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PTRS 746 Musculoskeletal > Amputation > Flashcards

Amputation Flashcards

1
Q

What are the majority of lower extremity amputation caused by? (2)

A
  • Vascular disease
  • Neuropathy
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2
Q

T/F: Amputations are more common in females.

A

False, more common in males

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3
Q

T/F: Amputations are more common in older individuals.

A

True

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4
Q

What are the majority of upper extremity amputations caused by?

A
  • Trauma
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5
Q

What are some of the other causes of amputation? (3)

A
  • Cancer
  • Infection
  • Congenital limb defects
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6
Q

What is peripheral vascular disease (PVD)?

A
  • Condition characterized by narrowing of blood vessels that causes reduced blood flow to the extremities.
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7
Q

What are the most common causes of PVD? (2)

A
  • Diabetes
  • Smoking
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8
Q

What are some of the common co-morbidities associated with PVD? (5)

A
  • Diabetes!!
  • Obesity
  • Hypertension
  • High cholesterol (high lipid profile)
  • Neuropathy
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9
Q

T/F: Patients with diabetes are at 4-5x more risk for claudications.

A

True

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10
Q

What are intermittent claudications?

A
  • Patient experiences very painful cramping sensation in the lower limbs.
  • Caused by decreased blood flow to lower limbs during activity (i.e. muscles are not getting enough oxygen or nutrients to support activity).
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11
Q

What is dysvascular amputation?

A
  • Amputation is required due to impaired circulation (PVD) to the affected limb
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12
Q

T/F: If a patient undergoes amputation of one limb due to PVD, they will be less likely to have their other limb amputated in the future.

A

False, more likely. 55% of amputees caused by PVD in one limb will eventually have bilateral amputation.

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13
Q

Most amputations caused by diabetes are preceded by ________ _____________.

A

Foot ulcerations

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14
Q

What is the 30 day and 5 year mortality rates following major leg amputations?

A
  • 40%, 70%
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15
Q

What is traumatic amputation? (3)

A
  • Amputation is required when limb is damaged by some traumatic event.
  • MVA, work injuries, combat/violent injuries, electrocution, and severe burns
  • More common in young men
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16
Q

What is replantation?

A
  • Reconnection of separated limb/tissues.
  • Alternative to limb amputation
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17
Q

How much time do doctors have to replant tissues before the tissue is no longer viable?

A
  • within 12 hours
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18
Q

T/F: Traumatic amputations are often accompanied by psychological trauma?

A

True

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19
Q

What are the advantages of replantation over amputation? (2)

A
  • Less expensive long-term
  • More psychologically acceptable
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20
Q

What are the advantages of amputation over replantation? (2)

A
  • Lower risk of being rehospitalized
  • Often associated with better functional outcomes
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21
Q

What is malignant amputation? (3)

A
  • Amputation required due to malignant cancer
  • Can be caused by primary or metastatic cancer
  • More common in lower limbs
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22
Q

T/F: The incidence of malignant amputation is increasing.

A

False, decreasing due to earlier diagnosis, better treatments, and improved salvage/reconstruction techniques.

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23
Q

What is pediatric amputation? (4)

A
  • Amputation done on children
  • 3:2 male to female ration
  • Majority of cases are congenital
  • Less than half of cases are acquired (mostly trauma)
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24
Q

What are the benefits to amputation in children? (3)

A
  • Disarticulation at the joint decreases risk of growth plate damage
  • Children have excellent circulation > increases wound healing
  • Children have superior tissue tolerance > early post-op prosthetic fitting
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25
Q

Surgeons most consider ____________ and ___________ growth when doing pediatric amputation.

A

Longitudinal (length), circumferential (girth)

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26
Q

T/F: Pediatric amputations are treated the same way as adult amputations because children are just miniature adults.

A

False

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27
Q

Name the 13 different types of lower limb amputations.

A
  1. Partial toe
  2. Toe disarticulation
  3. Partial foot/ray resection
  4. Transmetatarsal
  5. Syme’s
  6. Long transtibial
  7. Short transtibial
  8. Knee disartculation
  9. Long transfemoral
  10. Short transfemoral
  11. Hip disarticulation
  12. Hemipelvectomy
  13. Hemicorporectomy
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28
Q

Describe 1.) partial toe, 2.) toe disarticulation, 3.) transmetatarsal, and 4.) partial foot/ray resection

A
  1. ) Removal of a portion of one or more toes
  2. ) Amputation at MTP joint of the toe
  3. ) Amputation across the long axis of all 5 metatarsals
  4. ) Resection of the 3rd, 4th, and 5th metatarsals/digits only
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29
Q

Describe Syme’s amputation.

A
  • Disarticulation of the ankle while preserving the heel
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30
Q

Describe 1.) long transtibial, 2.) short transtibial, and 3.) knee disarticulation.

