Amputation Flashcards
Primary etiology of amputations
peripheral vascular disease
Hemicorporectomy
surgical removal of the pelvis and both lower extremities
Hemipelvectomy
surgical removal of one half of the pelvis and the lower extremity
Symes
surgical removal of the foot at the ankle joint with removal of the malleoli
Transverse tarsal
amputation through the talonavicular and calcaneocuboid joints. preservation of the plantarflexors, but severs the dorsiflexors (results in a equinus contracture)
Tarsometatasal
surgical removal of the metatarsals. preservation of the dorsiflexors and plantarflexors
Transradial - socket
Standard: covers 2/3 of forearm, can be shortened for increased pronation/supination
Supracondylar: self-suspending and require no additional harness
Transhumeral - socket
Standard: extends to acromion level
Modified design: allows for more stability with rotational movements
Lightweight friction: used with passive prosthetic arms
Transradial - suspension
- triceps cuff
- harness
- cable system
Transhumeral - suspension
- harness
- cable system
- suction
Transradial - elbow unit
attaches to triceps cuff or upper arm pad, flexible or rigid hinge connects socket to proximal component
Transhumeral - elbow unit
internal or external locking unit
Transradial/Transhumeral - wrist unit
- quick change unit
- wrist flexion unit
- ball and socket
- constant friction
Transradial/Transhumeral - wrist unit
- voluntary opening or closing
- body-powered, externally powered, myoelectric or hybrid
- hook, mechanical hand, cosmetic glove
Transfemoral - socket
- quadrilateral socket
- ischial containment socket
Transtibial - socket
- patella tendon bearing socket (PTB)
- supracondylar patella tendon socket (PTS)
- supracondylar - suprapatella socket (SC-SP)
Transfemoral - suspension
- landyard strap
- shuttle lock
- suction (seal in, skin fit)
- partial suction (silesian bandage, pelvic belt)
- vacuum
Transtibial - suspenstion
- supracondylar cuff
- thigh corset
- supracondylar brim
- rubber sleeve suspension
- waist belt with fork strap
- suction with sleeve
- shuttle lock
- vacuum
Transfemoral - knee
- single axis
- polycentric
- hydraulic
- microprocessor
Transfemoral/transtibial - shank
- exoskeleton (rigid exterior)
- endoskeleton (pylon covered with foam)
Transfemoral/transtibial - foot system
- solid ankle cushion heel (SACH)
- stationary attachment flexible endoskeleton (SAFE)
- single axis
- multi-axial
- hydraulic
- powered
- dynamic response
Rigid dressing
(+) early ambulation, stimulates proprioception, provides soft tissue support, ability to use immediate post-operative prosthesis
(-) cannot immediately inspect wound, cant do daily dressing changes, professional application
Semi-rigid dressing
(+) easily changeable, protection, soft tissue support
(-) does not protect as well as rigid, requires more changing, may loosen (develop edema)
Non-weight bearing rigid removable dressing
(+) removable, easily applied, prevents contracture, provides protection
(-) not for ambulatory purposes
Soft dressing
(+) inexpensive, easily removed, allows for AROM
(-) tissue healing is interrupted by frequent changes, AROM may delay healing times, less control of residual limb, risk of tourniquet effect
K-level 0
Prothesis will not enhance QOL - not eligible
K-level 1
Transfers, ambulate on level surfaces, household ambulator
Knee: single axis
Foot: SACH
K-level 2
Limited community ambulator, low level barriers
Knee: polycentric
Foot: flexible kneel, multi-axial foot/ankle
K-level 3
Community ambulator, variable cadence, tranverse more than simple locomotion
Knee: hydraulic, microprocessor
Foot: energy storing, dynamic response
K-level 4
Higher level (child/athlete) - any knee/foot
Prosthetic Training Considerations - forequarter
- loss of shoulder/arm/hand function
- most commonly caused by malignancy
- light weight prosthetic
Prosthetic Training Considerations - shoulder disarticulation
- most commonly caused by malignancy or electrical injuries
- external prosthetic shoulder joint in typically required
Prosthetic Training Considerations - transhumeral
- most commonly caused by trauma
- second most common UE amputation
Prosthetic Training Considerations - elbow disarticulation
- self-suspending socket
- external prosthetic elbow typically required
Prosthetic Training Considerations - transradial
- most common UE amputation
Prosthetic Training Considerations - wrist disarticulation
- uncommon
Prosthetic Training Considerations - partial hand
- limb sparing technique utilized when functional pinch can be preserved
Prosthetic Training Considerations - digit
- preserved function is variable
Prosthetic Training Considerations - hip disarticulation
- commonly caused by malignancy
- no activation of prosthesis through residual limb
- prosthetic limb advancement through pelvic motion
Prosthetic Training Considerations - transfemoral
- length of limb effects energy expenditure
- susceptible to hip flexor contracture
- stance control not activated until WBing
Prosthetic Training Considerations - knee disarticulation
- susceptible to hip flexor contracture
Prosthetic Training Considerations - transtibial
- susceptible to knee and hip flexion contractures
Prosthetic Training Considerations - symes
- diminished toe off during gait
Prosthetic Training Considerations - transmetatarsal
- loss of forefoot leverage
- tendency to develop equinus deformity
Complications
- DVT
- contractures
- hypersensitivity
- neuroma
- phantom pain
- phantom limb
- psychosocial
- infections
Lateral bending
prosthetic causes:
- too short
- high medial wall
- aligned in abduction
amputee causes:
- abduction contracture
- short residual limb
- weak abductors
Abducted gait
prosthetic causes:
- too long
- high medial wall
- aligned in abduction
amputee causes:
- abduction contracture
- weak hip flexors/adductors
Circumducted gait
prosthetic causes:
- too long
- excessive pf
amputee causes:
- abduction contracture
- weak hip flexors
- inability to initiate hip flexors
Excessive knee flexion
prosthetic causes:
- too long
- socket set too forward
- excessive df
- stiff heel
amputee causes:
- knee flexion contracture
- hip flexion contracture
- decreased quad strength
Vaulting
prosthetic causes:
- too long
- excessive pf
amputee causes:
- short residual limb
- pain
Rotation of forefoot at heel strike
prosthetic causes:
- excessive toe-out
- excessive pf
amputee causes:
- poor muscle control
- weak medial rotators
Forward trunk flexion
prosthetic causes:
- too big
- knee instability
amputee causes:
- hip flexor contracture
- weak hip extensors
- inability to initiate knee flexion
Medial or lateral whip
prosthetic causes:
- excessive knee rotation
- tight socket
- valgus
amputee causes:
- weak hip rotators
- knee instability
