Amputee

Question 1

Partial foot

Answer 1

generally one or more toes

can involve tarsals & metatarsals

impact- gait, balance, high level activities

causes- DM, trauma

Question 2

Lisfranc amputation

Answer 2

tarsometatarsal

Question 3

Chopart amputation

Answer 3

midtarsal (transverse tarsal)

preserve the talus and calcaneum

Question 4

Full foot amputation

Answer 4

full foot removal

less common in US

impact- gait, balance, high level activities

causes- landmines, DM, infection

Question 5

Pirogoff’s amputation

Answer 5

remove the calcaneus and rotate it 70 deg

not done here in the US a lot

removes the ankle joint

allows people weight bearning

Question 6

syme amputation

Answer 6

malleoli removed

only tib-fib weight bearing

Question 7

Below knee amputation (BKA)

Answer 7

transtibial and fibular

impact- action of ankle removed. knee and hip must accommodate

causes-disease, DM, trauma

Question 8

BKA strength and ROM

Answer 8

all BKA need-

strong quads, strong hamstrings, very strong abductors, full ROM in the knee

Question 9

Above knee (AKA)

Answer 9

impact- no knee, no ankle, hip has to accomodate

need extremely strong hip extensors, extremly strong hip abductors, hip extension 10-20 deg past normal range

Question 10

Hip disarticulation

Answer 10

causes- major trauma, osteosarcoma

impact- profound

Question 11

hemipelvectomy and hemicarporectomy

Answer 11

causes- trauma and cancer

impact- profound

Question 12

pre-prosthetics

Answer 12

management of edema- residual limb shrunk to minimal size

Full ROM:
AKA-hip ROM with increased hip extension

BKA-hip ROM and full knee EXT

Strength:
AKA- increased hip extension and abduction

BKA- increased hip extensor/ abductor and knee extensor/ flexor strength

Question 13

Management of edema

Answer 13

residual limb wrapping- generally done while sutures/staples present

shrinker- generally utilized after sutures/ staples removed

Bi-valve (aka rigid dressing)- used right after surgery, ideally prevents edema. Cheaper to make and easier to use.

Question 14

Amputee gait deviations

Answer 14

different position of pylon

prosthetic length-too long, too short

vaulting- up on toe to swing through opposite knee

lateral side lean- weak glute meds, short prothetic (pistoning), or outset foot

rotation of foot-

valgus moment-

trunk side bending=

Question 15

Fit weight bearing: BKA pressure tolerant

Answer 15

anterior and lateral-
supracondylar areas, suprapatellar areas, patellar tendon, medial flare of tibia, lateral flare of tibia, posterior area of the stump, popliteal area (gentle), distal end of stump for total contact socket (no press/contact only)

Question 16

Fit weight bearing: BKA pressure sensative

Answer 16

patella, lateral tibial condyle, tibial tuberosity, tibial crest, anterior distal end of tibia, fibular head, distal end of fibula, distal end of stump with surgical suture, medial femoral condyle, lateral femoral condyle

Question 17

Fit weight bearing: AKA pressure tolerant

Answer 17

ischial tuberosity, lateral flear of the stump, medial flear of stump, post flear of stump, distal end of stump for total contact socket ( no press/contact only)

Question 18

Fit weight bearing: AKA pressure sensitive

Answer 18

greater trochanter, ramus, adductor tendon, ASIS, distal end of femur, inguinal fossa, pubic tubercle, surgical suture