LE Amputations

Question 1

The majority of LE amputations are caused by _______

Answer 1

vascular disease

Question 2

The majority of UE amputations are due to ________

Answer 2

trauma

Question 3

List various causes of amputations

Answer 3

In order from most to least likely

1. Diabetes and PAD (dysvascular disease)
2. Trauma
3. Cancer
4. Congenital deficiences

Question 4

How can diabetes result in a LE amputation?

Answer 4

1. elevated blood sugar causes damage to blood vessels and nerves
2. results in periperal neuropathy
3. results in loss os protective sensation
4. blister or minor injury occurs
5. develops to an ulcer
6. amputation

Question 5

List the clinical signs of peripheral neuropathy

Answer 5

1. Deficits in sensation
2. motor impairments
3. autonomic dysfunction
   
   1. tropic changes

Question 6

How are deficits in sensation related to amputation?

Answer 6

makes the patient more vulnerable to high-pressure and repetitive low-pressure traumas

Question 7

Other than peripheral neuropathy, list other diabetic complications that can lead to amputation.

Answer 7

1. Severe ischemic pain
2. absent pulse → called arteriosclerosis obliterans
3. local necrosis
4. osteomyelitis
5. systemic toxicity
6. acute embolism
7. DVT

Question 8

List the classic symptoms of PAD

Answer 8

1. intermittent claudication
2. Arteriosclerosis obliteran →loss of one or more LE pulses

Question 9

what is intermittent claudication and how can we test for it?

Answer 9

leg pain brought about by activity and resolved with rest

test using a walking test

Question 10

List risk factors for PAD

Answer 10

1. poorly managed HTN
2. high cholesterol and triglyceride levels
3. history of tobacco use

*stroke and CVD also share these risk factors

Question 11

How do we prevent limb loss in diabetic patients?

Answer 11

1. provide all diabetic patients with a comprehensive foot screen
2. provide daily foot checks
3. teach patients how to perform daily foot checks

Question 12

what is included in a comprehensive diabetic foot screen?

Answer 12

tests for:

1. protective sensation (monofilament, sharp/dull testing)
2. skin temp
3. distal pulses
4. visual observations for:
   
   1. nail shape and color
   2. deformities
   3. swelling
   4. callus formation

Question 13

what are the leading causes of trauma that result in a LE amputation?

Answer 13

1. MVA
2. farming accidents
3. power tools
4. firearms
5. burns and electrocutions

Question 14

List various challenges unique to traumatic amputations

Answer 14

1. limb length and shape can vary due to the trauma
2. parital vs full amputation
3. multiple surgeries usually required
4. tissue viability and loss
5. pain
6. other injuries may take priority like CNS injuries

Question 15

what are clinical symptoms for osteosarcoma?

Answer 15

1. pain w/weightbearing
2. Hx of worsening, deep local pain
3. fractures

Question 16

T/F: there is an overall decreasing need for amputations in osteosarcoma patients

Answer 16

TRUE
medical field getting better at early screening and treating

Question 17

what is the prevelance of congenital deformities resulting in amputation?

Answer 17

accounts for less than 1% of amputations

7.9 per 100,000 live births

Question 18

what are unique challenges presented by congenitial deficiency amputations?

Answer 18

1. rapid growth
2. cosmesis
3. must be provided for function in order to meet developmental benchmarks