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PTRS 746 Exam 1 Combined and Randomized > Amputation > Flashcards

Amputation Flashcards

1
Q

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

A

As high as 40%

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1
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
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1
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
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2
Q

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

A

Energy cost of ambulation

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3
Q

UE Amputation Term: Amputation of hand and carpals

A

Wrist disarticulation

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3
Q

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

A

Acceptance

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4
Q

Defn: Limb socks

A

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

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4
Q

Content: Positioning (3)

A
  1. Should start immediately 2. Optimize both in and out of bed 3. Monitor edema and limb volume fluctuation
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5
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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5
Q

UE Amputation Term: Amputation through radius and ulna

A

Transradial

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6
Q

Q: When should you begin transfer training?

A

POD1 if medically stable

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7
Q

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

A
  1. Obesity 2. HTN 3. Hyperlipidema 4. Nephropathy
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7
Q

Defn: Limb Shrinkers

A

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

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8
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
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9
Q

T/F: Amputations may result in better functional outcomes

A

True

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10
Q

Q: What are 3 other causes of amputation?

A
  1. Cancer 2. Infection 3. Congenital limb defects
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11
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
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11
Q

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

A

False

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12
Q

LE Amputation Term: Amputation through knee with intact femur

A

Knee disarticulation

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13
Q

UE Amputation Term: Amputation through shoulder joint

A

Shoulder disarticulation

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14
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
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15
Q

Term: indicated if severe infection or toxicity are present

A

Open/guillotine/provisional/delayed closure

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16
Q

Term: Fascial envelope is sutured over transected muscles

A

Myofascial

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17
Q

UE Amputation Term: Excision of one or more fingers

A

Partial digit

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17
Q

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

A

20

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17
Q

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

A

Unilateral BKA Bilateral BKA

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18
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
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18
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
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20
Q

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

A

55, bilateral

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21
Q

T/F: Amputation is among the oldest medical procedures

A

True

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21
Q

Q: How should position roller walker?

A

Pts. elbow in full extension

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22
Q

T/F: Children are miniature adults.

A

False

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22
Q

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

A

False, may be useful

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22
Q

Q: What is dehissing?

A

When an amputation incision reopens

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23
Q

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

A

Hemicorporectomy

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23
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
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24
Q

Content: Post-surgical phase (4)

A
  1. Compression 2. ROM 3. Positioning 4. Endurance
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25
Q

LE Amputation Term: Disarticulation at MTP joint

A

Toe disarticulation

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27
Q

Content: Traumatic Amputation Causes (4)

A
  1. MVA 2. Violence related combat injuries 3. Severe burns 4. Electrocution
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28
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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29
Q

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

A

False: increase, men

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29
Q

Q: What is the 5 year mortality for amputation?

A

As high as 70%

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30
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
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31
Q

UE Amputation Term: Disarticulation of elbow

A

Elbow disarticulation

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33
Q

LE Amputation Term: Amputation through long axis of all MTs

A

Transmetatarsal

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34
Q

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

A

Myoelectric

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35
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
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36
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
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36
Q

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

A

200

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37
Q

Video: BKA Prosthetics

A

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

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38
Q

Video: Residual Limb Care

A

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

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40
Q

LE Amputation Term: Amputation through hip joint, pelvis intact

A

Hip disarticulation

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41
Q

Q: Why must muscle length be preserved with amputation?

A

To prevent contracture and atrophy

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42
Q

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

A

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

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43
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
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45
Q

LE Amputation Term: Resection of half of the pelvis

A

Hemipelvectomy

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45
Q

T/F: Intermittent claudication is very predictable.

A

True

46
Q

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

A

Myodesis

48
Q

LE Amputation Term: Ankle disarticulation with preservation of heel pad

A

Syme’s

48
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
49
Q

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

A

200

49
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
50
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
52
Q

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

A

Partial toe

53
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
54
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
55
Q

Content: Components to selection of prosthetic parts (4)

A
  1. Age 2. Activity level/vocational demands 3. Funding sources 4. Compliance
56
Q

LE Amputation Term: Retains < 50% of tibial length

A

Short transtibial

57
Q

Defn: claudication

A

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

58
Q

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

A

False do

59
Q

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

A

True

61
Q

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

A

True

62
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)
63
Q

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

A
  1. Level of amputation 2. Pre-Sx function
64
Q

Content: Disadvantages of RRD

A

May require frequent refitting

66
Q

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

A

60, 40

67
Q

Content: When to refer to the prosthetist (4)

A
  1. Weight gain 2. Volume changes 3. ROM 4. Functional changes
68
Q

Video: AKA Prosthetics

A

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

69
Q

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

A

True

71
Q

T/F: Amputation may be more psychologically acceptable.

