Amputation

Question 1

AMPUTATION:

causes (4) + trend & example of 1

Answer 1

PVD
trauma
malignancy (3rd most common but easy detect; osteosarcoma)
congenital

Question 2

AMPUTATION: Factors

(3) + describe 3rd (3)

Answer 2

• length of residual limb
• vascularization
• prosthetic fitting (scar should be painless pliable non-adherent)

Question 3

AMPUTATION: Procedures

sagittal - other name, for, how

posterior - for

skewed - for, how=purpose

fishmouth - how + direction, cons

Answer 3

SAGITTAL/MEDIAN SKIN FLAP
- for: no vascular problem
- how: small incision ant to pos

POSTERIOR SKIN FLAP
- for: need vascularization (use pos vessels)

SKEWED SKIN FLAP
- for: severe vascular problem
- how: angular = avoid bony prominence

FISHMOUTH SKIN FLAP
- how: skin + fascia lateral/horizontal
- cons: dog ears

Question 3

AMPUTATION: Procedures

open - other name, how, source

closed - skin flap what

Answer 3

OPEN (GUILLOTINE)
- amputate then cover c skin graft (buttocks)

CLOSED
- skin flap: area of skin is retained & used to cover

Question 4

AMPUTATION: Muscle Stabilization

myoplasty, myofascia, myodesis, tenodesis

which common & uncommon

Answer 4

MYOPLASTY
- muscle to muscle

MYOFASCIA
- muscle to fascia
- use myoplasty for stabilization & avoid sliding to bony prominence
- common

MYODESIS
- muscle to bone

TENODESIS
- tendon/skin flap to bone
- uncommon

Question 5

AMPUTATION: Stump/Residual Limb

conical, cylindrical, bulbous, krukenberg + for

which ideal for fitting, which to avoid

Answer 5

CONICAL
- 1 bone (AKA)
- ideal for prosthetic fitting

CYLINDRICAL
- 2 bones (BKA)

BULBOUS
- wide distal aspect of stump = avoid

KRUKENBERG
- pincer grip from pronator teres
- for UE

Question 6

AMPUTATION: Congenital

trend, UE vs. LE

amelia phocomelia meromelia hemimelia aphalangia adactyly acheira

Answer 6

• 4th most common cause of amputation
• UE 2x > LE
• amelia: absence of limb
• phocomelia: not bone just flipper-like skin flap appendage attached to trunk
• meromelia: partial limb
• hemimelia: half limb
• aphalangia: fingers/toes
• adactyly: carpal/tarsal; uncommon in 1st
• acheira: hand/foot

Question 7

AMPUTATION: Eval

subjective - common demographic, c/c (3)

pain - residual limb where, phantom limb when

stump - length (unit), circumference how, adhesion what

LTG duration

Answer 7

• demographics: DM
• c/c: pain > weakness, functional

PAIN
- residual limb pain: in residual limb
- phantom limb pain: 1st few months & can persist
- phantom limb sensation

STUMP
- length: cm
- circumference: from stump go 2in above middle below
- adhesions: scar area that when pushed = hardens & doesn’t budge

LTG: 4-6m

Question 8

AMPUTATION: Types

UE (12)

Answer 8

shoulder disarticulation

very short above elbow: 0-30% of humerus
short above elbow: 30-50%
standard above elbow: 50-90%
long above elbow: 90-100%

elbow disarticulation

very short below elbow: 0-35% of radius/ulna
short below elbow: 35-55%
long below elbow: 55-90%
wrist: 90-100%

carpal
transmetacarpal

Question 9

AMPUTATION: Types

LE (9)

Answer 9

hip disarticulation

short AK: 3-4in below ischial
middle AK: 10-12in
supracondylar

knee disarticulation

very short BK: 2in below knee
short BK: 2-4in
medium BK: 5-8in
long BK: >8in

Question 10

AMPUTATION

goals (5)

Answer 10

goals:
- pain control
- maintain range of motion
- strengthen residual muscles
- prepare limb for prosthetic fitting
- indep in ADLs

Question 11

AMPUTATION

post op considerations (3)
prosthesis how long
(2) how long

Answer 11

• basic components are used
• don’t prescribe until after significant anatomic change
• prosthesis: 3-5y
• gel liner & socks: 6m
• follow up appointments: week 1

Question 12

AMPUTATION: Energy Expenditure

consistent age, prox vs. distal

transtibial, (B), transfemoral, AKA BKA, (B) AKA, w/c, crutches

Answer 12

• consistent til 80y
• metabolic cost: proximal > distal
• transtibial: 20-25%
• (B) transtibial: 41%
• transfemoral: 60-70%
• AKA + BKA: 118%
• (B) AKA: >200%
• w/c: 8-9%
• crutches: 60%

Question 13

AMPUTATION: Types

hemicorporectomy - other name (2), where

hemipelvectomy - where (2)

hip - other, where

Answer 13

hemicorporectomy
- complete hip amp; translumbar
- anything below waist

hemipelvectomy
- partial pelvis intact, whole legs out

hip disarticulation
- complete thigh amp
- pelvis intact, whole legs out
- cut at trochanter or femoral neck

Question 14

AMPUTATION: Types

syme chopart lisfranc - joint, where, other name

Answer 14

syme’s
- ankle joint
- complete tarsal amp

chopart’s
- midtarsal joint
- partial tarsal

lisfranc’s
- tarsometatarsal joint
- complete metatarsal amp
- whole tarsal intact

Question 15

AMPUTATION: Types

transmetatarsal - through, where

partial foot - where

toe - through

Answer 15

transmetatarsal amp
- through shafts
- partial metatarsal

partial foot
- 3rd to 5th

toe disarticulation
- MTPJ

Question 16

AMPUTATION: Mx

most common contracture (2), deg for 1st, indications (1.2)

edema mx

Answer 16

• hip & knee flexion contracture
• > 15 hip flex = diff prosthetic fit
• knee flex = inc expenditure & strength needed for amb
• edema = semirigid removable dressing