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PTRS 746 Exam 1 > Amputation > Flashcards

Amputation Flashcards

1
Q

Q: 1 out of every ______ Americans will undergo an amputation.

A

200

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2
Q

T/F: Amputations rates decrease with age and are twice as common in women.

A

False: increase, men

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3
Q

Q: Over ____% of lower extremity amputations are due to ___________ disease and/or _________.

A

80, vascular, neuropathy

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4
Q

Q: Over ____% of upper extremity amputations are due to _____

A

70, trauma

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5
Q

Q: What are 3 other causes of amputation?

A
  1. Cancer 2. Infection 3. Congenital limb defects
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6
Q

Q: Who is peripheral vascular disease (PVD) most common in?

A

African Americans followed by Native Americans and Hispanics, then Caucasians

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7
Q

T/F: Peripheral vascular disease is associated with diabetes and/or smoking.

A

True

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8
Q

Q: Diabetes alone increases the risk of intermittent claudication by _______x, even after controlling for HTN, smoking, and cholesterol

A

4-5

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9
Q

Q: What comorbidities increase risk for PVD and amputation? (4)

A
  1. Obesity 2. HTN 3. Hyperlipidema 4. Nephropathy
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10
Q

T/F: 40% of amputations in those with diabetes are preceded by a foot ulceration.

A

False, Most ~85%

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11
Q

Q: ____% of those with PVD results in amputation will eventually undergo _________ amputations.

A

55, bilateral

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12
Q

Q: What is the 30 day mortality rate follow a major leg amputation?

A

As high as 40%

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13
Q

Q: What is the 5 year mortality for amputation?

A

As high as 70%

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14
Q

Q: Who is traumatic amputation more common in?

A

Younger men

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15
Q

Q: Within what window must re-plantation of a traumatic amputation occur?

A

12 hour window

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16
Q

Content: Traumatic Amputation Causes (4)

A
  1. MVA 2. Violence related combat injuries 3. Severe burns 4. Electrocution
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17
Q

Q: The lifetime cost of amputation is as much as ___ times higher than salvage.

A

3

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18
Q

T/F: The risk of subsequent hospitalization is lower after salvage.

A

False: greater

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19
Q

T/F: Amputations may result in better functional outcomes

A

True

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20
Q

T/F: Amputation may be more psychologically acceptable.

A

False, Salvage

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21
Q

Content: Malignancy and Amputation (2)

A
  1. Can be due to primary cancer or metastatic disease 2. More commonly involve the lower limbs
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22
Q

Q: Why are amputation rates declining? (3)

A
  1. Earlier diagnoses 2. Improved chemotherapy 3. Limb salvage/reconstruction techniques
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23
Q

T/F: Children are miniature adults.

A

False

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24
Q

Q: What is ratio of male to female pediatric amputations?

A

3:2

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25
Q

Q: _____% of pediatric amputations are congenital and _____% are acquired.

A

60, 40

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26
Q

Content: Acquired pediatric amputations (3)

A
  1. 90% are single limb 2. 60% are LE 3. Most result from trauma
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27
Q

Content: Pediatric amputation (4)

A
  1. Disarticulation minimizes growth plate disruption 2. Must consider longitudinal and circumferential growth 3. Excellent circulation enhances wound healing 4. Superior tissue tolerance may allow early post-op prosthetic fitting
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28
Q

