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Practice Topics Exam 4 > LE Prosthetics - 1 - Intro to Prosthetics > Flashcards

LE Prosthetics - 1 - Intro to Prosthetics Flashcards

1
Q

How many amputations occurring annually in US

A

185,000

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2
Q

Number 1 cause for amputation in US

A

diabetes!

Lifestyle choices - we can have a positive impact on changing this

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3
Q

What percent due to disvascularity

A

54%

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4
Q

What percent due to trauma

A

45%

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5
Q

What percent due to other diseases (like CA)

A

less than 2%

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6
Q

Of people with diabetes and amputation what percent will need a contralateral amputation

A

55%!

within 2-3 years

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7
Q

African Americans ___% more/less likely than White American to have amputation

A

4x more likely! (higher risk of disvascularity)

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8
Q

1/2 the people with amputation secondary to PVD will die within __ years and why

A

5 years!

Is is that the amputation is an indicator of the progression of the disease, not the amputation leading to their death

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9
Q

2009, hospital cost associated with amputation was more than

A

8.3 billion

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10
Q

Challenges to interdisciplinary care

A

Ownership issue (my pt)
Focus on diff tasks/specialties
Located in various physical locations
Common outcome not established

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11
Q

Optimum rehab team

A 
Focused motivated and goal oriented pt
Ortho surgeon
Vascular surgeon
Plastic surgeon
Rehab case manager
Home health care nurse
PT
Prosthetist
Insurance company
Family
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12
Q

Maximizing prosthetic rehab requires

A

Early intervention and multi-disciplinary approach
Education, clear and concise expectations to reduce anxiety and stress
PT, pre and post surgery will improve func and reduce overall rehab time

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13
Q

PT role

A

Consultation with education
Evaluation
Training/coaching to optimize prosthesis

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14
Q

Prosthetist role

A 
Provides pt care
Prosthetic design
Prosthetic fitting/alignment
Long term prosthetic mnmgt
Member of rehab team
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15
Q

Certified prosthetist requires what

A 
Baccalaureate degree
Post grad training
Clinical practice residency (18 m to 2 yrs)
Certification exams
Continuing ed
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16
Q

What to expect from your prosthetist

A 
Prosthetic rx
pt and PT education
Design of prosthesis
Prosthetic fabrication
Prosthetic fitting/alignment
Long term prosthetic care
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17
Q

Amputations of the foot

A 
Symes
Boyd
Pirogoff
Chopart
Lisfranc
Mid metatarsal
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18
Q

Amputations of the foot - Symes

A

Takes off distal malleoli
Leaves talus intact
Take fat pad from heel and end up with tubular shape amputation that is WB (put weight on heel)
Good function but prosthetically can’t do much

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19
Q

Amputations of the foot - 1st toe

A

This one is significant because we need it for push off with gait - can cause decreased step length on contralateral side which leads to asymmetry
Will often do something prosthetically to replace that tow

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20
Q

Amputations of the foot - Mid metatarsal

A

Removing all toes
Midtarsal head is where we carry a lot of the weigh tin our foot - so if we cut above that, we will have sig impact on gait
Still functional level of ambulation - can make changes in shoe to restore gait pretty well

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21
Q

Amputations of the foot - Lisfranc

A

Disarticulating the metatarsals from the tarsal bones
So now we have a short foot
Nonfunctional amputation! Too long to do prosthetic and too short to stay put in a shoe

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22
Q

Amputations of the foot - Chopart

A

disarticulating the tarsals from the calcaneus and talus

Also nonfunctional for same reason as Lisfranc

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23
Q

Below knee amputations - Symes

A

Cutting through the tibia and fibula with this so Symes is considered below the knee (that is where the below the knee term kind of starts)

