Amputations and Prosthetics Flashcards
Forequarter (scapulothoracic)
removal of UE including the shoulder girdle
- lost of shoulder, elbow and hand function
- most common cause is malignancy
- functional prosthetic use is common
- a lightweight cosmetic prosthetic is typically well tolerated
Shoulder disarticulation
removal of UE through shoulder joint
- loss of all shoulder, elbow, and hand function
- most commonly the result of malignancy or severe electrical injuries
- functional prosthetic use is possible
- an external prosthetic shoulder joint is typically required
transhumeral
removal of UE proximal to elbow
- loss of elbow and hand function
- most commonly due to trauma
- typically 7-10 centimeters proximal to the distal humeral condyles
- trauma associated fracture, dislocation or peripheral nerve injury may delay prosthetic interventions
elbow disarticulation
removal of lower arm and hand through elbow joint
- loss of all elbow and hand function
- most commonly due to trauma
- allows for self-suspending socket
- an external prosthetic elbow joint is typically required
transradial
removal of UE distal to the elbow
- loss of all hand function
- must be a minimum of five centimeters proximal to the distal radius
- typically the result of trauma
- trauma associated fracture, dislocation, or peripheral nerve injury may delay prosthetic interventions
- functionally preferred over wrist disarticulation or selected partial hand amputations
- most common UE amputation
wrist disarticulation
removal of hand through wrist joint
- loss of all hand function
- relatively uncommon level of amputation
- cosmetic and functional prosthetic disadvantage
partial hand
removal of portion of hand and digits at either the transcarpal, transmetacarpal, or transphalangeal level
- loss of a portion of digit/hand function
- limb sparing technique utilized when functional pinch can be perserved
- toe transfer to replace a thumb may be considered if prosthesis fails
digit amputation
removal of digit at MCP, proximal interphalangeal or distal interphalangeal level
- preserved function is highly variable depending on number of digits involved
- prostheses are not typically used
- a long transradial amputation may be more functional if multiple digits are involved at proximal levels
hemicorporectomy
removal of pelvis and both LE
hemipelvectomy
removal of one half of the pelvis and the LE
hip disarticulation
removal of the LE from the pelvis
- all functions of the hip, knee, ankle, and foot are absent
- most common cause is malignancy
- does not allow for activation of the prosthesis through a residual limb
- prosthetic limb advancement initiated through use of pelvis
transfemoral
removal of the LE above the knee
- length of the residual limb with regard to leverage and energy expenditure
- knee componentry will determine ability to functionally reciprocate gait
- stance control may not activate until weight bearing occurs through limb
- donning can be more difficult than with a transtibial amputation
- weight bearing through the ischium in an ischial containment socket
- susceptible to hip flexion contracture
- adaptation required for balance, weight of prosthesis, and energy expenditure
knee disarticulation
removal of the LE through the knee joint
- loss of all knee, ankle, and foot function
- residual limb can weight bear through its end
- susceptible to hip flexion contracture
- knee axis of the prosthesis is below natural axis of the knee
- gait deviations can occur secondary to the malalignment of the knee axis
transtibial
removal of the LE below the knee joint
- loss of active foot and ankle motions
- weight bearing in the prosthesis should be distributed over the total residual limb
- areas of primary weight bearing should be pressure tolerant
- adaptations required for balance
- susceptible to both knee and hip flexion contracture
Symes
removal of the foot at the ankle joint with removal of the malleoli
- loss of all foot function
- residual limb can bear weight through its end
- residual limb is bulbous with a non- cosmetic appearance
- dog ears must be reduced for proper prosthetic fit
- adaptation required for increased weight of the prosthesis
- adaptation required due to diminished toe off during gait
transverse tarsal (Choparts)
removal through the talonavicular and calcaneocuboid joints. preserves the PF but sacrifices the DF resulting in equinus contracture
