Day 1 Amputation (updated)

Question 1

What is an amputation and its primary indications?

Answer 1

→ Complete removal of an injured or deformed body part

→ Indications: Peripheral vascular disease, diabetic limb disease, necrotizing fasciitis, trauma, infection, tumors, nerve injury, congenital anomalies

Question 2

What are the epidemiological statistics of amputations in the U.S.?

Answer 2

→ 185,000 individuals admitted annually for amputations (mostly PVD/DM)
→ 1.35 amputations per 1,000 people
→ 80% for vascular disease, 45% trauma, < 2% cancer

Question 3

What is the distribution of lower extremity amputations by type?

Answer 3

• toe
• transtibial
• transfemoral
• foot/ankle

Question 4

Describe toe amputation and its variations.

Answer 4

→ Phalangeal removal

→ Ray amputation: Toe and metatarsal removal

→ Transmetatarsal: Partial foot amputation through metatarsals

Question 5

What is a transmetatarsal amputation, and what are its shoe modifications?

Answer 5

→ Amputation through metatarsals

→ Modifications: Extended carbon fiber foot plate, steel shank in the sole, rigid rocker bottom sole, toe filler

Question 6

What is the difference between Lisfranc and Chopart amputations?

Answer 6

→ Lisfranc: Tarsometatarsal disarticulation.

→ Chopart: Midtarsal disarticulation, not recommended due to poor healing and equinus deformity.

Question 7

What is a Syme’s amputation?

Answer 7

→ Removal of the limb distal to the ankle joint (both malleoli)

Question 8

What is the primary focus of a transtibial amputation?

Answer 8

→ Saves the knee joint, optimal prosthetic fit with 5-7 inches of tibia

→ Long posterior flap technique preferred

Question 9

What are the two methods of muscle attachment in amputations?

Answer 9

→ Myodesis: Muscle anchored to bone for stronger stabilization, used in transfemoral amputations

→ Myoplasty: Muscle sutured to muscle, used in transtibial amputations, preferred for ischemic patients

Question 10

Describe the main features of a knee disarticulation.

Answer 10

→ Preserves femur and condyles, creates a bulbous residual limb → Provides better adduction angle and weight-bearing capacity

Question 11

What are key advancements in transfemoral amputation?

Answer 11

→ Improved socket designs, suspension systems, and dynamic prosthetic components → Enhanced energy-efficient function, better ambulation outcomes

Question 12

What is a hip disarticulation, and when is it indicated?

Answer 12

→ Removal of the entire femur

→ Indications: Trauma, advanced ischemic disease, non-ambulatory patients, osteosarcoma

Question 13

What is a hemipelvectomy, and how common is it?

Answer 13

→ Removal of part of the pelvis and lower limb

→ Rare, often performed due to severe trauma or malignancy

Question 14

What is a hemicorporectomy, and its historical context?

Answer 14

→ Removal of both lower extremities and pelvis → Introduced during WWII to save soldiers from severe trauma, only ~250 cases worldwide

Question 15

What is a rotationplasty (Van Ness procedure), and when is it used?

Answer 15

→ Partial amputation above the knee, lower leg rotated 180°, foot functions as knee joint

→ Used for osteosarcoma or congenital limb differences

Question 16

What is osteointegration in amputations?

Answer 16

→ Direct connection of the prosthetic device to bone → Eliminates need for suspension/socket

Question 17

What is the Ertl procedure, and its purpose?

Answer 17

→ Osteomyoplastic amputation with tibia-fibula synostosis or bone bridge → Provides greater stability for prosthetic use

Question 18

What are common types of upper extremity amputations?

Answer 18

→ Forequarter, above the elbow, elbow disarticulation, below the elbow, Krukenberg procedure

Question 19

Describe the Krukenberg procedure.

Answer 19

→ Separation of the radius and ulna to create pincers capable of strong prehension

→ Provides excellent manipulative ability

Question 20

What is the importance of myodesis in amputations?

Answer 20

→ Suturing muscle to bone for stronger attachment

→ Reduces contracture and limits muscle atrophy

Question 21

What are the challenges of knee disarticulation prosthetics?

Answer 21

→ Bulbous residual limb complicates prosthetic donning

→ Enhanced suspension but challenging cosmetic finishing

Question 22

What are the benefits of myoplasty over myodesis in certain cases?

Answer 22

→ Preferred for patients with poor vascular health

→ Provides soft tissue padding and protection over the bone

Question 23

What are typical considerations for hip disarticulation rehabilitation?

Answer 23

→ Focus on maintaining balance and mobility

→ Adapted prosthetic components for functional ambulation

Question 24

How does rotationplasty improve function for children?

Answer 24

→ Ankle joint functions as a natural knee

→ Provides better mobility and sensory feedback

Question 25

What is the impact of advanced prosthetic technology on transfemoral amputations?

Answer 25

→ Increases comfort, efficiency, and functionality → Allows patients to run and perform daily activities more effectively

Question 26

What is a forequarter amputation, and why is it performed?

Answer 26

→ Removal of the entire upper limb, including scapula

→ Primarily done for malignancy

Question 27

What are the components of a transtibial prosthetic fitting?

Answer 27

→ Socket, suspension system, pylon, and foot component

→ Must ensure proper alignment and weight distribution

Question 28

How does vascular health influence amputation level selection?

Answer 28

→ Higher amputation levels chosen for severe ischemia

→ Preservation of blood supply critical for healing

Question 29

What are the psychological impacts of amputation, and how can they be addressed?

Answer 29

→ Depression, anxiety, and body image concerns

→ Provide counseling, support groups, and adaptive training

Question 30

What are the typical complications of lower extremity amputations?

Answer 30

→ Phantom limb pain, residual limb infection, contractures

→ Address with medication, therapy, and proper limb care

Question 31

Describe the concept of distal weight bearing in Syme’s amputation.

Answer 31

→ Allows for better prosthetic function and proprioception

→ Provides stability during ambulation

Question 32

How does amputation rehabilitation differ between below and above the knee?

Answer 32

→ Below-knee: Easier prosthetic fitting, more energy-efficient → Above-knee: More complex prosthetic design, higher energy demand

Question 33

What is the Van Ness procedure, and its functional benefits?

Answer 33

→ 180° rotation of lower leg, ankle functions as knee joint → Provides a more natural gait and improved mobility

Question 34

What factors influence prosthetic choice in amputees?

Answer 34

→ Amputation level, residual limb condition, patient activity level → Consider patient goals and preferences

Question 35

What is the role of adaptive equipment in upper extremity amputations?

Answer 35

→ Enhances daily living activities and functional independence → Includes prosthetic limbs, gripping tools, and assistive devices