Amputations

Question 1

Etiology

Answer 1

PVD (most common- Type 2 diabetics)
Trauma
Malignancy
Infection
Congenital deficiency

Question 2

Residual limb

Answer 2

The part of the limb that is left

Question 3

Common levels of amputation- LE (foot)

Answer 3

Partial toe amputation
Toe disarticulation
Ray resection
Transmetatarsal
Lisfranc (not done anymore commonly)
Chopart (not done anymore commonly)

Question 4

Syme’s

Answer 4

Amp through malleoli

Question 5

Transtibial

Answer 5

Amp through tibia

Question 6

Knee disarticulation

Answer 6

Disarticulation at the tibiofemoral jt

Question 7

Transfemorla

Answer 7

Above knee through femur

Question 8

Transtibial amp ad and disad

Answer 8

Ad
- greater potential of ambulation
- decreased energy expenditure w ambulating

Disad
- not a weight bearing end
- bony prominences are at increased risk for skin breakdown

Question 9

Transfemoral amp

Answer 9

Ad
- greater healing in vascular amputees

Disad
- not a weight bearing end
- lower potential for ambulations
- increased energy expenditure

Question 10

Rotationplasty

Answer 10

Take the thigh and replace with tibia and foot and rotate it backwards at the knee. So the ankle acts as a knee
Removal of a boney tumor

Question 11

Postsurgical dressings

Answer 11

Rigid dressing
Semi-rigid
Soft

Question 12

Goals of post surgical dressings

Answer 12

Control edema
Prevent infections
Protect limb from external, trauma
Shape residuum in preparation for prosthesis

Question 13

Rigid dressing- types

Answer 13

Non-removable
- immediate postoperative prosthesis (IPOP)

Removal
- removable rigid dressing

Question 14

Semi-rigid- paste and ads/disad

Answer 14

Unna’s paste
Good edema control, removable for inspection
May loosen easily and needs frequent changes

Question 15

Sorts dressings- types and ads/disads

Answer 15

Elastic wraps
-Easily removable if there is an infection and cheap
-Poor edema control and minimal protection

Elastic Shrinkers
- socklike garment
- easily to apply with good edema control and stump shaping
- requires changing of size as residuum shrinks (correct size essential)

Question 16

Phases of care

Answer 16

Postsurgical (time b/w surgery and hospital discharge)
Preprosthetic (time b/w hospital discharge and prosthetic fitting)
Prosthetic (time after fitting)

Question 17

Post surgical phase- goals

Answer 17

Healing residuum
Protecting unamputated limb
Increase independence in transfers and mobility
Understanding and demonstrating proper positioning

Question 18

Post surgical phase Common contracture for Transtibial

Answer 18

Knee flexion and hip flexion
To prevent, encourage client to lie prone

Question 19

Post surgical phase Common contracture for Transfemoral

Answer 19

Hip flexion, abduction and ER

Encourage to spend time in prone (15-20 mins/ day)

Question 20

Post surgical phase Balance training

Answer 20

COG will be change
Sitting and single leg balance (on unamputaed limb) balance

Question 21

Post surgical phase Transfer training

Answer 21

Transfer leading with unamputated limb

Question 22

Post surgical phase Mobilty training

Answer 22

Fit patient with appropriate mobility aid
Walker= greater stability, crutches= greater mobility
Wear shoe on the remaining limb to prevent slippage and protect remaining foot

Question 23

Post surgical phase Residual limb care

Answer 23

Teach wrapping to patient and family
Teach how to protect limb while moving in bed and transferring (don’t drag residual limb)
Gentle ROM
No strength on residual care

Question 24

Post surgical phase REmaining limb car

Answer 24

Foot care

Question 25

Preprosthetic phase- Goals

Answer 25

Independent residual limb care, and mobility and transfers Home exercise care understanding Unaffected limb care

Question 26

Preprosthetic phase- residual limb care

Answer 26

Skin Shape Length Circumference Pain

Question 27

Preprosthetic phase- strength and ROM

Answer 27

ROM to prevent the common contractures Strength for gross motor strength (functional activities- like arm strength for movement) MMT of residuum must wait until most healing has occurred

Question 28

Preprosthetic phase- remaining limb inspection

Answer 28

Skin Pulses Sensations Temp Edema Pan on exercise or at rest ROM Strength

Question 29

Preprosthetic phase- functional status

Answer 29

ADLS Functional mobility skills Balance

Question 30

Preprosthetic phase- phantom limb

Answer 30

Sensations and pain in the area of the limb that has been amputated

Question 31

Preprosthetic phase- Intervnion

Answer 31

Residual limb care (desensitizing skin where the prosthetic will be fitted Skin care ROM Strengthening - key muscles for ambulations: - TF: hip extensors, abductors, and adductors - TT: hip extensors, abductors, adductors, knee flexors and extensors Balance and mobilty exercises

Question 32

Prosthetic phase- Goals

Answer 32

Smooth and energy efficient gait so ADL’s are okay Slowly get off stability structures

Question 33

Prosthetic phase- pressure sensitive and tolerant areas

Answer 33

Areas where are more sensitive and areas where they are not

Question 34

Prosthetic phase- Donning Prosthesis

Answer 34

1 roll liner over amputated lib 2 Fill up socket with socks 3 fit prosthesic 4 stand on prosthetic 5 continue to bear weight until prosthesis is locked in place

Question 35

Prosthetic phase- prosthetic training (critical training elements)

Answer 35

Stability ove both legs Knee control Stability on prosthesis Prosthetic control Proprioception Pelvic control Stepping with prosthesis Stepping with sound leg Side stepping/ backward stepping

Question 36

Prosthetic phase- Advanced Training (in gym before going home)

Answer 36

Going up and down stairs and ramp Sitting on the floor Getting up from the floor Kneeling Picking up and object from the floor Clearing obstacles

Question 37

Gait Deviations

Answer 37

Look into it