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Integ Patho (PTH 701) Quiz #1 > Amputations > Flashcards

Amputations Flashcards

1
Q

Where is Ben Branch from?

A

Chicago

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2
Q

What are the 5 different Etiologies and Pathophysiologies for Amputees?

A 
Traumatic
Dysvascular
Elective
Cancer
Congenital 
(CC-TED)
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3
Q

What are reasons for the Dysvascular etiology?

A 
DM
PVD (A/V)
Atherosclerosis
Tobacco use
Peripheral Neuropathy (loss of protective sensation - DFE)
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4
Q

What are the stats for the Elective etiology?

A

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)

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5
Q

What are the facts about the Cancer etiology?

A

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

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6
Q

Congenital facts?

A

Limb dysplasia
Agenesis
Typically most adaptive

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7
Q

What percentage of amputees are over Age 40

A

81.3%

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8
Q

What percentage of amputees had their lower limb affected?

A

90.3%

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9
Q

Are prosthetics efficient?

A

According to the graphics, no.

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10
Q

What is the energy expenditure cost for a Unilateral BKA?

A

25% (125%)

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11
Q

What is the energy expenditure cost for a Bilateral BKA?

A

45% (145%)

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12
Q

What is the energy expenditure cost for a Unilateral AKA?

A

100% (200%)

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13
Q

What is the energy expenditure cost for a AKA and BKA?

A

120% (220%)

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14
Q

How does a BKA/Transtibial work?

A 
Tibia transected and fibula 3-5 cm shorter
Posterior muscle flap
Nerve traction and resection
PT goals
Patient exercises
Cylindrical shape
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15
Q

What is the ERTL Procedure?

A

Osteomyoplastic amputation
Prevention of excess tibia/fibula motion
Maintain intramedullary P across distal end
Distal end bearing, bone remodeling
PREVENTS CHOPSTICKS

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16
Q

How does an AKA/Transfemoral amputation work?

A 
Femur transected
Distal flap using adductors
Nerve traction and resection
PT goals
Patient exercises
Tapered shape
17
Q

What makes up early Post-op care?

A 
Limb shape
Edema reduction
Pain control
Protection
Ctx prevention
Education
18
Q

What makes up Late Post-op care?

A 
Scar massage/mob
Selective strengthening
Balance/Core
Education
Gait efficiency
Fit issues
19
Q

What % of the gait cycle is stance?

A

60%

20
Q

What is the early 2015 MMC data?

A

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

21
Q

What % of gait cycle is swing?

A

40%

22
Q

What does the Amputee Longitudinal Care Pathway do?

A

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

23
Q

What is the amputee care model?

A

MMC –> Rehab –> MMP Physiatry –> PCP/surgery

*Don’t let the cycle repeat. Make it end after surgery

24
Q

When do you begin prosthetic rehab after surgery?

A

4-6 weeks after surgery - when initial prosthesis is installed

25
Q

When are staples removed after surgery?

A

3 weeks after surgery

26
Q

When do you see the Physiatrist? (4)

A

Before surgery, after surgery, when staples are removed/before prosthesis is installed, after prosthetic rehab has been started (6-8 weeks after surgery)

27
Q

Brighton Rehab clinic stats?

A 
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

28
Q

What are 4 common clinical issues?

A 
DISTAL limb vs Phantom Limb Pain
Fit and Function
"Clinical blinders"
Medical comorbidities
*Use holistic approach
29
Q

Do most people get amputations on the R or L?

A

It’s about equal

30
Q

What % of amputee patients get a prosthesis?

A

95% - most of other 5% just don’t want it or use an AD

31
Q

What % of those with a prosthesis choose not to wear it?

A

11% - most of them find it easier to perform daily tasks without one

32
Q

Does wearing a prosthesis have an effect on phantom limb pain?

A

For most, no it does not have an effect.

But protheses make residual limb pain, joint pain, and muscle pain worse

Integ Patho (PTH 701) Quiz #1 (8 decks)

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