Amputation Flashcards
In the United States, upper extremity amputations are
(a) most often due to vascular disease.
(b) more common in males than females.
(c) rarely caused by workplace injuries. Page 6 of 23
(d) increasing due to the relaxing of occupational safety standards.
Answer: (b) Commentary: Of all upper extremity amputations, 90% are due to trauma. The majority of these are related to workplace injuries involving saws or blades. Males account for 75% of all upper extremity amputations. Trauma related amputations have decreased over the last 20 years and they are expected to remain flat or decrease, due to ongoing enforcement of safety standards.
Reference: Sheehan TP. Rehabilitation and prosthetic restoration in upper limb amputation. In: Braddom RL, editor. Physical medicine and rehabilitation. 4th ed. Philadelphia: Elsevier
Saunders; 2011. p 257
2013
You see a patient in clinic with what appears to be a non-infected diabetic foot ulcer over the first
metatarsal head and order an ankle-brachial index (ABI) study. The patient’s ABI is 1.4. What is
your next step in treatment?
(a) Proceed with off loading the ulcer, since blood flow is normal.
(b) Order additional testing, such as an arterial duplex.
(c) Refer for to vascular surgery for urgent revascularization.
(d) Refer for consideration of a transmetatarsal amputation.
Answer: (b)
Commentary: Evaluation of vascular status is critical in any patient presenting with diabetic ulcer. The ABI is considered a useful screening tool to look for peripheral arterial disease. Values under 0.91 are considered consistent with peripheral arterial disease. However, calcified vessels can lead to higher values and possibly false negative test results. If ABI is >1.3, this most likely due to calcified, non-compressible vessels; therefore, other means of testing vascular status should be used.
Reference: Salameh MJ, Ratchford EV. Update of peripheral arterial disease and claudication rehabilitation. Phys MedRehabil Clin N Am 2009;20:632.
2013
Comparing lower limb amputations to upper limb amputations in the United States, lower limb
amputations are
(a) most often due to trauma.
(b) expected to significantly increase over the next 20 years due to increasing rates of
diabetes mellitus.
(c) less common than upper extremity amputations.
(d) expected to decrease over time due to improved prenatal care leading to less congenital
malformations.
Answer (b)
Commentary: The prevalence of diabetes mellitus continues to increase in the United States and this trend is expected to cause increasing rates of lower extremity amputation. Lower extremity amputations are more common than upper extremity amputations and are more likely to be related to dysvascular causes. Despite improvements in prenatal care enabling more births, rates
of amputations due to congenital defects have not changed significantly. The most common cause of upper extremity limb loss is trauma-related injury
2012
Of the following modalities, which is the most effective in treating phantom limb pain?
(a) Iontophoresis
(b) Transcutaneous electrical nerve stimulation
(c) Short wave diathermy
(d) Paraffin baths
Answer: (b)
Commentary: Of the options listed, transcutaneous electrical nerve stimulation (TENS) is the
modality that may be useful in treating phantom limb pain. Iontophoresis is generally used for
dispersion of medications. Short wave diathermy is a method of deep heat. Paraffin bath is a
superficial heat modality.
2011
A patient with a left transfemoral amputation demonstrates a lateral trunk lean towards his
prosthetic side. What is the most likely cause?
(a) Prosthesis too long
(b) Long residual limb
(c) Prosthesis aligned in adduction
(d) Hip abduction contracture
Answer: (d)
Commentary: Causes of lateral trunk lean towards the prosthetic side include: prosthesis too
short, hip abduction contracture, prosthesis lined in abduction, and short residual limb
2011
Comparing lower limb amputations to upper limb amputations in the United States, lower limb
amputations are
(a) most often due to trauma.
(b) expected to significantly increase over the next 20 years due to increasing rates of
diabetes mellitus.
(c) less common than upper extremity amputations.
(d) expected to decrease over time due to improved prenatal care leading to less congenital
malformations.
Answer (b)
Commentary: The prevalence of diabetes mellitus continues to increase in the United States and
this trend is expected to cause increasing rates of lower extremity amputation. Lower extremity
amputations are more common than upper extremity amputations and are more likely to be
related to dysvascular causes. Despite improvements in prenatal care enabling more births, rates
of amputations due to congenital defects have not changed significantly. The most common cause
of upper extremity limb loss is trauma-related injury.
2012
What is the primary benefit of using a postoperative, rigid, non-removable dressing in a new
transtibial amputee?
(a) Improved monitoring of postoperative wounds
(b) Protection of the wound and edema control
(c) Prevention of hip flexion contractures
(d) Improved strength in the residual limb
Answer (b)
Commentary: The primary benefits of a rigid dressing include wound protection, edema control
and prevention of knee flexion contractures (not hip flexion contractures). Monitoring the wound
may be more difficult with a non-removable rigid dressing. The dressing should be removed for
wound check regularly and if there is a concern for infection. Type of postoperative dressing has
no effect on residual limb strength.
