Amputations Flashcards
Where is Ben Branch from?
Chicago
What are the 5 different Etiologies and Pathophysiologies for Amputees?
Traumatic Dysvascular Elective Cancer Congenital (CC-TED)
What are reasons for the Dysvascular etiology?
DM PVD (A/V) Atherosclerosis Tobacco use Peripheral Neuropathy (loss of protective sensation - DFE)
What are the stats for the Elective etiology?
High rate of compound, open tib/fib fracture patients (85% in 5 years post Fx)
CRPS, RSD (Complex regional pain syndrome, also called RSD - Reflex Sympathetic Dystrophy)
Revision surgeries (fit, function, wound)
What are the facts about the Cancer etiology?
Sarcoma, lyoma
Amputation level determines by local tissue destruction, nerve effect
Soft tissue injuries more common, skin breakdown if RT
Neuropathy more common with CT
Congenital facts?
Limb dysplasia
Agenesis
Typically most adaptive
What percentage of amputees are over Age 40
81.3%
What percentage of amputees had their lower limb affected?
90.3%
Are prosthetics efficient?
According to the graphics, no.
What is the energy expenditure cost for a Unilateral BKA?
25% (125%)
What is the energy expenditure cost for a Bilateral BKA?
45% (145%)
What is the energy expenditure cost for a Unilateral AKA?
100% (200%)
What is the energy expenditure cost for a AKA and BKA?
120% (220%)
How does a BKA/Transtibial work?
Tibia transected and fibula 3-5 cm shorter Posterior muscle flap Nerve traction and resection PT goals Patient exercises Cylindrical shape
What is the ERTL Procedure?
Osteomyoplastic amputation
Prevention of excess tibia/fibula motion
Maintain intramedullary P across distal end
Distal end bearing, bone remodeling
PREVENTS CHOPSTICKS
How does an AKA/Transfemoral amputation work?
Femur transected Distal flap using adductors Nerve traction and resection PT goals Patient exercises Tapered shape
What makes up early Post-op care?
Limb shape Edema reduction Pain control Protection Ctx prevention Education
What makes up Late Post-op care?
Scar massage/mob Selective strengthening Balance/Core Education Gait efficiency Fit issues
What % of the gait cycle is stance?
60%
What is the early 2015 MMC data?
BKA 90% (AKA 10%)
Unilateral 85%, Bilateral 10%, Other 5%
NONE had coordinated care at time of consult
Most have only ONE specialist involved (Vascular, General Surgery, Trauma)
Post-discharge follow-up = PCP or none
What % of gait cycle is swing?
40%
What does the Amputee Longitudinal Care Pathway do?
Improve delivery of care for amputees
Reduce # of Urgent care, ED, Hospital visits
Reduce unnecessary PCP, prostheist, surgery visits
Provide a resource in the community for amputee care (pre and post-op)
Advocate for amputee patient care needs
What is the amputee care model?
MMC –> Rehab –> MMP Physiatry –> PCP/surgery
*Don’t let the cycle repeat. Make it end after surgery
When do you begin prosthetic rehab after surgery?
4-6 weeks after surgery - when initial prosthesis is installed
When are staples removed after surgery?
3 weeks after surgery
When do you see the Physiatrist? (4)
Before surgery, after surgery, when staples are removed/before prosthesis is installed, after prosthetic rehab has been started (6-8 weeks after surgery)
Brighton Rehab clinic stats?
Unilateral 70%, Bilat 30% AKA 25%, BKA 75% UE 15%, LE 85% Dysvascular is most common! Dysvascular 80%, Traumatic 15%, Elective 5%
*Coordinated care efforts amongst prosthetist, therapists, PCP, endocrinology, podiatry, surgery
What are 4 common clinical issues?
DISTAL limb vs Phantom Limb Pain Fit and Function "Clinical blinders" Medical comorbidities *Use holistic approach
Do most people get amputations on the R or L?
It’s about equal
What % of amputee patients get a prosthesis?
95% - most of other 5% just don’t want it or use an AD
What % of those with a prosthesis choose not to wear it?
11% - most of them find it easier to perform daily tasks without one
Does wearing a prosthesis have an effect on phantom limb pain?
For most, no it does not have an effect.
But protheses make residual limb pain, joint pain, and muscle pain worse
