Amputee Lecture and Lab Flashcards
what is myodesis?
-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
what is myoplasty?
attaching sectioned muscles to opposing muscles
what is a minor amputation
toe and partial foot amputations
what is a major amputation
proximal to tarsometatarsal joint
what are primary indications for amputation
PVD, diabetic wounds, trauma, infection, tumor, cancer, congenital
what is the leading cause of LLA
diabetes
what does a loss of the ankle joint cause?
- loss of somatosensory input
- reduced WB through residual limb and reduced confidence
- altered postural control and increased reliance on remaining balance strategies
what is a symes foot amputation
- removal of foot, medial and lateral malleoli removed, heel pad relocated to distal tibia
what is a chopart foot amputation?
disarticulation between the navicular/cuboid bones and the talus/calcaneus bones
what is the lisfranc foot amputation?
amputation of the tarsometatarsal joint
what is a transmetatarsal foot amputation
-amputation of the midshafts of metatarsals
- well-preserved arch and mobile ankle
what are the characteristics of transtibial amputation (BKA)
- 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
what are the characteristics of a transfemoral AKA amputation
- preserves the hip joint
- loss of joints below and impaired musculature below the pelvis
what are common contracture sites for amputee patients
hip flexion, hip abduction, hip ER, knee flexion, ankle PF
what are the advantages and disadvantages of ACE wrapping?
Advantages
- edema control
- easy access
- inexpensive
Disadvantages
- does not protect limb from environment
-hard to apply
- uneven compression
- will not prevent contracture
what are the advantages and disadvantages of shrinkers?
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
what are the advantages or disadvantages of rigid dressing?
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
why is compression bandaging important for all amputees?
reduced edema, pain control, enhanced wound healing, incision protection, facilitates preparation for prosthetic placement
what is rigid compression bandaging?
- 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
what are principles of ACE wrapping?
-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
what are the most common contractures to prevent (transtibial)
- hip flexion and knee flexion
- prolonged sitting, protective flexion pattern with LE pain, muscle imbalances, loss of sensory input
what are common contractures in transfemoral amputations?
- hip flexion
-hip abduction - hip lateral rotation
what are steps for contracture management
- 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
what are the levels of the medicare functional classification?
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
when do you prescribe a prosthesis for TTA? (Ignore)
Patient has their own knee power
Prosthesis helps w/ transfer
Prosthesis helps with STS
when do you prescribe a prosthesis for TFA (ignore card)
Patient has no knee power
Prosthesis has no knee power
Transfers- often easier without prosthesis
STS- prosthesis makes it more challenging
what vital skill must be mastered before a TF prosthesis is prescribed
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