LE Amputation Term: Excision of portion of 1 or more toes

A

Partial toe

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29
Q

LE Amputation Term: Disarticulation at MTP joint

A

Toe disarticulation

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30
Q

LE Amputation Term: Resection of 3rd, 4th, and/or 5th, MTs and digits

A

Partial foot/ray resection

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31
Q

LE Amputation Term: Amputation through long axis of all MTs

A

Transmetatarsal

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32
Q

LE Amputation Term: Ankle disarticulation with preservation of heel pad

A

Syme’s

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33
Q

LE Amputation Term: Retains > 50% of tibial length

A

Long transtibial

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34
Q

LE Amputation Term: Retains < 50% of tibial length

A

Short transtibial

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35
Q

LE Amputation Term: Amputation through knee with intact femur

A

Knee disarticulation

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36
Q

LE Amputation Term: Retains > 50% of femoral length

A

Long transfemoral

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37
Q

LE Amputation Term: Retains < 50% of femoral length

A

Short transfemoral

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38
Q

LE Amputation Term: Amputation through hip joint, pelvis intact

A

Hip disarticulation

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39
Q

LE Amputation Term: Resection of half of the pelvis

A

Hemipelvectomy

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40
Q

LE Amputation Term: Amputaiton of both LEs and pelvis below L4-5

A

Hemicorporectomy

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41
Q

UE Amputation Term: Excision of one or more fingers

A

Partial digit

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42
Q

UE Amputation Term: Disarticulation at MCP joint

A

Digit disarticulation

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43
Q

UE Amputation Term: Resection through long axis of MTCs

A

Transmetacarpal

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44
Q

UE Amputation Term: Amputation of hand with preservation of wrist

A

Transcarpal

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45
Q

UE Amputation Term: Amputation of hand and carpals

A

Wrist disarticulation

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46
Q

UE Amputation Term: Amputation through radius and ulna

A

Transradial

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47
Q

UE Amputation Term: Disarticulation of elbow

A

Elbow disarticulation

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48
Q

UE Amputation Term: Amputation through humerus

A

Transhumeral

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49
Q

UE Amputation Term: Amputation through shoulder joint

A

Shoulder disarticulation

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50
Q

UE Amputation Term: Amputation of humerus, scapula, and clavicle

A

Forequarter amputation

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51
Q

Content: Surgical Principles of Amptuation (5)

A
  1. Maintain adequate circulation for wound/incision healing 2. Remove damaged or involved tissues 3. Preserve as many anatomical joint as possible, esp. knee 4. Preserve maximal bone length 5. Provide residual limb that will accept prosthesis and tolerate WB
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52
Q

Content: Surgical considerations for dysvascular patients often present with (4)

A
  1. Comorbidities 2. Neuropathy 3. Vascular compromise 4. Infection/osteomyelitis
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53
Q

Content: Surgical considerations for traumatic injuries often involve (2)

A
  1. Open, comminuted fx with soft tissue loss 2. Vascular/nerve disruption
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54
Q

Content: Surgical considerations for cancer-related amputation is indicated in (4)

A
  1. High grade neoplasms 2. Proximal lesions 3. Risking pathologic fx or neurovascular involvement 4. Recurrent disease
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55
Q

T/F: Amputation is among the oldest medical procedures

A

True

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56
Q

Q: Why must muscle length be preserved with amputation?

A

To prevent contracture and atrophy

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57
Q

Content: Muscle Stabilization (Closure) Techniques (5)

A
  1. Myodesis 2. Tenodesis 3. Myofascial 4. Myopasty 5. Open (guillotine), provisional, or delayed closure
58
Q

Term: Transected muscles are re-attached by suturing through drill holes at distal end of the bone.

59
Q

Term: Intact tendon(s) re-attached to bone

60
Q

Term: Fascial envelope is sutured over transected muscles

A

Myofascial

61
Q

Term: Suturing of one muscle group to its antagonist

62
Q

Content: Osteomyoplasty (3)

A
  1. Used in transtibial amputation 2. Bone bridge harvested from tibia 3. Bridge connects distal ends of tibia and fibula
63
Q

Q: What are the benefits osteomyoplasty? (2)

A
  1. Prevents chopsticking of distal bone ends 2. Improves WB on residual limb
64
Q

Content: Post-Op complications of amputation (5)

