Fitzsimons Army Medical Center (FAMC) Institutional Memory Preservation Project
Fitzsimons' institutional memory can be viewed as the collection of innovations, protocols and techniques — developed and adopted by the attending FAMC personnel — resulting from practical experience with a large number of amputee cases during the Vietnam War.
From 1966 to 1971, Fitzsimons General Hospital  in Aurora, Colorado, averaged roughly one-hundred amputees per year,  which represented 10 percent of the orthopedic population at any given time.  The average Vietnam amputee was 21.7 years old , had "17 percent body fat, and reasonable cardiovascular fitness, heat acclimated and 10 percent dehydrated."  During American involvement in the Vietnam war, there were 5,283 amputations, with over a thousand comprising multiple amputations.  The average Vietnam amputee spent nine to eleven months  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.  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." 
*[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,  yet resulted in adoption of a new alignment protocol  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"  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.
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
… more info
- Bickford LA. Fitzsimons Hospital Begins New Civilian Life. Engineer Update September 2000; 24 (9): 5.
- 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).
- 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.
- 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),
- 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.
- Gailey, R. As History Repeats Itself, Unexpected Developments Move Us Forward. J Rehabil Res Dev 2007; 44(4): vii-xiv.
- LaNoue, AM. Care and Disposition of Amputee War Casualties. (Student Paper) U.S. Army Command and General Staff College, 1971. Available here.
- 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.
- 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.
- 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.
- 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.
- 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.
- Long I. Normal shape normal alignment (NSNA) above-knee prosthesis. Clin Prosthet Orthot 1985; 9(4): 9-14. Available here.
- Sabolich J. Contoured adduction trochanteric controlled alignment method (CAT-CAM). Clin Prosthet Orthot 1985; 9(4):15-26. Available here.
- 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.
Retrospective Letters of Clinical Practice
Recollections of the Radiographic Control of the Position of the Femur in Prosthetic Fitting of the AK Amputee
Fitzsimons Army Medical Center 1974 to 1983
Letter from William W. Eversmann, Jr. MD
Col. MC Assistant Chief and Chief, Orthopedic Service, FAMC 1974-1983
PDF file (57 kB), posted on 01/27/2009
Font change of original signed letter with added hyperlinks. Additional letters from former Fitzsimons' personnel can be viewed here.
Prosthetic Memories of Fitzsimons Army Medical Center
Letter from Ivan Long, CP
Prosthetist, Fitzsimons Army Medical Center, circa 1974
PDF file with original digital text (99 kB), posted on 01/27/2009
Recollections of Fitzsimons Army Hospital and the Origin of the X-ray Checkout of the Above Knee Limb
Letter from Gerald W. Mayfield, MD
Col. MC Teaching Staff, Fitzsimons Army Medical Center, 1971-1974
PDF file (37 kB) ), posted on 01/06/2010
Font change of original signed letter with added hyperlinks. Additional letters from Dr. Mayfield can be viewed here.
Published Reference Articles
TECHNICAL NOTE: ALLOWING NORMAL ADDUCTION OF FEMUR IN ABOVE-KNEE AMPUTATIONS
- Ivan Long, C.P.: Orthotics and Prosthetics. Vol. 29, No. 4, pp. 53-54, December 1975
PDF file with OCR (578 kB), posted on 02/09/2009
A NEW LOOK TO AND THROUGH THE ABOVE-KNEE SOCKET
- Gerald W. Mayfield, MD, Jim Scanlon, PT, and Ivan Long, CP: Proceedings of the American Academy of Orthopaedic Surgeons.
Orthopaedic Transactions 1:95, 1977.
PDF file with OCR (866 kB), posted on 02/09/2009
This is the published abstract of a paper given at the 1977 American Academy of Orthopaedic Surgeons (AAOS). The Final Program of the meeting, showing the date and time of Dr. Mayfield's paper presentation, can be viewed here. The abstract shows a greater patient total than detailed in the AAOS Final Program. The actual paper was never published and believed lost. A twelve page (excluding cover) surviving copy has been located and can be viewed here in its original recovered format or below digitally re-typeset. The recovered paper contains a nearly identical patient aggregate as detailed in the published abstract and contains the individual patient statistics of the study.
Recovered FAMC Documents
Armed Forces Institute of Pathology Photograph Negative No. 76-706
Date: 01/01/1976 (ca.)
JPEG file (100 kB), posted on 07/03/2009
A LOOK THROUGH THE ABOVE KNEE PROSTHESIS
Date: 01/01/1976 (ca.)
Slide presentation with audio, posted on 07/03/2009
This narrated slideshow is from a historic Armed Forces Institute of Pathology (AFIP) constructed scientific exhibit detailing the Fitzsimons' X-ray checkout of the above knee limb. The official monochrome AFIP exhibit photograph (Neg. no #76-706) is presented above. This narrated slideshow was looped continuously on the central display screen of the exhibit. The presentation was organized by Jim Scanlon, PT with staff support of Fitzsimons Army Medical Center. The exhibit toured physical therapy meetings and the AOPA-Interbor International Congress and Assembly in 1976 and was then lost in the archives of the AFIP. This slideshow has been carefully reconstructed from surviving 35mm slide duplicates. The narration has been re-recorded using the recovered transcript (below) and the slides were arranged using Mr. Scanlon's contemporaneous handwritten notes.
TRANSCRIPT: A LOOK THROUGH THE ABOVE KNEE PROSTHESIS
Date: 01/01/1976 (ca.)
Previously unpublished PDF file with OCR (23 kB), posted on 07/03/2009
Digital re-typesetting of recovered transcript, completed on 1/24/09
A NEW LOOK TO AND THROUGH THE ABOVE-KNEE SOCKET
- Gerald W. Mayfield, MD, Jim Scanlon, PT, and Ivan Long, CP
Date: 11/04/1976 (ca.)
Previously unpublished PDF file with OCR (198 kB), posted on 06/22/2009
Digital re-typesetting of original paper. The individual patient statistics of the study, which comprise 73 X-rays of 51 above knee amputees can be viewed on pages 11 and 12. The recovered data is consistent with the statistics presented in the 1997 published abstract, with two additional "second fitting" X-ray measurements recorded. This paper was written to support a 12-minute presentation given by Dr. Mayfield at the 1977 annual meeting of the American Academy of Orthopedic Surgeons (AAOS). This document has been digitally re-typeset, which means retyped with similar font, sentence length, and page layout with drawings carefully traced, scanned and sized appropriately. Minor corrections, such as correct name spellings and proper credentials are carefully carried out in this process, all with the approval of the surviving author(s). Care is taken to duplicate the original, whose image quality has suffered from multiple duplication. For accuracy of archival preservation, the original source document (link above) is also provided.
X-Ray Evaluation of the Above Knee Socket; A Supplement to Standard Check-out Procedures
- Jim Scanlon, PT and Bob Doctor, PT
Date: 01/01/1977 (ca.)
Previously unpublished PDF file with OCR (734 kB), posted 06/22/2009
This document details the written procedures for the X-ray checkout instituted at Fitzsimons Army Medical Center. It has been re-imaged with consultation and approval of Jim Scanlon, PT (surviving coauthor). Period figures and X-ray images have been added. Text corrections, taken only from the original handwritten notations of the surviving draft copy, have been employed.
Letters from Former Fitzsimons' Personnel
Photographs, Films, and Support Documents
Editorial Review Board