The Krukenberg Procedure: A Scoping Review.

Abstract

Background: The Krukenberg procedure involves surgically separating the radius and ulnar to create a pincer-like grasp, providing an alternative for upper limb amputees in resource-limited settings where advanced myoelectric prosthetics are inaccessible. It restores prehension and potentially offers patients' autonomy in daily tasks. This review explores the patient demographics; indications; surgical techniques and outcomes of published reports of the Krukenberg procedure. Methods: A scoping review was conducted following PRISMA guidelines across PubMed, MEDLINE, Cochrane, Web of Science, EMBASE, Scopus, Ovid and Google Scholar. Studies that were peer-reviewed and published outcomes following a Krukenberg procedure were eligible for inclusion. Data on demographics, surgical methods and postoperative results were extracted. Results: Twenty-two studies (1937-2024) were included. Trauma was the primary indication (83.4%), followed by burns (10.4%) and congenital anomalies (5.5%). The Bunnell incision was most frequently employed, with nerve and muscle preservation critical for function. Interosseous membrane dissection and selective muscle resection, preserving vascular integrity, minimised bulk while maintaining function. Most patients regained independence, with a mean pincer strength of 7 kg. Complications were minimal, and were primarily skin necrosis, scarring and rare osseous sequelae, i.e. osteomyelitis, malalignment or bony overgrowth, managed via stump shortening or osteotomy. Conclusions: The Krukenberg procedure improves functional independence and socio-economic reintegration, especially in bilateral amputees. It remains a viable option in resource-limited settings where advanced prosthetics are unavailable. However, the evidence is limited by study heterogeneity. Success depends on vascular and neural preservation and early rehabilitation. Level of Evidence: Level III (Therapeutic).