A

False, Salvage

71
Q

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

A

less

72
Q

UE Amputation Term: Amputation of hand with preservation of wrist

A

Transcarpal

73
Q

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

A

Forequarter amputation

74
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
74
Q

Q: What should be emphasized with gait training?

A

Stance and stability on prosthesis

75
Q

LE Amputation Term: Retains > 50% of tibial length

A

Long transtibial

75
Q

UE Amputation Term: Disarticulation at MCP joint

A

Digit disarticulation

75
Q

Content: Muscle Stabilization (Closure) Techniques (5)

A
  1. Myodesis 2. Tenodesis 3. Myofascial 4. Myopasty 5. Open (guillotine), provisional, or delayed closure
76
Q

T/F: Phantom sensation is normal.

A

True

77
Q

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

A

280

79
Q

Q: What are the benefits osteomyoplasty? (2)

A
  1. Prevents chopsticking of distal bone ends 2. Improves WB on residual limb
80
Q

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

A
  1. Harness 2. body powered cable control systems
81
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
83
Q

Q: What is the pressure gradient for limb shrinkers?

A

Distal to proximal

84
Q

Q: When is the definitive socket provided?

A

Volume stabilized

85
Q

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

A

40

86
Q

Content: WC setup considerations (3)

A
  1. Offset rear axis 2. Power system 3. Anti-tip system
88
Q

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

A

3:2

89
Q

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

A
  1. Open, comminuted fx with soft tissue loss 2. Vascular/nerve disruption
90
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
91
Q

Q: When does the post-surgical phase end?

A

When pt. is provided with a definitive prosthesis

93
Q

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

A

Pull in medial to lateral, posterior to anterior direction

95
Q

Video: Bilateral AKA

A

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

97
Q

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

A

False: greater

98
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
100
Q

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

A
  1. Comorbidities 2. Neuropathy 3. Vascular compromise 4. Infection/osteomyelitis
102
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
103
Q

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

A

12 hour window

105
Q

LE Amputation Term: Retains < 50% of femoral length

A

Short transfemoral

106
Q

Q: How long does scar maturation continue?

A

Up to 1 year

108
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
109
Q

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

A

False

110
Q

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

A

Tenodesis

111
Q

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

A

80, vascular, neuropathy

112
Q

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

A

70, trauma

113
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
115
Q

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

A

False, Most ~85%

116
Q

Defn: Phantom Limb Pain

A

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

117
Q

Content: Malignancy and Amputation (2)

A
  1. Can be due to primary cancer or metastatic disease 2. More commonly involve the lower limbs
118
Q

LE Amputation Term: Retains > 50% of femoral length

A

Long transfemoral

119
Q

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

A

False

120
Q

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

A

4-5

122
Q

Content: Disadvantages of Rigid Dressing (3)

A
  1. Difficult to apply 2. Requires very close supervision 3. Cannot visualize wound or residual limb
123
Q

Content: Advantages of Soft Dressing (3)

A
  1. Inexpensive 2. Lightweight 3. Readily available
125
Q

UE Amputation Term: Amputation through humerus

A

Transhumeral

126
Q

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

A
  1. Immediate Post Op Prosthesis (IPOP) 2. Plaster socket with removable pylon and foot
127
Q

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

A
  1. Zinc-oxide, gelatin, glycerin, and calamine compound 2. Applied in OR or PACU
128
Q

Q: Why are amputation rates declining? (3)

A
  1. Earlier diagnoses 2. Improved chemotherapy 3. Limb salvage/reconstruction techniques
129
Q

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

A
  1. ROM 2. Prone positioning 3. Wrapping/shrinker
130
Q

UE Amputation Term: Resection through long axis of MTCs

A

Transmetacarpal

131
Q

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

A

3

132
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
133
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
134
Q

Term: Suturing of one muscle group to its antagonist

A

Myoplasty

135
Q

Q: Who is traumatic amputation more common in?

A

Younger men

136
Q

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

A

Partial foot/ray resection

137
Q

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

A

49-65%

138
Q

Video: AKA Post-Op Bandaging

A

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

139
Q

Content: Disadvantages of Semi-Rigid Dressing (3)

A
  1. Loses effectiveness as edema resolves 2. Not as protective 3. May permit contracture formation
140
Q

Content: Advantages of RRD (4)

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

PTRS 746 Exam 1 Combined and Randomized (7 decks)

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