A
  1. Contracture 2. Edema 3. Phantom limb sensation or pain 4. Personal grief/depression 5. Sx complications (i.e. pain, infection, respiratory compromise, DVT, etc)
65
Q

Content: Acute Post-Sc Exam (14 - general idea)

A
  1. Medical history 2. Social situation 3. Pain level 4. Sensation / Proprioception 5. A/AROM or PROM 6. Strength 7. Bed mobility 8. Sitting / Standing balance 9. Transfers 10. Locomotion: gait and/or wheelchair 11. Endurance 12, Home and work environment 13. Barriers to care or adjustment 14. Knowledge: limb care and prosthetic use
66
Q

Content: Goals of acute rehab (5)

A
  1. Prevent complications and allow healing 2. Develop limb strength and ROM for prosthesis 3. Maximize independence in mobility and ADLs 4. Pre-prostehtic training and limb preparation 5. Endurance training and initiation of HEP
67
Q

Content: Amputation Education (5)

A
  1. Positioning 2. Residual limb care 3. Protection of contralateral limb 4. Prosthetic info and time frame 5. Support smoking cessation
68
Q

Content: Post-surgical phase (4)

A
  1. Compression 2. ROM 3. Positioning 4. Endurance
69
Q

Q: When does the post-surgical phase end?

A

When pt. is provided with a definitive prosthesis

70
Q

Content: Post-op Dressing - Rigid dressing (2)

A
  1. Immediate Post Op Prosthesis (IPOP) 2. Plaster socket with removable pylon and foot
71
Q

Content: Advantages of Rigid Dressing (6)

A
  1. Limits edema 2. Reduces pain 3. Prevents contracture 4. Allows early WB/gait 5. Easier move to definitive prosthesis
72
Q

Content: Disadvantages of Rigid Dressing (3)

A
  1. Difficult to apply 2. Requires very close supervision 3. Cannot visualize wound or residual limb
73
Q

Content: Post-op Dressing - Rigid Removable Dressing (RRD) (2)

A
  1. After suture/staple removal, a polypropylene or cast is fist from an impression of the residual limb 2. The RRD is worn over the wound dressing or compression socks
74
Q

Content: Advantages of RRD (4)

A
  1. Allows skin inspection 2. Provides consistent pressure 3. Easily donned 4. Protects residual limb
75
Q

Content: Disadvantages of RRD

A

May require frequent refitting

76
Q

Content: Post-Op Dressing - Semi-Rigid Dressing (2)

A
  1. Zinc-oxide, gelatin, glycerin, and calamine compound 2. Applied in OR or PACU
77
Q

Content: Advantages of Semi-Rigid Dressing (6)

A
  1. Controls edema 2. Adheres to skin 3. Allows some ROM 4. Breathable 5. Inexpensive 6. Easy to contour
78
Q

Content: Disadvantages of Semi-Rigid Dressing (3)

A
  1. Loses effectiveness as edema resolves 2. Not as protective 3. May permit contracture formation
79
Q

Content: Post-Op Dressing - Soft Dressing (2)

A
  1. Incision dressed with 4x4s and Kerlix 2. Compression provided with ACE bandages or elastic shrinker
80
Q

Content: Advantages of Soft Dressing (3)

A
  1. Inexpensive 2. Lightweight 3. Readily available
81
Q

Content: Disadvantages of Soft Dressing (4)

A
  1. Inconsistent, weak compression 2. Requires frequent re-wrapping and replacement 3. Does not prevent contracture 4. Difficult for pt. to self apply
82
Q

Content: ACE Wrapping Amputations (4)

A
  1. Must be rewrapped every 4-6 hrs 2. distal to proximal pressure gradient 3. Figure 8 pattern to prevent tourniquet effect 4. Pt. and caretaker education
83
Q

Q: How should an ACE wrap be applied to a BKA?

A

Pull in medial to lateral, posterior to anterior direction

84
Q

Q: How should an ACE wrap be applied to AKA?

