Introduction to Amputation Flashcards
facts about limb loss:
– individuals with ______ have a 30x greater risk for amputation
– up to ____% of individuals with diabetes and a lower limb amputation will undergo an amputation of the other lower limb within _____ years
– diabetes
– 55% ; 2-3
these are ______ causes of amputations:
- dysvascular (PAD, PVD, diabetes, non-healing wounds)
- limb deficiencies/congenital
- infections
- tumors
- disease
non-traumatic
these are ______ causes of amputations:
- high-energy trauma
- burns
- electrocution
- MVA
traumatic
what are the most frequent causes of amputation in adults? (4)
PVD (most common from diabetes)
tumors
trauma
burns
what are the most frequent causes of amputation in children? (4)
congenital limb deformities
tumors
trauma
infection
what is the most likely cause if all 4 limbs are amputated?
systemic infection
what is seen in utero and when with a limb deficiency/congenital amputation?
malformation of the limb bud ~28 days in utero
what are causes of limb deficiencies/congenital amputations?
medications or toxins
viral infections rubella
diabetes
abortion attempts
unknown
what are transverse limb deficiencies?
distal structures do not exist
– leaves a “cut off” appearance
what are longitudinal limb deficiencies?
partial or total absence of a structure along the long axis of a segment
ex: may be missing a fibula in one leg, but has the tibia
what are possible surgical interventions for a child without a fibula?
limb lengthening
amputation
what are possible surgical interventions for a child without a tibia?
knee disarticulation
brown procedure - centralization of the fibula
what are possible surgical interventions for a child with proximal femoral focal deficiency (PFFD)?
limb lengthening
foot amputation
rotationplasty
in someone with a rotationplasty:
– DF = knee _____
– PF = knee _____
– flexion
– extension
who is a rotationplasty most indicated for?
kids with cancer of the bone
proximal femoral focal deficiency
what are goals of PT following a limb lengthening surgery?
maintain ROM above and below fixator
strengthen the limb
encourage weightbearing
increase endurance
restore function
what types of tumors are amputations most used for to control the spread?
bone sarcomas (osteosarcoma)
soft tissue tumor
metastatic disease
in someone with diabetes, what are 4 risk factors for amputation?
male
smoking
poor glycemic control
depression
in someone with diabetes, what are 3 risk factors for re-amputation, re-ulceration, and mortality?
previous amputation
level of amputation
comorbidities
what are two common infections that can lead to amputation?
osteomyelitis
sepsis
osteomyelitis can be consequences of:
PVD or diabetes
RA
corticosteroid therapy
poor nutritional status
post-prosthetic implantation
trauma
fracture
what kind of burn injuries can lead to amputation?
electrical – direct contact with high-voltage electrical current
chemical
thermal – extreme heat, frostbite
what are 4 traumatic events that often lead to amputation?
MVA/MCA
non-union fractures
military conflicts
work accidents
what population is more likely to experience traumatic amputations?
young males
the level of amputation is dependent on:
vascular status of limb
neuropathy
infection
necrosis
malignancy
bone and joint condition
age
function and rehab potential
in children:
you generally want to preserve ____ and _______
if distal bone cannot be salvaged, amputate through _____
___ and ____ may be needed to accommodate growth
– proximal joints and length (growth plates)
– through the joint
– proximal osteotomies or external fixator techniques
what are common complications of traumatic amputation in adults?
infection
slow wound healing
DVT
what are common complications of traumatic amputation in children?
phantom limb pain
residual limb pain
terminal overgrowth
amputation surgical procedures:
– major nerves are cut ____ and retract into soft tissue to prevent ____
– _____ of major arteries and veins. _____ for smaller vessels
– distal bone is ____ to help with prosthetic fit
– high ; neuromas
– ligation ; cauterization
– beveled
muscle stabilization:
– posterior flap:
– myofascial closure =
– myoplasty =
– myodesis =
– tenodesis =
– post. tissues have better blood supply than anterior. scar will be anterior
– muscle to skin
– muscle to muscle
– muscle to bone
– tendon to bone
residual limb shapes:
– common post-op due to swelling
– common in congenital amputations
– typically due to poor surgical technique
– common in traumatic amputations
– durable, well-vascularized, tolerates friction/pressure, ideal shape
– bulbous
– conical
– dog ears
– complicated
– cylindrical
what should you examine in the residual limb?
