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Prosthetics & Orthotics > Introduction to Amputation > Flashcards

Introduction to Amputation Flashcards

1
Q

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

A

– diabetes
– 55% ; 2-3

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2
Q

these are ______ causes of amputations:
- dysvascular (PAD, PVD, diabetes, non-healing wounds)
- limb deficiencies/congenital
- infections
- tumors
- disease

A

non-traumatic

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3
Q

these are ______ causes of amputations:
- high-energy trauma
- burns
- electrocution
- MVA

A

traumatic

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4
Q

what are the most frequent causes of amputation in adults? (4)

A

PVD (most common from diabetes)
tumors
trauma
burns

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5
Q

what are the most frequent causes of amputation in children? (4)

A

congenital limb deformities
tumors
trauma
infection

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6
Q

what is the most likely cause if all 4 limbs are amputated?

A

systemic infection

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7
Q

what is seen in utero and when with a limb deficiency/congenital amputation?

A

malformation of the limb bud ~28 days in utero

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8
Q

what are causes of limb deficiencies/congenital amputations?

A

medications or toxins
viral infections rubella
diabetes
abortion attempts
unknown

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9
Q

what are transverse limb deficiencies?

A

distal structures do not exist
– leaves a “cut off” appearance

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10
Q

what are longitudinal limb deficiencies?

A

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

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11
Q

what are possible surgical interventions for a child without a fibula?

A

limb lengthening
amputation

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12
Q

what are possible surgical interventions for a child without a tibia?

A

knee disarticulation
brown procedure - centralization of the fibula

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13
Q

what are possible surgical interventions for a child with proximal femoral focal deficiency (PFFD)?

A

limb lengthening
foot amputation
rotationplasty

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14
Q

in someone with a rotationplasty:
– DF = knee _____
– PF = knee _____

A

– flexion
– extension

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15
Q

who is a rotationplasty most indicated for?

A

kids with cancer of the bone
proximal femoral focal deficiency

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16
Q

what are goals of PT following a limb lengthening surgery?

A

maintain ROM above and below fixator
strengthen the limb
encourage weightbearing
increase endurance
restore function

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17
Q

what types of tumors are amputations most used for to control the spread?

A

bone sarcomas (osteosarcoma)
soft tissue tumor
metastatic disease

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18
Q

in someone with diabetes, what are 4 risk factors for amputation?

A

male
smoking
poor glycemic control
depression

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19
Q

in someone with diabetes, what are 3 risk factors for re-amputation, re-ulceration, and mortality?

A

previous amputation
level of amputation
comorbidities

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20
Q

what are two common infections that can lead to amputation?

A

osteomyelitis
sepsis

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21
Q

osteomyelitis can be consequences of:

A

PVD or diabetes
RA
corticosteroid therapy
poor nutritional status
post-prosthetic implantation
trauma
fracture

22
Q

what kind of burn injuries can lead to amputation?

A

electrical – direct contact with high-voltage electrical current
chemical
thermal – extreme heat, frostbite

23
Q

what are 4 traumatic events that often lead to amputation?

A

MVA/MCA
non-union fractures
military conflicts
work accidents

24
Q

what population is more likely to experience traumatic amputations?

A

young males

25
Q

the level of amputation is dependent on:

A

vascular status of limb
neuropathy
infection
necrosis
malignancy
bone and joint condition
age
function and rehab potential

26
Q

in children:
you generally want to preserve ____ and _______
if distal bone cannot be salvaged, amputate through _____
___ and ____ may be needed to accommodate growth

A

– proximal joints and length (growth plates)
– through the joint
– proximal osteotomies or external fixator techniques

27
Q

what are common complications of traumatic amputation in adults?

A

infection
slow wound healing
DVT

28
Q

what are common complications of traumatic amputation in children?

A

phantom limb pain
residual limb pain
terminal overgrowth

29
Q

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

A

– high ; neuromas
– ligation ; cauterization
– beveled

30
Q

muscle stabilization:
– posterior flap:
– myofascial closure =
– myoplasty =
– myodesis =
– tenodesis =

A

– post. tissues have better blood supply than anterior. scar will be anterior
– muscle to skin
– muscle to muscle
– muscle to bone
– tendon to bone

31
Q

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

A

– bulbous
– conical
– dog ears
– complicated
– cylindrical

32
Q

what should you examine in the residual limb?

A

length
circumference
integumentary
vascular status
sensation
pain
ROM
strength

33
Q

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

A

soft post-op dressings
– shrinker
– elastic wrap

34
Q

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

A

semi-rigid post-op dressing

35
Q

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

A

rigid post-op dressing

36
Q

the CPG for lower and upper limb amputations advises:
– promote a ____
– maximize patient’s _____ _and ______
– develop recommendations consistent with ______

A

– patient-centered transdiciplinary approach
– functional independence and QoL
– evidence-based rehab methods

37
Q

what are some goals of rehab for patients with amputations?

A

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

38
Q

phases of rehab for amputees:
– pre surgical
– 1-2 weeks
– 2-8 weeks
– 8 weeks - 18 months
– throughout lifespan

A

– before surgery
– acute post-surgical
– pre-prosthetic training
– prosthetic training
– lifelong care

39
Q

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

A

b) 8 weeks
(8 weeks to 18 months)

40
Q

according to the CPG, what should rehab providers be provided with?

A

an algorithm of appropriate rehab interventions to improve patient outcomes and reduce practice variation

41
Q

according to the CPG, what should primary care providers be provided with?

A

an algorithm to assist with the referral process

42
Q

during all phases of amputation rehab, it is recommended that providers consider ____ and self-identified ____ in developing individualized treatment plans

A

birth sex ; gender identify

43
Q

during all phases of amputation rehab:
– provide:
– measure:
– offer:
– assess:

A

– 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

44
Q

what is the PROMIS?

A

patient-reported outcome measurement information system – evaluates and monitors physical, mental, and social health

45
Q

what are causes of residual limb pain?

A

expected from surgical trauma
poor prosthetic fit
bruising or chafing
poor perfusion/ischemia
heterotopic ossification
neuroma

46
Q

what are some treatment options for residual limb pain?

A
  • oral meds: antidepressants, tricyclics, antiepileptics, opioids
  • IV: ketamine, opioids
  • nerve block
  • physical therapy
  • prosthetic mods
47
Q

what does physical therapy focus on to improve residual limb pain?

A

exercise & modalities (massage, TENS)
desensitization exercises

48
Q

how often does phantom limb pain occur?

A

in 80% of patients with amputations

49
Q

phantom limb pain:
– (episodic/constant)
– lasts:
– mechanisms:

A

– episodic
– seconds to days; or continuous
– unclear – abnormal regeneration of primary afferent neurons, central sensitization, chronic pre-amp pain

50
Q

how do you treat phantom limb pain?

A

massage, ultrasound, ice, TENS
non-narcotic analgesics
biofeedback, guided imagery
psychotherapy
nerve blocks
mirror therapy
– apply these things to the good leg

51
Q

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

A

– 59-68%
– unilateral
– bilateral

52
Q

in patients with traumatic upper limb amputations:
– ______ develop an overuse MSk injury within 1st year

A

47-58%

Prosthetics & Orthotics (17 decks)

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