A

Include adductor tissue (prevent adductor roll) and pull into extension and adduction

85
Q

Defn: Limb Shrinkers

A

Elastic socks that help decrease edema and assist in shaping the residual limb

86
Q

Q: What is the pressure gradient for limb shrinkers?

A

Distal to proximal

87
Q

T/F: AKA socks do not require waist belts.

88
Q

T/F: Intermittent claudication is very predictable.

89
Q

Defn: claudication

A

Not enough vascular supply to support the demand, results in pain typically in the calf

90
Q

Defn: Limb socks

A

Used between residual limb and prosthetic socket for protection, friction absorption, and to fill socket volume

91
Q

Content: Limb sock (4)

A
  1. Absorbs perspiration 2. Allows optimal socket fit and contact 3. Cotton, wool, or blended fabric 4. 1, 3, and 5 ply socks can be layered up to 15 ply
92
Q

Video: AKA Post-Op Bandaging

A

http://www.youtube.com/watch?v=zaGgLlK0kGE&feature=related

93
Q

Video: Residual Limb Care

A

http://www.youtube.com/watch?v=KUf66OgRqY0&list=UUlp8fuyor5U_GwWzfQc4utg

94
Q

Video: BKA Prosthetics

A

http://www.youtube.com/watch?v=1_8Io-L2PAo

95
Q

Video: AKA Prosthetics

A

http://www.youtube.com/watch?v=u_ltzVd1zQw&feature=related

96
Q

Video: Bilateral AKA

A

http://www.youtube.com/watch?v=D49YKNM1Kr8

97
Q

T/F: Phantom sensation is normal.

98
Q

Content: Phantom Limb Sensation (4)

A
  1. Painless awareness of the amputated body part 2. Incomplete sensation, often mild tingling 3. Occurs in over 90% of the traumatic/Sx amputees 4. Usually persists throughout life
99
Q

Defn: Phantom Limb Pain

A

Painful sensation of amputated body part, described as cramping, squeezing, burning, or shooting

100
Q

Content: Phantom Limb Pain (4)

A
  1. Can be consistent or intermittent, with varying intensity 2. 30-75% incidence 3. Uncommon in individuals with congenital amputation 4. More common after crush injury or amputation in later life
101
Q

Content: Interventions for Phantom Pain (6)

A
  1. Desensitization and massage 2. Compression 3. Exercise 4. Limb handling and use 5. Modalities: TENS, US, icing 6. Psychological counseling
102
Q

Content: Mirror Therapy (3)

A
  1. Pt. performs a movement with the unaffected limb 2. Movement is viewed in mirror positioned in front of pt. 3. Simultaneously, pt. attempts to perform the movement with their residual or phantom limb
103
Q

Q: How long does scar maturation continue?

A

Up to 1 year

104
Q

Q: Skin integrity andpressure tolerance is only ____% of normal.

105
Q

Content: Desensitization and MAssage (3)

A
  1. Initiate gentle touch and textural stimulation after wound is closed 2. Initiate scar and deep friction massage after the incision is fully healed 3. Massage to residual limb should be used as an adjunct to daily skin inspection and care routine
106
Q

Content: Positioning - Initiate the following as soon as allowable (3)

A
  1. ROM 2. Prone positioning 3. Wrapping/shrinker
107
Q

Content: Positioning (3)

A
  1. Should start immediately 2. Optimize both in and out of bed 3. Monitor edema and limb volume fluctuation
108
Q

Content: Modern Amputation Technique (5)

A
  1. Skin/muscle flaps made anterior and posterior 2. dissect, clamp, cut A&V 3. Dissect nerve and retract back into tissue 4. Severe bone, make a smooth edge 5. Close muscle and skin flaps
109
Q

Content: TherEx (4)

A
  1. Maintain full ROM 2. Strengthen hip ext, add, and knee ext 3. CC exercise and functional activites 4. CV endurace
110
Q

Q: Unilateral BKA increases energy cost of ambulation by ____%.