length
circumference
integumentary
vascular status
sensation
pain
ROM
strength
what kind of dressing is this describing:
patient is at high risk for infection
worn all day except bathing
reapplied every 4-6 hours
pt or caregiver can apply
very common
soft post-op dressings
– shrinker
– elastic wrap
what kind of dressing is this describing:
better edema control, but not the best
impregnated bandage with a paste compound of zinc oxide, gelatin, glycerin, calamine
typically 4” wide
uncommon
semi-rigid post-op dressing
what kind of dressing is this describing:
removable or non-removable
pylon and foot component
complications: infection, damage to wound, pressure or traction from pistoning
rigid post-op dressing
the CPG for lower and upper limb amputations advises:
– promote a ____
– maximize patient’s _____ _and ______
– develop recommendations consistent with ______
– patient-centered transdiciplinary approach
– functional independence and QoL
– evidence-based rehab methods
what are some goals of rehab for patients with amputations?
manage pain
prevent injuries to sound limb
improve/maintain physical health
independent and safe in walking and ADLs
participate in community
maintain QOL
healthy body image
find satisfaction with independence
improve independence with and without prosthesis
phases of rehab for amputees:
– pre surgical
– 1-2 weeks
– 2-8 weeks
– 8 weeks - 18 months
– throughout lifespan
– before surgery
– acute post-surgical
– pre-prosthetic training
– prosthetic training
– lifelong care
around what week at the earliest do post-op amputees start prosthetic training?
a) 4 weeks
b) 8 weeks
c) 12 weeks
d) the earlier the better
b) 8 weeks
(8 weeks to 18 months)
according to the CPG, what should rehab providers be provided with?
an algorithm of appropriate rehab interventions to improve patient outcomes and reduce practice variation
according to the CPG, what should primary care providers be provided with?
an algorithm to assist with the referral process
during all phases of amputation rehab, it is recommended that providers consider ____ and self-identified ____ in developing individualized treatment plans
birth sex ; gender identify
during all phases of amputation rehab:
– provide:
– measure:
– offer:
– assess:
– patient education
– intensity of pain and interference with functioning
– multi-modal, transdisciplinary approach to pain management including transition to non-narcotics AND peer support interventions as early as feasible
– behavioral health and psychosocial functioning
what is the PROMIS?
patient-reported outcome measurement information system – evaluates and monitors physical, mental, and social health
what are causes of residual limb pain?
expected from surgical trauma
poor prosthetic fit
bruising or chafing
poor perfusion/ischemia
heterotopic ossification
neuroma
what are some treatment options for residual limb pain?
- oral meds: antidepressants, tricyclics, antiepileptics, opioids
- IV: ketamine, opioids
- nerve block
- physical therapy
- prosthetic mods
what does physical therapy focus on to improve residual limb pain?
exercise & modalities (massage, TENS)
desensitization exercises
how often does phantom limb pain occur?
in 80% of patients with amputations
phantom limb pain:
– (episodic/constant)
– lasts:
– mechanisms:
– episodic
– seconds to days; or continuous
– unclear – abnormal regeneration of primary afferent neurons, central sensitization, chronic pre-amp pain
how do you treat phantom limb pain?
massage, ultrasound, ice, TENS
non-narcotic analgesics
biofeedback, guided imagery
psychotherapy
nerve blocks
mirror therapy
– apply these things to the good leg
in patients with traumatic lower limb amputations:
– ______% develop an overuse MSK injury during 1st year
– those with ____ amputation were 2x more likely to develop upper or lower limb MSK injury
– those with _____ amputations were >2x more likely to develop lumbar spine injury and 4x more likely to develop an upper limb injury
– 59-68%
– unilateral
– bilateral
in patients with traumatic upper limb amputations:
– ______ develop an overuse MSk injury within 1st year
47-58%
