Amputee Lecture and Lab

Question 1

what is myodesis?

Answer 1

-when the muscle is secured to bone by suturing the distal tendon through holes drilled into the bone
- it is often used in BK/AKA to aid in deformities

Question 2

what is myoplasty?

Answer 2

attaching sectioned muscles to opposing muscles

Question 3

what is a minor amputation

Answer 3

toe and partial foot amputations

Question 4

what is a major amputation

Answer 4

proximal to tarsometatarsal joint

Question 5

what are primary indications for amputation

Answer 5

PVD, diabetic wounds, trauma, infection, tumor, cancer, congenital

Question 6

what is the leading cause of LLA

Answer 6

diabetes

Question 7

what does a loss of the ankle joint cause?

Answer 7

• loss of somatosensory input
• reduced WB through residual limb and reduced confidence
• altered postural control and increased reliance on remaining balance strategies

Question 8

what is a symes foot amputation

Answer 8

• removal of foot, medial and lateral malleoli removed, heel pad relocated to distal tibia

Question 9

what is a chopart foot amputation?

Answer 9

disarticulation between the navicular/cuboid bones and the talus/calcaneus bones

Question 10

what is the lisfranc foot amputation?

Answer 10

amputation of the tarsometatarsal joint

Question 11

what is a transmetatarsal foot amputation

Answer 11

-amputation of the midshafts of metatarsals
- well-preserved arch and mobile ankle

Question 12

what are the characteristics of transtibial amputation (BKA)

Answer 12

• preserves the knee
  -loss of muscular control of the lower limb muscle groups and foot and ankle
• demonstrate decreased velocity, shorter step length, increased stance phase, increased time on sound limb, asymmetrical stance

Question 13

what are the characteristics of a transfemoral AKA amputation

Answer 13

• preserves the hip joint
• loss of joints below and impaired musculature below the pelvis

Question 14

what are common contracture sites for amputee patients

Answer 14

hip flexion, hip abduction, hip ER, knee flexion, ankle PF

Question 15

what are the advantages and disadvantages of ACE wrapping?

Answer 15

Advantages
- edema control
- easy access
- inexpensive
Disadvantages
- does not protect limb from environment
-hard to apply
- uneven compression
- will not prevent contracture

Question 16

what are the advantages and disadvantages of shrinkers?

Answer 16

Advantages
- edema control
- easy access
- inexpensive
-even compression
Disadvantages
- may catch on staples or sutures
- may increase pain during application
- does not protect wound or limb from external environment
- will not prevent contracture

Question 17

what are the advantages or disadvantages of rigid dressing?

Answer 17

Advantages
- stays in place for 7-10 days
- protect residual limb
- best for edema control
- contracture prevention in BKA
Disadvantages
- high risk of infection
- bulky and heavy
- requires close monitoring
-limited access

Question 18

why is compression bandaging important for all amputees?

Answer 18

reduced edema, pain control, enhanced wound healing, incision protection, facilitates preparation for prosthetic placement

Question 19

what is rigid compression bandaging?

Answer 19

• Rigid applied by surgeon in OR
  -removed 3-4 day
  -can then put new with IPOP-allows limited TTWB in 2-3 days-prosthetist
• Best for controlling edema and pain
• Not good for pt. with significant risk for infection because wound status not easily visualized unless removable

Question 20

what are principles of ACE wrapping?

Answer 20

-Distal pressure should exceed proximal
- Pressure applied on oblique turns only, No wrinkles
- Should be reapplied at least every 4 hours
- Don’t use metal clips—tape down
- No aching, burning or numbness—remove
- Wear 23 hours a day (remove for hygiene only)
- Wash daily, squeeze, don’t wring and air dry (need 2 sets)
- Continue use until pt. has definitive prosthesis
- pt. can leave stump unwrapped overnight and don prosthesis without difficulty in the morning

Question 21

what are the most common contractures to prevent (transtibial)

Answer 21

• hip flexion and knee flexion
• prolonged sitting, protective flexion pattern with LE pain, muscle imbalances, loss of sensory input

Question 22

what are common contractures in transfemoral amputations?

Answer 22

• hip flexion
  -hip abduction
• hip lateral rotation

Question 23

what are steps for contracture management

Answer 23

• maintain the knee in extension, avoid use of pillows under the residual limb, use amputee board, avoid long periods of sitting, lie prone, PNF, mobility, AROM PROM

Question 24

what are the levels of the medicare functional classification?

Answer 24

K0 – not able to ambulate or transfer without assistance
K1 – uses prosthesis and walks mainly level surfaces or fixed cadence, household ambulator
K2 – uses prosthesis and walks limited community distances, uneven surfaces, curbs, stairs
K3 – uses prosthesis and walks community ambulation distances, can traverse most barriers in environment, variable cadence
K4 – uses prosthesis and walks without any limitations – child, active adult, athlete – exceeds basic abilities/demands for gait and can handle high-impact activity

Question 25

when do you prescribe a prosthesis for TTA? (Ignore)

Answer 25

Patient has their own knee power
Prosthesis helps w/ transfer
Prosthesis helps with STS

Question 26

when do you prescribe a prosthesis for TFA (ignore card)

Answer 26

Patient has no knee power
Prosthesis has no knee power
Transfers- often easier without prosthesis
STS- prosthesis makes it more challenging

Question 27

what vital skill must be mastered before a TF prosthesis is prescribed

Answer 27

Transfer independently (both in/out of bed, on/off toilet)
STS independently
Walk in parallel bars or walker (one leg gait), for at least 6-8 meters