Intro to Patient Management Flashcards
1
Q
True or False:
Amputation may be controlled with orthotics or prosthetics
A
True
2
Q
Who is more likely to get an amputation men or women
A
Men
3
Q
What are the 5 causes of amputation
A
- Dysvascular disease
- Trauma
- Cancer
- Limb deficiences
- Infection
4
Q
What is PVD
A
Any abnormal condition affecting the blood vessels peripheral to the heart
5
Q
What can cause PVD (6)
A
- Embolism
- Thrombosis
- Trauma
- Vasospasm
- Inflammation
- Arteriosclerosis
6
Q
PVD leads to deficits in what 3 things
A
- Arteries
- Veins
- Lymphatic systems
7
Q
What are the signs and symptoms of PVD (4)
A
- Changes in temp
- Perfusion
- Swelling
- Wounds
8
Q
Is cyanosis an arterial or venous issue
A
Arterial
9
Q
Are wounds due to an arterial or venous issue
A
Both! Tricked you fucker
10
Q
What is the pathophysiology of diabetes
A
The lack of ability to properly maintain levels of glucose
11
Q
What does the excess glucose due
A
Causes clots and/or damage in vessels
12
Q
What are the complications that come with diabetes (4)
A
- Duration is directly related to morbidity
- Macrovascular problems
- Microvascular problems
- Neurologic problems
13
Q
What is damaged in macrovascular problems
A
Arteries and veins
14
Q
What is damaged in microvascular problems
A
Capillaries
15
Q
What does microvascular problems lead to damage of
A
Nerves, eyes, and kidneys
16
Q
True or False:
The longer they have the disease the greater the disability regardless of whether or not the disease is controlled
A
True
17
Q
What age range is most common for trauma
A
Under 45 years old
18
Q
What are common cancers that could lead to amputation (3)
A
- Bone sarcomas
- Soft tissue tumors
- Metastatic disease
19
Q
What are the 3 types of limb deficiencies
A
- Congenital
- Transverse deficiency
- Longitudinal deficiency
20
Q
What is a transverse deficiency
A
Missing the limb after a certain point (example: arm is present up to the elbow and nothing below that)
21
Q
What is a longitudinal deficieny
A
Shorter limb length but distal limb is present (dwarf limb)
22
Q
What is Ilizarov-lmb lengthening procedure
A
Used to correct a longitudinal deficiency where they break the bone and apply an external fixator and adjust the space allowing bony callus formation and the patient being upright is extremely important
23
Q
What is amelia
A
Congenital absence of a limb
24
Q
What is apodia
A
Congenital absence of a foot
25
What is adactylia
Congenital absence of toes or fingers
26
What is aphalangia
Congenital absence of a single finger or toe
27
What is phocomelia
Lack of proper formation of distal portion of a limb
28
What is a common cause of phocomelia
Thalidamide exposure
29
What is the most common bacteria in wounds in healthy patients
Staphlococcus
30
What is the most common bacteria found in wounds of immunocompromised patients
Pseudomonas
31
What is the level of amputation determined by (3)
1. Ability to heal successfully at the incision based on adequate circulation
2. Removal of all nonviable tissues, structures, especially in presence of infection
3. Achieve long term functional residual limb, restore patient to some level of activity without pain
32
What is myoplasty
Attachment of a muscle to another muscle
33
What is myodesis
Attachment of a muscle to periosteal bone
34
What is a myofascial flap
Attachment of muscle to fascia
35
What will amputation of the great toe affect
Push off
36
What will amputation of the 2nd toe cause
Hallux valgus
37
True or False:
| Prosthesis is usually not necessary for phalangeal amputation
True
38
What is a transmetatarsal amputation (TMA)
Amputation through the mid to proximal metatarsal shafts where a myocutaneous plantar flap is used
39
Where is closure with a transmetatarsal amputation
Dorsum of the foot
40
What is a lisfranc amputation
Amputation at the tarsalmetatarsal joint and involves disarticulation of all 5 metatarsals and digits
41
What is a chopart amputation
Disarticulation through the midtarsal joint leaving only the talus and calcaneous remaining
42
What makes up the midtarsal joint
Talonavicular and calcaneal cuboid joints
43
What is a syme amputation
Ankle disarticulation where the heel pad is kept for distal end weight bearing and the tibia and fibula ends may be shaved to create a narrow end
44
True or False:
