LE Fractures and Amputation

Question 1

Partial foot

Answer 1

work on balance (compensate w other extremity)

hard w diabetics w neuropathy/ decreased feeling on other foot

Question 2

Below the Knee

Answer 2

Most common site for LE Amputation
Good functional outcome for sitting & walking
Knee disarticulation
Short BK
Standard BK- more leg length = better for prosthetic

*don’t let knee contract (no pillow under knee)
knee board on w/c- encourage them to extend knee/don’t keep relaxed

Question 3

Above the Knee

Answer 3

Poorer prognosis for prosthetic use
Hemipelvectomy
Hip disarticulation
Short AK
Standard AK

increased issues
increased issues with wound healing and perspiration

Question 4

Issues Related to Amputation

Answer 4

Generalized weakness- older or diabetic, previous bad health, fragile after surgery, progress slowly
Balance- peripheral neuropathy- good relationship w PT/ transfer over skills, don’t over work pt on residual limb (mat work, sitting balance, watch time in standing, check skin and let rest)
Sensation- check and build up gradually
COG- will shift/prosthetic (heavy)
Mobility- ambulate to and in bathroom/kitchen/transfers
ADL’s- don and doff prosthesis, manage any other IADL

build strength and stamina for prosthesis

Question 5

Issues Related to Amputation

Answer 5

Geriatric client- diabetic (unmanaged infection in foot grows)
PVD
Cardiovascular disease
109,000 vascular amputations annually in U.S

Question 6

Rehab

Answer 6

Foot inspection- big push- prevent further wounds on residual limb. keep stump as healthy as possible
Hygiene- wash and dry residual limb
Suitable footwear-no open toe shoes

• need to know what to look for
• learn/know pressure area for hot spots

Question 7

Preprosthetic training

Answer 7

(done in rehab a lot)
Reduce pain- residual limb-tolerating touch, bed sheets, clothes, gentle WB/gentle pressure
Foster healing- keep up diet/ keep sugar under control to increase healing
Prevent contractures/optimize positioning- educational level of pt
Prevent skin ulcers- can develop from prosthesis, lack of mobility
Stump shaping & wrapping- surgeon tries to shape stump in cone shape for prosthetic use (shrinker socks to decrease swelling)
Endurance building- lack stamina, biomechanical approach , build up cardiovascular system
ADL’s (seated)- initially- eventually progress to completing in standing
Ambulation (crutch or walker)- transition to IADL’s

look at whole picture- age, home life

Question 8

Post-Prosthetic Training

Answer 8

Balance
Mobility
Endurance
Strength & conditioning
Standing tolerance- inspecting skin each time they doff prosthesis
ADL’s in standing
Community level functioning- higher level fx

keep in mind diabetic retinopathy - decreased vision and increased falls