Amputation Flashcards
Most common causes of amputation
- Peripheral Vascular Disease (54%)
- Trauma (45%)
- Malignany (<1%)
- Congenital limb deficiency (<1%)
People with DM2 are ____x more likely to have an amputation
10
Consequences of Type 2 DM
- PVD
- Peripheral neuropathy - insensate
- Non-healing neuropathic ulcers
3 most common predisposing factors for LE amputation
- DM2 w/HTN (10x+ risk)
- DM2 w/o HTN
- HTN w/o DM2
Most at risk ethnicity for amputation
- Native Americans
Likely due to lack of access to healthcare
Most individuals who have an amputation from trauma are due to
- MVA
- Accidents with machines
- war
- GSW (Gunshot wounds)
Most individuals who have a trauma amputation are very ____ and active prior to amputation.
healthy
What is a more common trauma amputation for civilians? UE or LE?
UE
____ is a more common amputation for military than civilans
LE
What type of malignancy often results in amputation?
- Osteogenic Sarcoma (Tumors in the muscles, tissue and bone)
- Adolescence/young adults
- Femur, tibia and humerus account for 85% of cases
What is more common for people with Osteogenic Sarcoma: Amputation or limb salavage technique?
- Limb Salvage Technique (plus chemotherapy)
- Survival rate for this condition is low
What is a congenital limb deficiency? Why does it require amputation?
- Genetic variation due to environmental exposure to teratogens (hot tubs)
- Most commonly seen in the UE
Types of Congenital Limb Deficiency
- Transverse Amelia: Complete loss of limb (Ex: Arm or Leg)
- Transverse Hemimelia: Loss of limb below level of next joint (Ex: Keep humerus, lose elbow distal; Keep Tibia, lose knee distal
- Paraxial Terminal: Complete loss of one bone in a region (Ex: Have fibula, not tibia)
- Paraxial Intercalary: Portion of a bone is absent
How is the level of amputation determined?
Goals:
* Maintain greatest bone length and save all possible joints while providing adequate soft tissue coverage
* Produce a comfortable and functional residual limb (RL)
Levels of Amputation: Transmetatarsal
Amputation through the midsection of all metatarsals
LOA: Transtibial
How many types?
- Below Knee
- 3 (Long Trans, Trans, Short Trans)
Ankle Disarticulation
- Also called Symes
- Amputation through the ankle joint
- Foot removes, heel pad preserved and placed on the bottom to help with weight bearing
Goal:
* Remove diseased tissues or non-usable foot
* Create functional painless limb
Transtibial Amputation
- “below-knee amputation”
- Superior tibiofibular joint preserved (distally gone)
- Preservation of knee joint
- Amputations distal to the lower thrid of the leg are avoided due to lack of soft tissue (think of gastrocnemius muscle belly)
Knee Disarticulation
- Also known as “through knee amputation”
- Directly at the knee joint, leaving femur and patella intact
- No dissection of bone or muscle
- Quadriceps muscle preserved
- Stump permits total end bearing and easy/firm attachment of the prothesis
- Weight Bearing for Bilateral
Rotationalplasty
- Van Nes Procedure
- Portion of the leg is removed, the remaining lower leg is rotated and reattached.
- Converts knee into hip and the ankle into knee
- Hip is stable as the femur is fused to the pelvis
- Dorsiflexion is now bending knee, Plantarflexion is now extending knee
- Most commonly seen with Ewing’s Sarcooma or osteosarcoma in children
Transfemoral Amputation
- “Above knee amputation”
- Amputation of the femur of some length
- Presevation of the distal 1/3 of adductor magnus preserved for biomechanical alignment.
- The longer this is, the less energy expenditure needed
Hip Disarticulation
- Removal of the entire lower limb by transection through the hip joint
Indications:
* * Malignant tumor of bone/soft tissue of the thigh, hip or pelvis
* Extensive trauma
* Uncontrolled infections
* Congenital limb anomaly (rare)
Hemipelvectomy
- “transpelvic amputation”
- Amputation of the affected bone of the hip and the ipsilateral extremity
- Rarest form of LE amputations
- Indications: Malignant tumor/sarcome or trauma
