LE Amputation Etiology

Question 1

Rates of limb loss (decrease/increased) dramatically with age.

Answer 1

Increase

Question 2

82% of amputations are due to what?

Answer 2

Vascular disease secondary to complications of diabetes and PAD

Question 3

What will reduce the incidence of amputations among DM population?

Answer 3

Early patient education and proper foot care reduces the incidence of amputations

Question 4

Majority of LE amputations due to what?

Answer 4

vascular disease

Question 5

Majority of UE amputations due to what?

Answer 5

trauma

Question 6

Amputations among diabetics are (declining/increasing), but the number of diabetics are (decreasing/increasing).

Answer 6

Amputations among diabetics are declining, but the number of diabetics are increasing

Question 7

Combined illness burden of multiple co-morbidities will do what to risk of amputations?

Answer 7

Increase risk

Question 8

Males =/> females for dysvascular and trauma related amputations

Answer 8

males > females

Question 9

Amputations more common in what 3 groups?

Answer 9

1. African Americans
2. Hispanic Americans
3. Native Americans

Question 10

Trauma and cancer related amputations are (decreasing/increasing)

Answer 10

Decreasing

Question 11

4 Causes of amputation:

Answer 11

1. Diabetes and PAD (Dysvascular Disease)
2. Trauma
3. Cancer
4. Congenital deficiencies

Question 12

What is the primary complication leading to amputation?

Answer 12

non-healing diabetic ulceration

Question 13

Describe how diabetes can lead to amputation:

Answer 13

1. Elevated blood sugars- Damages blood vessels and nerves
2. Loss of protective sensation
   - Ability to recognize when something is uncomfortable to feet
   - Blister or minor injury
3. Ulceration- Non-healing
4. Amputation

Question 14

Clinical signs of peripheral neuropathy:

Answer 14

1. Deficits of sensation
2. Motor impairments
3. Autonomic Dysfunction (changes in skin
   coloration, distal loss of hair)

Question 15

Peripheral neuropathy leaves the foot vulnerable to what type of pressures?

Answer 15

Vulnerability of the foot to high-pressure and repetitive low-pressure traumas

Question 16

Other diabetic complications leading to amputation:

Answer 16

1. Severe ischemic pain
2. Absent pulses
3. Local necrosis
4. Osteomyelitis (bone death)
5. Systemic toxicity
6. Acute embolism
7. DVT

Question 17

PAD -

Answer 17

Peripheral artery disease - is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs

Question 18

Intermittent claudication -

Answer 18

• leg pain brought about activity

- Test = walking test, experience cramping that is relieved with rest

Question 19

Classic symptoms of PAD:

Answer 19

1. Intermittent claudication

2. Loss of one or more LE pulses (dorsalis pedi, popliteal pulse)

Question 20

Risk factors for PAD:

Answer 20

1. Poorly managed HTN
2. High cholesterol & triglyceride levels
3. History of tobacco use

Question 21

T/F All diabetic patients receive foot screen.

Answer 21

True

Question 22

What is included in diabetic foot screen?

Answer 22

1. Protective sensation (10 kg monofilament)
2. Skin Temp (palpation for elevated skin temp = underlying inflammatory mechanism)
3. Distal pulses
4. Visual observation:
   - Nail shape and color
   - Deformities (claw toe)
   - Swelling (poor venous return)
   - Callus formation
   - Dry skin

Question 23

Recommendations for DM patients for foot screens:

Answer 23

1. Daily for all DM patients
2. Can’t see feet - mirror, caregiver, work on impairments to help get in position to see feet
3. Shoes

Question 24

What two things are the major predisposing risk factors for lower extremity amputation in individuals with DM?

Answer 24

1. Peripheral neuropathy

2. PAD

Question 25

Amputations in the DM population are associated with

Answer 25

``` Significant morbidity Significant functional limitations Future disability Another LE amputation Mortality (33% in one-year) ↑ Health care costs ```

Question 26

Unexpected injury to an extremity that results in immediate separation of the limb or will result in the loss of the limb as a result of accident or injury

Answer 26

Trauma

Question 27

Leading causes of trauma induced amputations:

Answer 27

1. MVA 2. Farming accidents 3. Power tools 4. Firearms 5. Burns and electrocution

Question 28

Typical patient profile of amputation due to trauma:

Answer 28

- MEN - 20-29 years old - Primary cause of UE amp

Question 29

T/F Trauma induced amputee will have increased psychological impact.

Answer 29

True

Question 30

Challenges of traumatic amputations -

Answer 30

1. Limb length, shape 2. Partial v. full amputation 3. Multiple surgeries 4. Tissue viability and loss 5. Pain 6. Other injuries

Question 31

Amputations due to cancer are a result of what?

Answer 31

osteosarcoma at or near epiphysis of long bones

Question 32

Amputations due to cancer are where?

Answer 32

1. Distal femur 2. Proximal tibia 3. Proximal humerus

Question 33

Amputee cancer patients are often what sex? Age?

Answer 33

male, late childhood thru early adulthood

Question 34

Other factors to consider with cancer amputee:

Answer 34

1. Chemo and radiation | 2. Surgery

Question 35

What to look for with osteosarcoma?

Answer 35

- Pain with weightbearing - Hx of worsening, deep local pain - Fractures

Question 36

Congenital deficiency -

Answer 36

Absence of all or part of a limb at birth (7.9 per 100K live births)

Question 37

T/F Surgical intervention less common with congenital deficiency amputee.

Answer 37

True

Question 38

Challenges of congenital deficiency amputee:

Answer 38

Rapid growth Cosmesis Provide for function

Question 39

T/F Dysvascular disease is leading cause of LE amputation

Answer 39

True

Question 40

T/F Females more affected than males

Answer 40

False, males

Question 41

T/F Lower limb 11x more likely than upper limb

Answer 41

True

Question 42

T/F Traumatic amputations are more likely to occur in men, 20-29 years old

Answer 42

True

Question 43

T/F Traumatic amputations is 3rd leading cause

Answer 43

False, cancer is 3rd leading cause

Question 44

T/F Congenital deformity/deficiency is less than 1% of all amputations

Answer 44

True