Amputation and Prosthetics Flashcards
what percentage of US service members do not return to duty following an amputation
about 90%
what are the four main reasons for amputation
disease, trauma, tumor, and congenital defects
what is the primary etiology that leads to amputation of the LE
vascular disease/DM accounts for 80% of all amputations
which subpathology of vascular disease is the likely cause of LE amputation
arterial pathology with gangrene
what is the 5 year survival for a diabetic amputee and how does that relate to nondiabetic amputee
42% for DM, 86% for non-DM
For those with DM and PAD, what is the 1 year, 2 year, and 3 year mortality rates
about 50%, 60%, and 70%
what three comorbidities significantly increase mortality in amputation patients; which is the number one risk factor?
CAD (#1), CVA, and renal dysfunction
___% of DM amputees require revision after 1 year ___% of DM amputees require revision after 5 years
30%; 60%
about half of DM amputees are statistically likely to have the contralateral limb amputated after how many years?
5
What are the major contributors to disease pathology of LE amputation
chronic infection such as osteomyelitis and gas gangrene and frostbite such as dry gangrene
___% of amputations are due to vascular disease
70-90%
what three things that could significantly reduce the risk of amputation in DM patients
education, clinic follow ups, and proper shoe fitting
what is the primary cause of amputation in the younger populations <45yrs
trauma
in what patient population (name one) are we most likely to see primary bone tumors (name two)
adolescents; osteogenic and/or Ewing’s sarcoma
what is PFFD
rare non hereditary usually femur deformity that results from the lack of femur growth in utero
discuss the differences between myoplasty, myodesis, and myofascial surgical stabilization techniques
- suture the ends of the muscle to the bone
- suture the ends of the muscle to the distal bone
- suture the ends of the muscle to the fascia
what is neuroma and how does it develop
nerves are distracted, cut, and allowed to retract
what combats neuroma pain
TMR/TNR procedures decrease neuroma pain and improve myoelectrical prostheses
what is the most common and preferred surgical technique
trick question: for adults, primary closure is preferred but for kids they will preference a disarticulation if there is preservation of the growth plate
what does phantom pain feel like
cramping, shooting, stabbing, burning
what is the difference between a chopart and lisfranc amputation
chopart - mid tarsal cut leaving the talus and calcaneus intact
lisfranc - cut between the tarsals and metatarsals
what is a symes and what is the advantage
ankle disarticulation that cuts through the talocrural joint and allows for good weightbearing
what is the most common amputation linked to PVD
TTA approx 5.5 in below tibial plateau for average males
what is an ERTL procedure
links distal tibfib together post-TTA - not usually performed in vascular amputations
what are the documented benefits of post-op rigid dressing for amputees (4)
- controls edema
- promotes early maturation
- decreased post op pain
- decreased LOS and time to fitting
if the benefits of rigid dressing post-amputation are well documented, how come its not the preferred method for post-op care? (2)
- rigid doesn’t allow us to monitor wound healing
- expensive with debatable reimbursement
what reasons usually lead to a knee disarticulation
trauma, not usually vascular
how does the anatomy shift in a TFA
anterior and posterior compartments are myoplasty-d together and the adductor magnus is myodesis’d to the femur
in what population are we likely to see a rotation plasty
pediatrics
when are hip disarticulations and hemipelvis surgeries indicated; what is a major consideration for this population
malignancy or severe trauma; high prosthetic rejection rate
