Amputations

Question 1

What is the prevalence of amputations?

Answer 1

300,000-2.5 million

Question 2

By what percent does the rate of amputations increase per year?

Answer 2

8-10%

Question 3

_____ loose a limb every year

_____ lose a limb every month

_____ lose a limb every week

_____ lose a limb every day

Answer 3

156,000 loose a limb every year

13,000 lose a limb every month

2,996 lose a limb every week

428 lose a limb every day

Question 4

What are the 4 major causes of amputation?

Answer 4

(1) vascular disease and infection
(2) trauma
(3) tumors (osteosarcoma)
(4) congenital anomalies/demorfnities

Question 5

What is the percent of transtibial, transfemoral, and ankle disarticulation amputations?

Answer 5

transtibial = 75%

transfemoral = 19%

ankle disarticulation = 3%

Question 6

Why is a transtibial amputation considered more optimal than the others?

Answer 6

Because it has more options of prosthetic componentry available

Question 7

Why do ankle disarticulations occur less than other amputations?

Answer 7

Because they have less options for prosthetic componentry

Question 8

An ankle disarticulation in which the tibia and fibula are separated form the talus, and the patients have end weight bearing capabilities is called what?

Answer 8

Syme’s amputations

Question 9

An amputation which is usually performed on children who have developed osteosarcomas near the knee, and removed the affected bone segments but attaches the lower leg and foot rotated 180 degrees to the femur is called what?

Answer 9

Rotationplasty

Question 10

What are the goals with transtibial post-operative care? (5)

Answer 10

(1) wound healing
(2) minimizing pain
(3) reducing edema/total contact
(4) limb protection
(5) preservation of knee ROM

Question 11

What are the benefits of post-operative rehabilitation? (4)

Answer 11

(1) faster wound healing with reduced complications
(2) decreased pain
(3) quicker shaping of limb
(4) overall reduced hospital stay

Question 12

An _____ _____ _____ or IPOP is a rigid dressing with a pylon and foot utilized for toe touch weight bearing within 24 hours of surgery to assist with progression from non-weight bearing activities to walking with an assistive device.

Answer 12

Immediate Postoperative Prosthesis

Question 13

Identify the 3 main components of a prosthesis.

Answer 13

(1) socket
(2) pylon
(3) foot component

Question 14

A ____ ____ bearing socket design has specific areas of relief that are pressure tolerate (loading specific) and pressure sensitive. This socket is triangular in shape.

Answer 14

patellar tendon bearing (PTB)

Question 15

A _____ _____ bearing socket design provides equal distribution of pressure over the limb with a gel liner providing internal natural reliefs over boney prominences.

Answer 15

Total Surface Bearing

Question 16

A _____ weight bearing socket design used fluid density and tissue elongation to equalize pressure across tissues.

Answer 16

hydrostatic weight bearing

Question 17

What can soft liners be used for? (2)

Answer 17

(1) shock absorption
(2) suspension

Question 18

What can soft liner material provide for pressure sensitive areas of skin?

Answer 18

They can provide relief

Question 19

What are the modes of suspension that are available? (7)

Answer 19

joint and lacer, belt or cuff, suspension or compression sleeve, supracondylar, locking pin, suction/expulsion valve (sealing), or vacuum

Question 20

In current clinical practice, what socket design and suspension is utilized the most?

Answer 20

patellar tendon bearing (socket design) & silicone suction (suspension)

Question 21

What criteria are considered when choosing the foot component of a prosthesis? (3-5)

Answer 21

(1) amputation level
(2) motivation level
(3) activity level

Also, weight, cosmesis, and cost

Question 22

What are the different feet component categories? (5)

Answer 22

(1) SACH
(2) single axis
(3) multi-axis
(4) dynamic response
(5) multi-axial dynamic response

Question 23

What does SACH stand for?

Answer 23

solid ankle cushioned heel

Question 24

Following transfemoral post-operation, what type of dressings or coverage is applied to the limb? (3)

Answer 24

(1) SHAMU dressing (usually applied in OR)
(2) Soft socks with garter belt
(3) Compression socks/Ace wrap

Question 25

Describe the characteristics of a preparatory prosthesis post-op following transfemoral amputation. (5)

Answer 25

• Single axis locking knee in combination with SACH
• Fit over compression and spacing sock
• Copolymer plastic socket
• Quadrilateral style brim shape
• Suspension – waist belt

Question 26

What are the structural goals of a transfemoral and up prosthesis? (3)

Answer 26

• Replace structural support to skeletal system
• Transfer support forces through the residual soft tissue to the femur
• Stabilize the femur into the hip in a natural position for posture and force.

Question 27

_____ _____ socket design for transfemoral amputation involves a “pelvic lock” with ischial tuberosity support. It is shaped as a transverse triangle which provides counter force for ischium.

Answer 27

Ischial Containment

Question 28

A ____ ____ socket design has ischial support that encapsulates the ramus, allowing for greatest hip ROM.

Answer 28

MAS Socket

Question 29

What are the suspension systems available for transfemoral prosthetics? (4)

Answer 29

(1) suction - one way expulsion valve with silicone sleeve, seal in liner, and vacuum
(2) lanyard/shuttle lock
(3) silesian belt (TES belt)
(4) hip joint and pelvic band

Question 30

Knee joints are categorized by what 3 things? And are appropriate based on an individual’s what activity level or _____-_____.

Answer 30

(1) rotational axis
(2) friction
(3) additional features

k-level

Question 31

There is an [proportional/inverse] relationship between coluntary control and inherent stability as far as knee prosthetic design goes.

Answer 31

Inverse, meaning that knees requiring the most voluntary control will in turn provide the least inherent stability

Question 32

A ______ is complete removal of the head of the femur from the acetabulum.

Answer 32

hip disarticulation

Question 33

A ______ is complete removal of one half of the pelvis (any portion of the illium, ischium, or pubis).

Answer 33

hemipelvectomy

Question 34

What can be challenging in hip fitting for hip disarticulation or hemipelvectomy patients? (5)

Answer 34

socket design, suspension, component options, alignment, or appearance

Question 35

How is suspension achieved with prosthetics for those with a hip disarticulation or hemipelvectomy?

Answer 35

By socket contours above the iliac crests

Question 36

For those with a hip disarticulation or hemipelvectomy, mechanical resistance is applied to swing phase, why is this? (3)

Answer 36

To prevent: excessive hip flexion or knee flexion

To assist: knee extension