Braddom - Prosthetics Upper Flashcards
accounts for 90% of all upper limb a tions.
Trauma
represents the highest percentage (78%) of upper limb amputations reported on hospital discharges.
Finger amputation
Excluding finger amputation, the most common upper limb amputations are through the
forearm (transradial) and humerus (transhumeral)
most common congenital amputation is at the
left short transradial level
has no distal r ing parts.
transverse deficiency
have distal portions present with a partial or total absence of a specific bone.
Longitudinal deficiencies
represent half of all congenital upper limb reductions, a
Longitudinal hand reductions
the most common type of a tation
Fingertip a tation (
the most functionally critical digit.
thumb
results in loss of palmer grip, side-to-side pinch, and tip-to-tip pinch.
Thumb amputation,
involve digits IV and V, and hook grasp is lost.
Ulnar amputations
involves digits III and IV, and reconstruction is usually not attempted, and a cosmetic substitute is used
Central amputation
refers to the remaining part of the amputated limb.
residual limb
refers to the nonamputated limb
sound limb
Transradial amputations are based on measurements made from the longest residual bone (ulna or radius) to the
medial epicondyle.
preserves 55% to 90% length, allows up to 60 degrees of supination and pronation with a prosthesis, and maintains strong elbow flexion. 4
long transradial amputation
preserves 35% to 55% length, and pronation and supination with a prosthesis are lost. Elbow flexion is reduced because of the inhibiting prosthesis.
medium transradial amputation
amputation is defined as 0% to 35% preservation, which results in difficult prosthetic suspension and the additional loss of full range of motion (ROM) at the elbow.
short transradial amputation
is recommended instead of bilateral transhumeral because of functional prosthetic control.
elbow disarticulation
It is most suitable for the growing child to preserve the epiphysis for growth. 38
elbow disarticulation
preservation of 50% to 90% of length relative to the sound side humeral
long transhumeral
defined as preservation of 30% to 50% of length, loss of glenohumeral motion because of the inhibition of the prosthetic socket that encompasses the acromion. 4
short t humeral
glenohumeral motions of flexion, extension, and abduction are lost with
humeral neck level amputation, shoulder disarticulation, and forequarter amputation.
defined as s cant injury to at least three of the four tissue groups (skin/ soft tissue, nerve, vessel and bone).
mangled extremity syndrome
poor predictors of amputation or salvage with regard to functional outcome
mangled e ity scoring systems
flap in which a local muscle inclusive of the overlying skin is moved over with its own blood supply to fill a large defect.
Pedicle flap
flap in which the donor is not local and the microvasculature of the donor muscle is anastomosed to the available vessels at the defect site.
Microvascular free flap
feasibility of limb salvage is d mined partly by the ability to reconstruct
soft tissue defect. I
which the deep layers are sutured directly to the periosteum.
myodesis
s cial antagonistic muscles are sutured together and to the deeper muscle layers.
myoplasty
ideal distal muscle stabilization occurs with
tenodesis
elbow
best possible option.
endoprosthetic reconstruction
tumors of the hand,
ray resection is done.
wrist, multiple options are available such as
endoprosthesis implant or an allograft or vascularized bone transplant (
humerus
similar to the wrist in that an endoprosthesis, or an allograft, or a vascularized bone transplant can be used
tumors of the scapula or proximal humerus,
forequarter amputation or flail arm is prevented by reconstruction with a combination of an endoprosthesis and allograft.
complication rate is much higher after
limb salvage than after amputation in the oncology population.
e est complications include
oncology population.
infection, wound necrosis, and neurapraxia. T
late complications i
aseptic l ening, prosthetic fracture and dislocation, and graft nonunion. 4
an outcome tool that assesses seven characteristics of upper limb use: ROM, stability, deformity, pain level, strength, functional activity, and emotional acceptance. Limb salvage has cosmetic advantages, but whether the quality of life of these patients is superior to that of those who undergo amputation is unclear.
Enneking Outcome Measurement Scale
traumatically amputated limbs is now possible, especially in children, because of the potential for successful neurologic recovery. 3
Reimplantation
prompt reimplantation within the initial
12-hour window.
Predictors of s ful reimplantation include a
adequate preservation, c tion of the muscle in the amputated limb after stimulation, the level of injury, and no tobacco use
best p tor of success is the
serum potassium level in the a tated segment.
If the serum potassium level is higher than
reimplantation should be avoided. 51
6.5 mmol/L