A
  1. ) Retains >50% of tibial length
  2. ) Retains <50% tibial length
  3. ) Amputation through the knee joint that leaves femur intact
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31
Q

Describe 1.) long transfemoral and 2.) transfemoral.

A
  1. ) Retains >50% femur length
  2. ) Retains <50% femur length
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32
Q

Describe 1.) hip disarticulation, 2.) hemipelvecotmy, and 3.) hemicorprectomy.

A
  1. ) Amputation through the hip joint that leaves pelvis intact
  2. ) Resection of one half of the pelvis
  3. ) Amputation of both LEs and the entire pelvis below L4-L5
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33
Q

Name the 10 upper extremity amputations.

A
  1. Partial digit
  2. Digit disarticulation
  3. Transmetacarpal
  4. Transcarpal
  5. Wrist disarticulation
  6. Transradial
  7. Elbow disarticulation
  8. Transhumeral
  9. Shoulder disarticulation
  10. Forequarter amputation
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34
Q

Describe partial digit, digit disarticulation, transmetacarpal, and transcarpal amputation.

A
  1. Removal of part of one or more digits
  2. Amputation at the MCP joint
  3. Resection along the long axis of all 5 metacarpals
  4. Amputation of the entire hand while preserving the wrist (carpal) bones
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35
Q

Describe wrist disarticulation, transradial, and elbow disarticulation.

A
  1. Amputation of the digits and carpal bones at the wrist joint.
  2. Amputation through the radius and ulna
  3. Amputation through the elbow joint
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36
Q

Describe transhumeral, shoulder disarticulation, and forequarter amputation.

A
  1. Amputation through the humerus
  2. Amputation through the shoulder joint.
  3. Amputation of the clavicle, scapula and humerus
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37
Q

What are the 5 main surgical principles of amputation?

A
  1. Maintain circulation for wound/incision healing
  2. Remove all damaged/involved tissues
  3. Preserve as many joints as possible (esp. the knee)
  4. Preserve maximal amount of bone length
  5. Provide residual limb that will accept prosthesis and weight bearing
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38
Q

What surgical considerations are associated with dysvascular amputation patients? (2)

A
  • Often have multiple co-morbidities
  • Often have neuropathy, infection, vascular compromise, or osteomyelitis.
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39
Q

What surgical considerations are associated with traumatic amputation patients? (2)

A
  • Patients often have open/comminuted fractures
  • May have extensive soft tissue loss and damage to blood vessels/nerves
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40
Q

What surgical considerations are associated with cancer-related amputation patients? (2)

A
  • Indicated in high grade neoplasms or cancer lesions located on proximal portions of the bone.
  • Patients are at high risk for pathological fractures, damage to nerves/vasculature, and recurrent disease
41
Q

________ _______ must be preserved in all amputation patients to prevent contractures and atrophy.

A

Muscle length

42
Q

What are the 5 different types of surgical closure techniques?

A
  1. Myodesis
  2. Tenodesis
  3. Myofascial
  4. Myoplasty
  5. Open (guillotine), provisional, or delayed closure
43
Q

Describe the myodesis closure technique.

A
  • Transected muscles are re-attached by suturing through drill holes made at the distal ends of the bone.
44
Q

Describe tenodesis closure.

A
  • Intact tendons are re-attached to the bone
45
Q

Describe myofascial closure.

A
  • A fascial envelope is sutured over transected muscles.
46
Q

Describe myoplasty closure.

A
  • The muscles of one group are sutured to their antagonist muscle group.
47
Q

Describe open, provisional or delayed closure.

A
  • Used if severe infection or toxicity is present.
48
Q

What is an osteomyoplasty (Ertl procedure)? (2)

A
  • Used in transtibial amputations
  • A bone bridge (periosteal flap) is harvested from the removed portion of the tibia that is then used to bridge the distal tibia and fibula ends together.
49
Q

What is the benefit of using the osteomyoplasty for a transtibial amputation? (3)

A
  • Stabilizes the distal ends of the tibia/fibula
  • Prevents chopsticking of the distal bones
  • Improves WBing of residual limb
50
Q

What are the post-op complications for amputations? (8)

A
  • Muscle contractures
  • Edema
  • Phantom limb sensation/pain
  • Depression
  • Pain
  • Infection
  • Respiratory compromise
  • Risk of DVT
51
Q

What are the acute rehab goals after amputation? (5)

A
  • Prevent complications, allow healing
  • Increase strength/ROM for prosthesis
  • Maximize independence in mobility/ADLs
  • Pre-prosthetic training/limb prep
  • Increase endurance, prepare HEP
52
Q

What are the goals of patient education? (7)

A
  • Post-op goals/expectations
  • Positioning to prevent contracture
  • Pain relief/control
  • Residual limb care/inspection
  • Protection of contralateral leg
  • Prosthetic information/time frame to use
  • Encourage no smoking
53
Q

What is an important thing to remember when educating your amputation patient?

