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Gritti-Stokes Amputation in the Trauma Patient: Tips and Techniques
Benjamin C. Taylor, MD; Attila Poka, MD; Sanjay Mehta, MD; Bruce G. French, MD
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Based on an original article: J Bone Joint Surg Am. 2012;94:602-8.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2012 Apr 11;2(2):e7 1-7. doi: 10.2106/JBJS.ST.K.00048
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The Gritti-Stokes amputation establishes osseous continuity between the patella and the distal part of the femur with maintenance of the intact prepatellar soft tissues.

Step 1: Preoperative Planning

As with all orthopaedic surgery, preoperative planning is essential to obtaining an optimal outcome with this procedure.

Step 2: Flap Design

Use an asymmetric flap consisting of the undisturbed prepatellar soft tissues and rotate it posteriorly to achieve closure.

Step 3: Soft-Tissue Dissection

Keep soft-tissue dissection subperiosteal or intratendinous to minimize blood loss and postoperative pain.

Step 4: Distal Femoral and Patellar Cuts

Use a high-speed saw to transect the femur and patella.

Step 5: Posterior Dissection

Carry out posterior dissection in a methodical manner, with individual identification and ligation of all neurovascular structures.

Step 6: Patellofemoral Arthrodesis

Suture the patella to the distal part of the femur using six drill holes and nonabsorbable suture.

Step 7: Soft-Tissue Closure

Close the remaining soft tissue, including the posterior musculature, subcutaneous layer, and skin, in a layered fashion.

Step 8: Postoperative Management

Postoperative care should be done in conjunction with a prosthetist to obtain optimal outcomes.


The Gritti-Stokes amputation technique appears to be a potentially valuable addition to the amputation surgeon's armamentarium.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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