L04. Intro to Amputation and Prosthetic Limbs Flashcards
Def: Amputation
Complete loss of all limb elements below a certain point
Def: Residual limb/stump
Intact remaining portion of the limb following amputation
Def: Prosthesis
Artificial device used to replace the function/appearance of a missing part of the body
Def: Socket
Interface between residual limb and external prosthesis
What are the 3 most common causes of limb amputation (in order from most to least)
Vascular Disease (often diabetes), Trauma, Cancer
Why do doctors try to amputate as distal as possible?
Less energy consumption required in gait due to the more effective lever arm that drives the prosthetic limb
What are the main complications related to amputations?
Infection
Edema
Residual limb breakdown
Neuromas
Contracture
Phantom Limb Sensation
What is a neuroma?
Cut end of the nerves heal with the formation of a bundle of nerve fibers
What is contracture?
Lack of movement causes shortening and stiffening of ligaments and joint capsule
Do all adult amputees experience phantom limb sensation?
Yes
What are the 4 LE amputation levels starting at the hip
- Hip disarticulation
- Above knee
- Below knee
- Syme’s (aka ankle)
Benefit to below-knee amputation
Stump is as long as possible with good tissue flap
Benefits and drawbacks to knee disarticulation
Benefit: Long stump
Drawback:
- Prosthetic limb longer than other limb potentially
- Concern with soft padding tissue at end of stump
Benefits and drawbacks to above-knee amputation
Benefit: Equal limb length and good soft tissue pad
Drawback: Must replace the knee
Drawback to hip disarticulation
Gait energy consumption high
What scenario is a hip disarticulation most appropriate
Malignant tumors in a younger patient
What do most upper extremity amputations result from?
Trauma (>80%)
What is an alternative to UE amputation?
Replantation
- most common in fingers
What are the 5 UE amputation levels starting at the shoulder
- Shoulder Disarticulation
- Above Elbow
- Elbow Disarticulation
- Below Elbow
- Wrist Disarticulation
What is the purpose of the flap the surgeon leaves during amputation
create a layer of skin that can be folded over and sutured to cover the exposed bone and muscle at the stump, promoting faster healing and reducing the risk of infection
Does an UE or LE amputation have more affect on QoL typically?
UE be individuals impacted are typically younger and more active and prosthetics aren’t as advanced in this area
What are the 2 main early complications of amputation stumps?
Breakdown of skin flaps
Gas Gangrene
What is Gas gangrene?
Bacterial Infection
- Clostridia are bacteria that produce spores, which are dormant forms of the bacteria that can survive in harsh conditions
- Spores can germinate into active bacteria that produce toxins, which can cause disease
What are late complications of amputation stumps?
- Eczema
- Ulcerations
- Muscle softens at the end of the stump causing incorrect use of prosthesis
- Blood supply (lack thereof)
- Neuroma
- Phantom limb pain/sensation
What causes residual limb pain?
- Neuromas
- Bony spurs in the residual stump
- Localized skin disease
- Infection
What is catastrophising?
Coping style characterized by excessively negative thoughts and emotions in relation to pain
What are the 6 steps in providing a prosthesis?
- Evaluation/Prescription
- Measurements/Impression
- Fabrication/Bench Alignment
- Fitting/Static Alignment
- Modifications/Dynamic Alignment
- Re-evaluation/Follow Ups
What characteristics to patients look for in a prosthetic?
Function
Comfort
Cosmesis
Fabrication
Economics
What material characteristics need to be considered for a prosthesis?
Strength
Stiffness
Durability
Density
Corrosion Resistance
Ease of Fabrication
Cost and Availability
What is the purpose of the socket?
- Transmit force from residual limb to prosthesis
- Distribute pressure
- Avoid bone prominences/sensitive areas
- Absorb Shock