2012
A 45-year-old man with a history of transtibial amputation secondary to trauma presents to your
office 6 months following surgery. He is successfully ambulating independently with his
prosthesis. His chief complaint today is new mild phantom limb pain. Evaluation does not reveal
any significant problems with his prosthesis or gait. What treatment would you recommend to
decrease his phantom limb pain?
(a) Cryotherapy
(b) Ultrasound
(c) Desensitization
(d) Paraffin wax
Answer (c)
Commentary: First line treatment for phantom limb pain should include use of desensitization
techniques (massage, friction rubbing, wrapping, etc.) The other types of therapeutics listed
would not be effective in phantom limb pain management. Phantom limb pain is one of many
sources of pain in an amputee and is difficult to treat. It affects anywhere from 67% to 79% of
amputees. For patients whose pain interferes with function and quality of life, a biopsychosocial
approach to pain management is crucial.
2012
In a transfemoral amputee, a circumducted gait pattern, on the prosthetic side, could be caused by
which factor?
(a) Insufficient prosthetic knee friction
(b) Long prosthetic limb
(c) Hip flexion contracture
(d) Poor balance
Answer (b)
Commentary: When observing gait deviations in an amputee, one should consider both the
prosthetic issues and amputee compensatory maneuvers as a potential cause for the deviation. A
circumducted gait pattern can have various causes, including a long prosthetic limb, excessive
prosthetic knee friction (making it difficult to bend the knee), and hip abduction contracture. Poor
balance is usually associated with excessive lateral trunk bending, uneven arm swing, and short
stance phase on the prosthetic side.
2012
A 65-year-old woman with diabetes who will be undergoing an elective transtibial amputation due to a nonhealing wound consults you regarding her upcoming surgery. Which postoperative dressing would you recommend to promote wound healing and prevent postoperative complications?
A. Elastic bandages
B. Nonadhesive gauze
C. Stump shrinker compressive bandage
D. Removable or nonremovable postoperative cast
Option d is correct.
The major tenets of postoperative wound management following transtibial amputation are edema control, wound protection and prevention of knee flexion contracture. This is best done with a rigid dressing. Elastic bandages and stump shrinkers can help control edema but may be applied inappropriately. They also do not protect the wound from trauma or prevent knee flexion contracture.
2014
Which lower extremity amputee group has the highest probability of successful mobility?
a. Dysvascular bilateral transtibial over age 85
b. Dysvascular unilateral transtibial under age 85
c Traumatic unilateral transtibial under age 85
d Traumatic unilateral transtibial over age 85
Option c is correct.
The person with a traumatic lower extremity amputation has higher mobility success: 97% of traumatic amputees are ambulating at 3 months. Dysvascular amputees can be successful ambulators but at a lower rate than traumatic amputees. Mobility success in bilateral amputees is less than unilateral amputees. Two studies report that 70% of bilateral transtibial amputees use their prostheses for ambulation. Age greater than 85 years is associated with very low rate of mobility success (2% success in 1 study).
2014
What is the 5-year mortality rate for persons with diabetes after sustaining a major lower limb amputation?
(a) 15%
(b) 25%
(c) 33%
(d) 50%
(d)
At least 50% of persons with diabetes and peripheral arterial disease who undergo major limb amputation will die within 5 years of sustaining major lower limb amputation.
2008
An advantage of a knee disarticulation compared to a transfemoral amputation is that the knee disarticulation offers
(a) more options for a prosthetic knee.
(b) enhanced ability to create power during ambulation or running.
(c) better soft tissue coverage within the zone of injury.
(d) better prosthetic cosmesis.
(b)
Disarticulation results in a bulbus distal residual limb, which may complicate prosthetic fitting. Choice of prosthetic knee options for a person with a knee disarticulation, therefore, is limited and potentially excludes the newer, more advanced knee-joint designs. Benefits of a knee disarticulation over a transfemoral approach include greater tolerance to distal limb weight bearing, a longer lever arm to create power during ambulation and running, and improved sitting balance. Of note, functional outcome studies of trauma-related lower extremity amputees concluded that persons with through knee amputations had significantly poorer outcomes. These poorer outcomes are attributed to complications arising from soft tissue failure within the zone of injury.
2008
The most common congenital limb deficiency is
(a) right transtibial limb deletion.
(b) right transradial limb deletion.
(c) left transtibial limb deletion.
(d) left transradial limb deletion.
(d)
The most common congenital limb deficiency is the left midlength transradial deficiency.
Ref: Gaebler-Spira D, Uellendahl J. Pediatric
2008
In adults, the prevalence of phantom limb pain, phantom sensation or residual limb pain after amputation is
(a) approximately 70% at 6 months postamputation.
(b) dependent on age at the time of amputation.
(c) directly related to surgical technique.
(d) primarily dependent upon the level of amputation.
(a)
Phantom sensation, phantom pain, and residual limb pain have all been reported about equally in over 70% of amputees 6 months or more after lower limb amputation. This is typically not dependent upon the person’s age at the time of amputation, the level of amputation, or surgical technique.
2008
