osteomyelitis TB septic arthritis

Intro to Prosthetics - 1 Flashcards by Victoria Caridi

indications for amputation

trauma

PVD

growths

thrombosis and embolism

infection

trophic changes

congenital

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primary cause of UE amputation

trauma

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trauma

via on job and home accidents

war related

MVA

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primary cause of LE amputation

PVD

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PVD

via diabetes

arterial insufficiency

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growths

sarcoma

carcinoma

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thrombosis and embolism

lack of blood flow

death to the area

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infection

osteomyelitis

septic arthritis

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trophic changes

spinae bifida

cord injuries

neoplasm

charcot joint

leprosy

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congenital

congenital absence

congenital amputation

gross inequality

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how is site of amputation measured

in % of what is left

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site of amputation UE

shoulder interscapulo-thoracic

shoulder disarticulation

trans-humeral

wrist disarticulation

thumb

fingers

elbow disarticulation

VSBE

trans radial

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shoulder interscapulo-thoracic

forequarter

scapula and below

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shoulder disarticulation

through GH joint

some of humeral head might remain

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trans-humeral

short v. long

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wrist disarticulation

through carpals

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thumb

50% of hand fxn

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sites of LE amputation

hemicorporectomy

hip disarticulation

transilliac

trans femoral

knee disarticulation

trans tibial

partial foot

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hemicorporectomy

half of body amputated

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hemicorporectomy includes

colostomy and ileostomy

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hemicorporectomy has difficulty w/

sitting

–> have special sockets

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hip disarticulation

thru femoral/acetabular joint

some pieces of the head left

above the lesser trochanter

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transiliac

half of pelvis down

hemipelvectomy

piece of pelvis can be present

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transfemoral

10-12” below GT

not end-bearing

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what of the femur remains --> transfemoral

35-60% of femoral length

knee disarticulation

tibia and down trim the femoral condyles has become more common

knee disarticulation is

end bearing RL

trans tibial

5.5" to 7" below tibial plateau or 20-50% of tibial length (at least 3")

trans tibial is...

not end bearing

2 trans tibial techniques

ertl technique symes technique

ertl technique

trans tibial w/ bone bridge b/w tib and fib increase weight tolerance on end of RL

symes technique

ankle disarticulation trim tib and fib, fat pad remains distal end bearing

partial foot

chopart lisfranc transmetatarsal and toes

cho part

talo-navicular/calcaneal cuboid leads to equinus deformity

lisfranc

tarso-metatarsal leads to equinus deformity

transmetatarsal and toes

effects push off

amputation of the other limb

10% --> 1 yr 20% --> 2 yrs 30-50% --> 5 yrs

individuals w/ limb loss from diabetes

55% will die in 5 yrs

what is most important about amputation surgery

education and prevention

level of surgery

dependent on healthy tissue& cause of the amputation

shape of surgery

conical

muscle stablization

myofascial tenodesis myoplasty myodesis

myofascial

muscle to fascia most fxnally strong

tenodesis

tendon to bone lots of bleeding precautions for PVD

myoplasty

muscle to muscle least physiologic weakest attachment

myodesis

muscle to bone lots of bleeding precautions for PVD

strongest to weakest muscle stabalization

tenodesis myodesis myofascial myoplasty

nerves --> surgery

neuroma formation ligation

neuroma formation

nerve grows into scar

ligation

prevent re-growth of nerves

closed/matches muscle flaps --> surgery

equal flaps long anterior flaps long posterior flaps

equal flaps

cut ends equal incision under RL

long anterior flaps

anterior long/short incision posterior RL

long posterior flaps

posterior long/ant short incision anterior RL

what is more common to preserve gastroc/soleus

long posterior flaps for trans tibial

medicare fxnal classification level

MFCL levels also called 'K' levels were adopted in 1995

how many K levels are there

5 0-4

what are the K lvls used for

to determine the prosthetic components of choice

prosthesis does not enhance quality of life = no prosthesis (w/c bound)

level surfaces fixed cadence = household walker

low level environment barriers = limited community ambulatory

fxnal level that demands prosthetic components beyond simple locomotion

exhibiting high impact, stress or energy lvl = child, active adult, athlete

how is the pt assessed by post op for K lvl

PT MD prosthetist

when is the pt reassessed

later w/ prosthesis

what is assessment based on

various outcome measures amputee mobility predictor TUG tinetti berg balance 6 min walk test

amputee mobility predictor

valid and reliable correlated well w/ 6 min walk similar to berg and tinetti

amputee mobility predictor includes

21 questions goal for pt (predictive of potential) K levels w/ and w/o prosthesis (no #8 w/o)