111
Q

Q: Unilateral AKA increases energy cost of ambulation by ____%.

112
Q

Q: Energy cost for ambulation of a bilateral BKA is ______ than a unilateral AKA.

113
Q

Q: Hip disarticulation increases energy cost of ambulation by ____%.

114
Q

Q: Bilateral AKA increases energy cost of ambulation by ____%.

115
Q

Q: When should you begin transfer training?

A

POD1 if medically stable

116
Q

T/F: Transfer prosthesis is not useful for non-ambulatory pts.

A

False, may be useful

117
Q

Q: How should position roller walker?

A

Pts. elbow in full extension

118
Q

Q: What is the largest factor in determining WC use for amputees?

A

Energy cost of ambulation

119
Q

Content: WC setup considerations (3)

A
  1. Offset rear axis 2. Power system 3. Anti-tip system
120
Q

Q: What is dehissing?

A

When an amputation incision reopens

121
Q

Q: What are the 2 best predictors of prosthetic potential?

A
  1. Level of amputation 2. Pre-Sx function
122
Q

Q: What 2 types of amputations can be functionally independent with prosthesis?

A

Unilateral BKA Bilateral BKA

123
Q

T/F: Most bilateral AKA amputees are prosthetic users.

124
Q

Content: Contraindications to prosthetic use (5)

A
  1. Dementia 2. Institutionalization 3. Adv cardiopulm or neurologic disease 4. Bilateral transfemoral amputation with inability to transfer/stand 5. Unacceptable energy expenditure for ambulation
125
Q

T/F: You can develop contractures with amputations no matter how far out you are.

126
Q

Content: Residual Limb Requirements (5)

A
  1. Fully healed incision 2. No signs of infection 3. No drainage from incision site 4. Ability to tolerate to WB 5. Frequent skin inspection
127
Q

Content: Components to selection of prosthetic parts (4)

A
  1. Age 2. Activity level/vocational demands 3. Funding sources 4. Compliance
128
Q

T/F: Pt. and PT must have understanding of selected components and their functional implications.

129
Q

T/F: Temporary prostheses are intended for full time wear until the permanent prosthesis is available.

130
Q

Q: When is the definitive socket provided?

A

Volume stabilized

131
Q

Content: Temporary Prosthesis (5)

A
  1. Shapes residual limb 2. Allows early gait training and independence 3. Evaluation for potential prosthetic use 4. Allows endurance training 5. Discourages contracture development
132
Q

Content: Progression of gait training (3)

A
  1. Parallel bars: sit to stand, SLB, weight shifting 2. Walker: stand to stand, hopping, stepping 3. Functional tasks: reaching, bending, turning
133
Q

Q: What should be emphasized with gait training?

A

Stance and stability on prosthesis

134
Q

Content: Advanced Gait Training (8 - general idea)

A
  1. Step up/downs onto prosthetic leg 2. Resisted ambulation 3. Running and jumping 4. Transfers to and from the floor 5. Uneven terrain, congested community ambulation 6. Curb and stair training 7. Reaching 8. Lifting and carrying objects
135
Q

Content: When to refer to the prosthetist (4)

A
  1. Weight gain 2. Volume changes 3. ROM 4. Functional changes
136
Q

T/F: As a PT you can make significant adjustments to prosthesis without input from the prosthetist

137
Q

Q: What 2 types of prostheses are typically used with UE?

A
  1. Harness 2. body powered cable control systems
138
Q

Q: What is often and issue with UE prosthetics, esp. with pediatric pts.

A

Acceptance

139
Q

Q: What type of control systems are becoming increasingly prevalent in UE prosthetics?

A

Myoelectric

140
Q

Term: indicated if severe infection or toxicity are present

A

Open/guillotine/provisional/delayed closure

PTRS 746 Exam 1 (9 decks)

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