| With a syme amputation you have the potential to ambulate with and without a prosthesis
True
45
What is a transtibial amputation
Amputation across the tibia and fibula
46
How much shorter than the tibia is the fibula transected in a transtibial amputation
1-2 cm
47
True or False:
| The anterior surface of the tibia is beveled
True
48
Where is the surgical closure for a transtibial amputation
Anterior
49
What are the 4 types of transtibial amputations
1. Very short
2. Short
3. Standard
4. Long
50
What is a short/very short transtibial amputation
Less than 20% of the tibial length remains
51
Where does a very short transtibial amputation transect
The tibial plateau
52
True or False:
You may choose a knee disarticulation over a very short/short transtibial amputation due to the shorter lever arm making control of the knee difficult
True
53
What is a standard transtibial amputation
20-50% of the tibial length remains
54
What is a long transtibial amputation
Greater than 50% of the tibial lengthen is present
55
True or False:
| A patient with a long transtibial amputation may have problems with distal limb circulation
True
56
What is a knee disarticulation
The tibia and fibula are removed the patella and patellar tendon are saved
57
What is done with the patellar tendon and hamstrings in a knee disarticulation
They are attached to the cruciate ligaments and up through the bone
58
True or False:
| Knee disarticulation provides good weight bearing surface and long lever arm
True
59
True or False:
| Cosmesis of the socket is a disadvantage with a knee disarticulation
True
60
Why is cosmesis of the socket a disadvantage with a knee disarticulation (2)
1. Femoral condyles being wider so prosthetics must be wider
| 2. Knee height is different than the other intact knee
61
What is a transfemoral amputation
Part of the femur is removed and the hamstrings and quadriceps muscles are connected to each other with a myoplasty technique
62
Where is the incision with a transfemoral amputation
Inferior
63
What is a supracondylar transfemoral amputation
Transectio through the femoral condyles
64
True or False:
| The patella may be left for distal end bearing with a supracondylar transfemoral amputation
True
65
True or False:
| Adequate healing may be a problem with transfemoral amputation
True
66
What is a long transfemoral amputation
Greater than 60% of the femur length is present
67
True or False:
| There is no distal end bearing with a long transfemoral amputation
True
68
What is a medium or standard transfemoral amputation
35-60% of the femur length is present
69
True or False:
| With a medium or standard transfemoral amputation a myodesis and myoplasty technique are both used at the distal end
True
70
What is a short transfemoral amputation
Less than 35% of the femoral length is present
71
Where can a short transfemoral amputation be transected up to
The lesser trochanter
72
What is a hip disarticulation
Removal of all of the femur
73
What is a hemipelvectomy
Loss of the LE including any part of the ilium, ischium, or pubis
74
What are common post-op complications (6)
1. Phantom limb pain/sensation
2. Death
3. Pulmonary problems/pneumonia
4. Non healing residual limb
5. Infection of residual limb
6. Pulmonary embolus
75
What are common early phase complications (5)
1. Infection
2. Delayed wound healing
3. Painful residual limb
4. Phantom sensations
5. Pressure sores
76
What are common late phase complications (3)
1. Phantom limb pain
2. Flexion contractures
3. Gangrene
77
What are the 2 primary goals of the immediate post-op period
1. Ensure optimal wound healing
| 2. Early preparation of the limb for prosthetic fitting
78
What are the 3 IPOP steps
1. Application of padding (prep site for prosthetic unit)
2. Application of rigid dressing
3. Incorporate prosthetic system
79
What is the rigid dressing
Like a cast the provides compression over the pad and allows for earlier WB and decreased swelling
80
What is a risk of the rigid dressing
You can't see the surgical sight
81
What does the rigid dressing need attachments for
Pylon and foot
82
What are the 4 factors that influence optimal rehabilitation
1. Level of amputation
2. Skill of surgical team, shaping optimal limb, and optimal healing
3. Appropriate post-op care/follow up
4. Design/fitting of prosthesis, access to comprehensive prosthetic training