A
  • Prioritize!!
  • Not every patient needs the same information in the same order - Determine what that patient needs to most and their level of understanding/compliance
54
Q

What are the 4 things patients need to focus on before they receive their prosthesis?

A
  • ROM
  • Positioning
  • Compression
  • Endurance
55
Q

What are the 4 types of post-op dressings?

A
  • Rigid (IPOP)
  • Rigid removable
  • Semi-rigid
  • Soft
56
Q

Describe rigid dressings.

A
  • aka Immediate Post Op Prosthesis (IPOP)
  • Consists of a plaster socket and removable pylon/foot
57
Q

What are the advantages of IPOP dressing? (6)

A
  • Limits edema
  • Reduces pain
  • Prevents contractures
  • Protects residual limb
  • Allows early WBing/gait
  • Eases transition to permanent prosthesis
58
Q

What are the disadvantages of IPOP dressings? (3)

A
  • Difficult to apply
  • Application requires close supervision
  • Patient cannot see wound or residual limb
59
Q

Describe rigid removable dressings (RRD). (3)

A
  • Applied after sutures are removed
  • A propylene covering or cast is made from an impression of the residual limb
  • RRDs are worn over wound dressings/compression socks
60
Q

What are the advantages of RRD? (4)

A
  • Allows patient to inspect skin
  • Provides consistent pressure
  • Easily put on
  • Protects residual limb
61
Q

What is the disadvantage of RRD?

A
  • May require frequent re-fittings
62
Q

Describe semi-rigid dressings.

A
  • Made of zinc-oxide, gelatin, glycerin, and calamine compound
  • Applied in OR or Post-op Care Unit
63
Q

What are the advantages of semi-rigid dressings? (6)

A
  • Controls edema
  • Adheres to skin
  • Allows some ROM
  • Breathable material
  • Inexpensive
  • Easy to contour to limb
64
Q

What are the disadvantages of semi-rigid dressings? (3)

A
  • Loses effectiveness as edema decreases
  • Not very protective
  • May allow contracture formation
65
Q

Describe soft dressings.

A
  • Wound incision is dressing with 4x4 Ace bandages and Kerlix
  • Ace bandages or elastic shrinkers provide compression
66
Q

What are the advantages of soft dressings? (3)

A
  • Inexpensive
  • Lightweight
  • Readily available materials
67
Q

What are the disadvantages of soft dressings? (4)

A
  • Inconsistent and weak compression technique
  • Requires frequent re-wrapping/replacement
  • Doesn’t prevent contracture
  • Difficult for patients to apply
68
Q

Which types of post-op dressings can potentially allow contractures to form?

A
  • Soft and semi-rigid
69
Q

What are the guidelines for using Ace bandages on residual limbs? (4)

A
  • Re-wrap every 4-6 hours
  • Pressure gradient decreases distal to proximal
  • Figure 8 pattern used to prevent tourniquet effect
  • Patient and caretaker education is needed
70
Q

Ace bandages need to be pulled ________ to _______ and ________ to __________ for BKA.

A

Medial, lateral, anterior, posterior

71
Q

Ace bandaging of AKA need to include adductor tissues to prevent ________ ________ and the limb needs to be pulled into ____________ and __________.

A

Adductor roll, extension, adduction

72
Q

What are limb shrinkers?

A
  • Elastic socks that help decrease edema and shape the residual limb.
  • Pressure gradient increases from proximal to distal
73
Q

What are the guidelines for using limb shrinkers? (5)

A
  • AKA socks require waist belt to prevent slipping
  • Size is determined by circumference and length measurements
  • Used prior to prosthetic fit/wearing
  • Worn 24 hrs/day
  • Patients/caregivers must examine skin!!!
74
Q

T/F: Pressure from Ace bandages and elastic shrinkers is highest proximally and lowest distally.

A

False, highest distal and lowest proximal

75
Q

What are limb socks?

A
  • Fabric sleeve worn between residual limb and prosthetic limb socket
  • Protects limb, prevents friction, optimizes socket fit/contact, absorbs perspiration
  • Made out of cotton, wool or other blended fabric
76
Q

What is phantom limb sensation?

A
  • Painless awareness of the amputated bod part
  • Causes incomplete sensation, mild tingling
  • Usually persists throughout lifetime
77
Q

What percent of surgical and traumatic amputees will experience phantom limb sensation?

A
  • up to 90%
78
Q

T/F: Phantom limb sensations are abnormal and need to be treated immediately.

