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RS PTRS 746 Musculoskeletal Conditions > Amputation Management and Rehab > Flashcards

Amputation Management and Rehab Flashcards

1
Q
  • one of every ____ americans will have an amputation
  • ___ as common in ment
  • over 80% due to ________ and _______
  • over 70% of UE are due to _____
A
  • 200
  • twice
  • vascular disease, neuropathy
  • trauma
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2
Q

most diabetic amputations are preceeded by ____

A

foot ulcer

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3
Q
  • over half those whose PVD results in amputation will eventually undergo ________
  • 30 dat mortality
  • 5 year mortality
A
  • bilateral amputations
  • 40%
  • 70%
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4
Q

Salvage vs. Amputation

  • higher lifetime cost?
  • increased risk of subsequent hospitalization
  • better fxnl outcomes
  • more psychologically acceptible
A
  • amp
  • salvage
  • amp
  • salvage
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5
Q

amputation secondary to malignancy is most commonly where?

A

lower limbs

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6
Q

in pediatric amputation, 60% are ____ and 40% are ______

A

congenital, acquired

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7
Q

-______ often present with comorbidities, neuropathy, vascular compromise, infection, or osteomyelitis

A

dysvascular patients

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8
Q

-_____ often involve open, comminuted fractures with soft tissue loss and vascular/nerve disruption

A

traumatic injuries

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9
Q

-_______ is indicated in high grade neoplasms, proximal lesions, those risking pathologic fractures or neurovascular involvement or recurrent disease

A

cancer-related amputation

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10
Q

skin and muscle are divided into _________.

A

anterior and posterior flaps (which are sewn together to form residual limb after vessels and nerves are severed and bone is severed and filled)

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11
Q

myodesis closure technique

A

transected muscles are re-attached by suturing through drill holes at distal end of the bone

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12
Q

tenodesis closure technique

A

intact tendons reattached to bone

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13
Q

myofascial closure technique

A

fascial envelope is sutured over transected muscles

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14
Q

myoplasty closure technique

A

suturing of one muscle group to its antagonist

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15
Q

open (guillotine), provisional or delayed closure

A

indicated if severe infection or toxicity are present

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16
Q

osteomyoplasty (Ertl Procedure)

A

osteoperiosteal flap is harvested from amputated tibia and implanted, bridging distal tibia and fibular ends. incision is closed over bone bridge

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17
Q

what is the purpose of osteomyoplast (ertl procedure)

A

stabilizes distal tibia and femur

  • prevents “chopsticking” of distal bone ends
  • improves weight bearing on residual limb
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18
Q

name some post-operative complications

A

contracture, edema, phantom limb sensation or pain, personal grief and depression
Sx complications

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19
Q

Post-surgical phase goals

A

compression, ROM, Positioning, endurance

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20
Q

when does the post-surgical phase end?

A

when patient is provided with a definitive prosthesis

21
Q

Rigid post-op dressing (IPOP)

A

immediate post-op prosthesis

-plaster socket with removable pylon and foot

22
Q

IPOP advantages

A

limits edema, reduces pain, prevents contracture, protects limb, allows early WBing and gait, easier to move to definitive prosthesis

23
Q

IPOP disadvantages

A

difficult to apply, requires very close supervision, cannot visualize wound or residual limb

24
Q

Rigid removable post-op dressing (RRD)

A

after suture/staple is removed, a polypropylene or cast is fit from an impression of the residual limb
- the rrd is worn OVER wound dressing or compression socks

25
Q

RRD advantages

A

allows skin inspection, provides consistent pressure, easily donned, protects residual limb

26
Q

RRD disadvantages

A

may require frequent refitting

27
Q

Semi-rigid post-op dressing

A

zinc-oxide, gelatin, gylcerin, and calamine compound

Applied in OR or PACU

28
Q

Semi-rigid post-op dressing advantages

A

controls edema, adheres to skin, allows some ROM, breathable, inexpensive, easy to contour

29
Q

semi-rigid post-op dressing disadvantages

A

loses effectiveness as edema resolves, not as protective, may permit contracture formation

30
Q

Soft dressing

A

incision dressed with 4x4s and kerlix

compression provided with ACE bandages or elastic shrinker

31
Q

soft dressing advantages

A

inexpensive, lightweight, readily available

32
Q

soft dressing disadvantages

A

inconsistent, weak compression, requires frequent re-wrapping and replacement, does not prevent contracture, difficult for patient to self-apply

33
Q

ACE wrapping

  • every _____
  • ___ to ___ pressure gradient
  • below knee
  • above knee
  • pattern
A
  • 4-6 hours
  • distal to proximal
  • pull M to L, P to A direction
  • include adductor tissue and pull into ext and add
  • figure 8
34
Q

Limb shrinkers

  • what are they?
  • gradient
  • AKA socks require ____
  • size determined by _______
  • wear _____
  • continue _____
A
  • elastic socks that help decrease edema and assist in shaping the residual limb
  • distal to proximal
  • circumference and length
  • 24 hrs/day
  • skin inspection
35
Q

limb socks

  • used for
  • absorbs ___
  • fabric
  • ply
A
  • between residual limb and prosthetic socket for protection, friction absorption, and to fill socket volume
  • perspiration
  • cotton, wool, or blend
  • 1, 3, 5, up to 15
36
Q

what is phantom limb sensation?

-prevalence

A

painless awarness of the amputated body part, often mild tingling

  • occurs in 90% of traumatic and surgical amputees
  • usually persists throughout life, normal
37
Q

phantom limb pain

A

can be constant or intermittent, 30-75% of amputees (usually after crush injury or in later life, not congenital)

38
Q

phantom limb pain interventions

A

desensitization, massage, compression, exercise, limb handling and use, TENS, US, icing, psych counseling, mirror therapy

39
Q
  • scar maturation occurs for up to ____

- skin integrity and pressure tolerance only ____ of normal

A
  • one year

- 40%

40
Q

Positioning

  • initiate ROM when?
  • initiate positioning when?
A
  • usually immediately post-op

- as soon as medically feasible

41
Q

ther ex

  • maintain full ROM and strengthen ______
  • ___ chain
  • what happens to energy cost?
A
  • hip adductors, extensors, and knee extensors
  • closed
  • increased energy cost
42
Q
  • transfer training should begin ____
  • what transfer?
  • position of RW
A
  • POD 1 if possible
  • stand pivot with RW
  • with elbows in full extension
43
Q
  • w/c and cushion for those at high risk for ________

- need ______

A
  • skin compromise or socket intolerance

- anti-tip system

44
Q

What are the best predictors of prosthetic potential?

A

level of amputation and pre-surgical function

45
Q

-any _____ and ____can be functionally independent

A

unilateral BKA or younger bilateral BKA amputee

46
Q
  • older unilateral AKA and most bilateral AKA amputees ____________
A

will have difficulty regaining upright independence

47
Q

name some residual limb requirements for prosthetic use

A

fully healed incision, no s/s of infection, no drainage from incision site, ability to tolerate weight bearing, frequent skin inspection

48
Q

when to refer to a prosthetist

A

if weight gain, volume change, ROM or functional changes affect fit

49
Q

UE amputation

  • utilize ______
  • ____ is often an issue, esp. in peds
A
  • harness and body-powered cable control systems

- acceptance

RS PTRS 746 Musculoskeletal Conditions (7 decks)

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