Amputation Types Flashcards
What can be done for transmetatarsal amputation
Shoe modifications: has enough length and necessary muscle attachment to remain functional
Extended Foot Plate: steel shank into sole of shoe to allow normal toe off
Toe filler: to fill distal empty toe portion
Rigid Rocker bottom
What type of amputation is the Lisfranc Amputation
tarsometatarsal articulation of the foot
In Lisfranc Amputation what is disassociated?
Disassociation between the Tarsal bones and Metatarsals
What type of amputation is Chopart?
Mid-tarsal Disarticulation
Describe the Chopart Amputation and what is removed
Removes the forefoot and midfoot, SAVING TALUS AND CALCANEUS
What type of disarticulation is the Symes Amputation
Ankle Disarticulation
Transmetatarsal Amputation
Shoe Modification: has enough length and necessary nuscle attachments to remain functional
Extended foot plate: extended carbon fiber foot plate
Toe filler: to fill distal empty toe portion of shoe
Rigid rocker bottom
What type of articulation is the Lisfrant Joint?
Type of transmetatarsal articulation of the foot
What is intact with the Lisfranc Joint
Calcaneus, Talus, and Tarsal bones
Describe Chopart Amputation
Removes the forfoot and midfoot, saving the talus and calcaneus
Example of Ankle Disarticulation
Symes Amputation
Describe Symes Amputation
amputation at the ankle
Syme’s amputation pt’s may be susceptible to what condition later in life?
Knee and hip OA
Advantages of Symes amputation (5):
Distal Weight Bearing Longer limb=less energy loss Can ambulate without prosthesis Proprioception Preservation of distal growth plate in children
Disadvantages of Symes amputation (3):
Wound healing
Compliance
Heel pad instability
Most important major amputation in VA patient population
Transtibial
Describe 2 benefits of transtibial amputations
- Knee is saved and viable. 2. Ambulation possible with good rehab and prosthetics, even when bilateral
What are the indications for amputation?
- Peripheral Vascular Disease
- Diabetic limb disease
- Necrotising fasciitis (rare)
- Trauma
- Infection
- Tumors (Malignant)
- Nerve injury (possible diabetic situation, SCI)
- Congenital anomalies
(extra digits, gross deformity)
Who is Ambrose Pare? and what did he do?
French surgeon who: stopped using oil for cauterization, developed Ligature with spring loaded forceps, and was the first to describe phantom sensation
Do more males or females have amputations?
Males (9:1 Ratio)
What is the most common reason for amputations?
Vascular disease (80%)
What are the odds of mortality after 1 and 5 years?
1 year = 25%
5 years = 67%
What should be included in the pre-op eval?
- pt’s functional status & age
- Overall medical condition
- Skin Condition (Temp, Hair Loss, Dystrophic nature)
- Infection (“deep” vs. superficial)
- Peripheral pulses
What is the difference between chronological age and physiological age?
- -> Chronological - your actual age (The number of years you have lived)
- -> Physiological - age judged in terms of physiological development
What are the 2 most common amputations?
Trantibial (BK) - 59%
Transfemoral (AK) - 35%
When does a Rotationplasty/Van Ness procedure get used?
- in cases of osteosarcoma and congenital lower-limb differences (proximal focal femoral deficiency)
What does a Rotationplasty involve in terms of surgery?
- partial amputation above the knee
- lower leg and foot are rotated 180 deg, length is adjusted and tibia is fused to the proximal femur
- foot is where knee used to be , heel portion in front and toes pointing backwards
- ankle is know functioning as the knee
What is the primary reason for the rotationplasty (think function)?
- to enhance the person’s mobility as a prosthesis user
- functional, natural knee is created and the toes provide sensory feedback
Is there a cosmetic component/worry to a rotationplasty?
- Yes!
- appearance is very unusual
- pts should talk with people who have had this procedure done before
- functional advantages usually quickly outweigh the appearance
Optimal Amputation Level for Transradial (forearm)
junction proximal 2/3 and distal 1/3
Shortest Amputation Level for Transradial
3 cm below biceps insertion
Longest Amputation Level for Transradial
5 cm above wrist joint
Optimal Amputation Level for Transhumeral
middle third
Shortest Amputation Level for Transhueral
4 cm below axillary fold
Longest Amputation Level for Transhumeral
10 cm above olecranon
Optimal Amputation Level for Transfemoral
middle third
Shortest Amputation Level for Transfemoral
8 cm below pubic ramus
Longest Amputation Level for Transfemoral
15 cm above knee joint
Optimal Amputation Level for Transtibial
8 cm for every meter of height
Shortest Amputation Level for Transtibial
7.5 cm below knee joint
What is a Forequarter Amputation ?
- the removal of the upper limb with the scapula
- mainly used for malignancy
Krukenberg Procedure
- separate radial and ulna rays distally
- forming radial and ulna pincers capable of strong prehension and excellent manipulative ability
Define myodesis
direct suturing of muscle or tendon to bone
When is a myodesis used?
transfemoral amputation; distal muscle stabilization gives greater stability
When is myodesis not recommended?
for ischemic patients; employ myoplasty instead
Define myoplasty
muscle is sutured to muscle and placed over end of bone before wound closure
When is myoplasty used?
patients with poor vascular health
Which provides better distal stabilization, myodesis or myoplasty?
Myodesis
Indications for hip disarticulation
prevention of life after trauma; co-morbid pt with infection and sepsis; necrotizing fasciitis; non-ambulators (paras); advanced ischemic disease; tumor-osteosarcoma
What anatomy is lost in hemipelvectomy?
femoroacetabular region and part of pelvis
What is a hemicorporectomy?
Amputation through part of the trunk
What is another name for a rotationplasty?
Van Ness procedure
Example of a Mid-Tarsal Disarticulation
Example of a Mid-Tarsal Disarticulation