A

False, they are perfectly normal

79
Q

What is phantom limb pain? (4)

A
  • Painful sensation of amputated limb
  • Pain my be constant, intermittent, and vary in intensity
  • Pain can be cramping, squeezing, burning, or shooting sensations
  • 30-75% of amputees may experience phantom pain
80
Q

Phantom pain is uncommon in __________ amputees and is more common after _______ injuries or amputations done _______ in life.

A

congenital, crush, later

81
Q

How is phantom limb pain treated? (7)

A
  • Desensitization/massage
  • Compression
  • Exercise
  • limb handling/use
  • Modalities (TENS, US, ice)
  • Psychological counseling
  • Mirror therapy
82
Q

What is mirror therapy?

A
  • A mirror is placed in front of the patient.
  • The patient completes a movement with their unaffected limb while watching in the mirror and then attempts to complete the same movement with their affected limb.
83
Q

How should desensitization and massage be used? (3)

A
  • Gentle touch and texture stimulation should be used after wound is healed
  • Deep friction massage should be used on scars after incisions are healed
  • Remember, patients skin integrity and pressure tolerance is only 40% what it use prior to injury
84
Q

How long does scar massage need to be used as a part of amputation treatment?

A
  • Up to 1 year or longer because new scar tissue is still forming up to 1 year after injury.
85
Q

What are the guidelines when working on positioning after amputation? (5)

A
  • Initiate ROM after surgery ASAP
  • Initiate positioning immediately; prone positioning as soon as medically feasible
  • Use wrapping or shinkers as soon as surgeon allows
  • Optimize positioning in and out of bed
  • Monitor changes in limb volume/edema
86
Q

What is the TherEx program after amputation? (4)

A
  • Maintain full ROM
  • Increase strength in hip extensors/adductors and knee extensors
  • Progress to closed chain and functional activities
  • Improve cardiovascular endurance
87
Q

Guidelines for transfer training after amputation. (5)

A
  • Start day 1 post-op if possible
  • Start with stand pivot w/ walker
  • Adjust walker so pt’s elbows can be fully extended
  • If patient cannot stand, use sliding board
  • Use of transfer prosthesis may help non-ambulatory patients
88
Q

If a patient is able you should initiate _________ ________ transfer w/ a ________; if the patient is unable to stand initiate a ________ _________ transfer.

A

Stand, pivot, walker, sliding, board

89
Q

Wheelchair use considerations (4)

A
  • WC should be used if energy cost of ambulation is too much for patient
  • Use cushions to reduce friction/skin compromise
  • Long-term WC should be powered, offset rear axis, and anti-tip
  • Use long-term specialized cushions
90
Q

What are the best predictors of prosthetic use potential?

A
  • Level of amputation and pre-surgical functional level
91
Q

Which patient groups are the most and least likely to regain function with their prosthesis after amputation? (3)

A
  • Any unilateral BKA and bilateral BKA in younger patients can be completely functional
  • Older AKA have problems regaining upright function
  • Majority of bilateral AKA do not use prosthetics
92
Q

What are the contraindications of prosthetic use? (5)

A
  • Dementia
  • Patient institutionalized
  • Advanced cardiopulmonary/neurological disease
  • Bilateral AKA w/ inability to transfer/stand
  • Unacceptable energy expenditure during ambulation
93
Q

Requirements of residual limb before prosthetic use. (5)

A
  • Incisions completely healed
  • No signs of infection
  • No incision site drainage
  • Tolerate WBing
  • Patient compliant w/ frequent skin inspections
94
Q

Decisions about which prosthesis is best for each patient is determined by who?

A
  • Input taken from patient, prosthetist, PT, and MD
  • Patient’s performance w/ temporary prosthesis
95
Q

Prosthetic components are determined based on what? (5)

A
  • Patient’s age
  • Activity level
  • Vocational demands
  • Sources of funding
  • Patient compliance
96
Q

What is a temporary prosthesis used for? (7)

A
  • Shapes residual limb
  • Early gait training/independence
  • Evaluates eventual prosthetic use
  • Allows endurance training
  • Reduces contractures development
  • Not worn full-time
  • Permanent socket size determined when limb volume normalizes
97
Q

What should gait training for amputees focus on? (4)

A
  • Sit-stand, single leg stance, weight shifting w/ prosthesis
  • Progress to standing transfers and hopping/stepping with walker
  • Integrate functional tasks like reaching, bending, turning
  • Work on stance and stability on the prosthesis
98
Q

What should later gait focus on? (6)

A
  • Stair straining
  • Curbs,
  • Uneven terrain
  • Lifting/carrying objects
  • Transfer to and from floor
  • Running/jogging
99
Q

When should a PT refer their patient back to their prosthetist?

A
  • If residual limb volume, weight, functional status, and ROM change that significantly affect prosthesis fit.
  • PTs should never make major adjustments to a prosthesis w/out instruction from prosthetist

PTRS 746 Musculoskeletal (9 decks)

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