).
3. Mayfield GW. Vietnam War amputees. In: Burkhalter WE, editor. Orthopedic surgery in Vietnam.  Washington (DC): Office of the Surgeon General and Center of Military History, U.S. Army, 1994. p. 130-53.
4. Dougherty, PJ. Vietnam Amputees: Long-Term Follow-Up. Fort Detrick, MD: U.S. Army Medical Research and Materiel Command, 1998 (AWARD NUMBER DAMD17-97-1-7148),
5. Feagin, JA. The Soldier and His Wound in Vietnam. In: Burkhalter WE, editor. Orthopedic surgery in Vietnam.  Washington (DC): Office of the Surgeon General and Center of Military History, U.S. Army, 1994. p. 1-19.
6. Gailey, R. As History Repeats Itself, Unexpected Developments Move Us Forward. J Rehabil Res Dev 2007; 44(4): vii-xiv.
7. LaNoue, AM. Care and Disposition of Amputee War Casualties. (Student Paper) U.S. Army Command and General Staff College, 1971.  Available here.
8. Mayfield G.  Recollections of Fitzsimons Army Hospital and the origin of the X-ray checkout of the above knee limb [Internet].  Gainesville (FL): Digital Resource Foundation for the Orthotics and Prosthetics Community, The Orthotics and Prosthetics Virtual Library, Fitzsimons Army Medical Center Institutional Memory Preservation Project: Introductory Letters of Clinical Practice, 2009 Dec 31 [cited 2010 Jan 7].  Available here.
9. Brown PW. Rehabilitation of the Combat-Wounded Amputee. In: Burkhalter WE, editor. Orthopedic surgery in Vietnam.  Washington (DC): Office of the Surgeon General and Center of Military History, U.S. Army, 1994. p. 189-209.
10. Fitzsimons Army Medical Center. Transcript: a look through the above knee prosthesis [Internet]. Gainesville (FL): Digital Resource Foundation for the Orthotics and Prosthetics Community, The Orthotics and Prosthetics Virtual Library, Fitzsimons Army Medical Center Institutional Memory Preservation Project, 2009 Jan 24 [cited 2009 Jul 3]. Available here.
11. Anderson MH, Bechotol, CO, Sollars RE.  Clinical prosthetics for physicians and therapists: a handbook of clinical practices related to artificial limbs. Springfield (IL): Charles C Thomas; 1959.
12. Long I. Allowing normal adduction of femur in above-knee amputees. Orthot Prosthet [Internet] 1975 Dec 1 [cited 2009 Jun 22] ; 29(4): 53-4.  Available here.
13. Long I. Normal shape normal alignment (NSNA) above-knee prosthesis. Clin Prosthet Orthot 1985; 9(4): 9-14. Available here.
14. Sabolich J. Contoured adduction trochanteric controlled alignment method (CAT-CAM). Clin Prosthet Orthot 1985; 9(4):15-26. Available here.
15. Mayfield GW, Scanlon J, Long I. A new look to and through the above-knee socket(Recovered research paper) [Internet]. Gainesville (FL): Digital Resource Foundation for the Orthotics and Prosthetics Community, The Orthotics and Prosthetics Virtual Library, Fitzsimons Army Medical Center Institutional Memory Preservation Project; 2009 Jun 22 [cited 2010 Jan 06]. Available here.