- loss of forefoot leverage
- loss of balance
- loss of weight bearing surface
- loss of proprioception
- tendency to develop equinus deformity
tarsometatarsal (lisfranc)
removal of the metatarsals. preserves the PF and DF
- loss of forefoot leverage
- loss of balance
- loss of weight bearing surface
- loss of proprioception
- tendency to develop equinus deformity
Rigid dressing advantages
- allows for early ambulation with pylon
- promotes circulation and healing
- stimulates proprioception
- provides protection
- provides soft tissue support
- limits edema
- ability to utilize an immediate post-op prosthesis
rigid dressing disadvantages
- immediate wound inspection is not possible
- does not allow for daily dressing change
- requires professional application
semi-rigid dressing advantages (unna)
- reduces post op edema
- provides soft tissue support
- allows for earlier ambulation
- provides protection
- easily changeable
semi-rigid dressing disadvantages
- does not protect as well as rigid
- requires more changing than rigid
- may loosen and allow for developmental edema
NWB rigid removable limb protectors advantages
- removable
- accommodates edema fluctuation
- easily applies
- prevents contracture
- provides protection
NWB rigid removable limb protectors disadvantage
not for ambulatory purposes
Soft dressing advantages
- reduces post-op edema
- provides some protection
- relatively inexpensive
- easily removed for wound inspection
- allows for AROM
Soft dressing disadvantages
- tissue healing is interrupted by frequent dressing changes
- joint ROM may delay healing of incision
- less control of residual limb
- cannot control the amount of tension on bandage
- risk of tourniquet effect
- shrinker cannot be applied until sutures are removed
Common contractures
transmetatarsal and symes- equinus deformity
transtibial- knee flexion
transfemoral- hip flexion and abduction
Hypersensitivity interventions
weight bearing, massage, tapping, residual limb wrapping
neuroma
a bundle of nerve endings that group together and can produce pain due to scar tissue, pressure from the prosthesis, or tension on the residual limb
Phantom pain treatment
TENS, ultrasound, icing, mirror therapy, relaxation techniques, desensitization, prosthetic use
Prosthetic causes of lateral bending
- prosthesis too short
- improperly shaped lateral wall
- high medial wall
- prosthesis aligned in abduction
Amputee causes of lateral bending
- poor balance
- abduction contacture
- improper training
- weak hip abductors on prosthetic side
- hypersensitive and painful residual limb
prosthetic causes of abducted gait
- prosthesis to long
- high medial wall
- poorly shaped lateral wall
- prosthesis positioned in abduction
- inadequate suspension
- excessive knee friction
amputee causes of abducted gait
- abduction contracture
- improper training
- adductor roll
- weak hip flexors and adductors
- pain over lateral residual limb
prosthetic causes of circumducted gait
- prosthesis too long
- excessive knee friction
- socket too small
- excessive plantar flexion
amputee causes of circumducted gait
- abduction contracture
- improper training
- weak hip flexors
- lacks confidence to flex the knee
- painful anterior distal residual limb
- inability to initiate prosthetic knee flexion
prosthetic causes of excessive knee flexion during stance
- socket set forward in relation to foot
- excessive dorsiflexion
- stiff heel
- prosthesis too long
amputee causes of excessive knee flexion during stance
- knee flexion contracture
- hip flexion contracture
- pain anteriorly in residual limb
- decrease in quad strength
- poor balance
prosthetic causes of vaulting
- prosthesis too long
- inadequate socket suspension
- excessive alignment stability
- excessive PF
amputee causes of vaulting
- poor muscle control
- improper training
- weak medial rotators
- short residual limb
prosthetic causes of forward trunk flexion
- socket too long
- poor suspension
- knee instability
amputee causes of forward trunk flexion
- hip flexion contracture
- weak hip extensors
- pain with ischial weight bearing
- inability to initiate prosthetic knee flexion
prosthetic causes of medial or lateral whip
- excessive rotation of the knee
- tight socket fit
- vagus in the prosthetic knee
- improper alignment of the toe break
amputee causes of medial or lateral whip
- improper training
- weak hip rotators
- knee instability