24
Q

Below knee amputations -

A 
Symes
Long below knee
Standard below knee
Short below knee
Very short below knee
25
Below knee amputations - Long below knee
Somewhere distal to the significant portion of the gastroc The longer the intact limb, the more lever arm that we have but these are rare Diff to fit in prosthesis because tibia is so "superficial" so need a lot of cushion to protect bone
26
Below knee amputations - Standard below knee
Somewhere between 5-7 in in length The more SA we have, the less pound per square inch of pressure they will have So we want that 5-7 in as long as possible to give good coverage for gastroc and good circulation for wound healing
27
Considerations that have to be made when determining length for amputation
Circulation Need to have good circulation for wound healing to occur Do we have tissue that we can wrap around is something else to consider too Fibula shorter than tibia
28
Soft dressings
Need to get rid of as much post op edema as possible before starting on prosthetics Ways to get edema down include use of soft dressings like: ACE wrap Compressive stockinette Traditional shrinker
29
ACE wrap - adv
Inexpensice | Accessibility of wound
30
ACE wrap - disadv
``` Requires skilled application - blisters, maceration, wounds Inconsistent pressure gradient Falls off limb easily Does not prevent knee contractures No protection from falls ```
31
Shrinkers provide
Graded compression More compression distally than proximally Encourage edema to go up towards heart
32
Shrinkers adv
Consistent compression Less expensive than RRD or IPOPS Little skill required for application Can be custom made for odd shapes
33
Shrinker disadvan
``` Limitations on sizing No protection from bumps or falls Smaller shrinkers have to be fit Can frequently fall down or wrinkle Can be painful to don ```
34
Shrinkers - common brand
Juzo
35
How long should a stump shrinker be worn
24 hours a day But we have to have some time out of it to allow skin to breathe Basically wearing it full time though so edema doesn't get started again
36
How to apply a stump shrinker
House coffee can Stretch shrinker over can and then place it on them to roll it out onto their skin Avoid pulling it on like a sock
37
How to apply a stump shrinker - what NOT to do
Pull it up like a sock Can put tension on suture line Can catch and pull suture and will probably be more uncomfortable for pt Also applies friction
38
Shrinker with transfemoral
NEED to include the hip | and make sure to go up to the perineum
39
Residual limb shaping/maturation
On day 100 that limb volume reduction stabilizes | So if we fit the socket before the 100 days, we will likely have a lot of issues from changes that occur
40
Prosthetic goals -
Functional restoration - safety - mobility - independence - balance (physical, mental, cosmetic)
41
Brief history - ortho docs came from
being brace makers
42
History - the verduyn leg
The first hinged knee joint TTA prosthesis | 1696
43
History - ambroise pare
trans femoral prosthesis heavy metal, first knee joint 1561 Allows for functional knee swing
44
History - Angelsey leg
Cord system that DF the ankle as the knee flexed | 1800s
45
History - Douglas Bly legs
Ball and socket joints (ankle) Leather cord to limit motion and rubber cushions to decrease impact Mid 1800s
46
History - JE Hanger
1861 - Eliminated the cord in feet and used rubber bumpers instead
47
History - Early 1900s what happened
Plug fit TTA with knee joints and thigh suspension | A lot of suspension devices to hold prosthesis on
48
History - PTB prosthetic design
PATELLAR TENDON BEARING 1946 Getting smarter about where we put pressure in the socket Deep carve in at patellar tendon
49
History - Quadrilateral socket
1946 for transfemoral Ischial tuberosity sits in it - so like sitting on bench
50
History - SACH foot designed by
Howard Eberhart and Charles Radcliffe 1958 SOLID ANKLE CUSHIONED HEEL Wood heel that anchors into wood leg Other part is foam - the heavier the person, the more dense the foam Idea was that at heel strike, the foam would condense and simulate and try to get foot flat to take away the moment (takes away the knee flexion moment that exists at heel strike) Primarily for transtibial Multiple sizes of each made on an assembly line - more similar to modern
51
History - Hans Mauch
Introduced hydraulic knee control 1986 Faster they walked, the more resistance they would have Helped control knee flexion with swing
52
History - Otto Bock
1980s Introduces endoskeletal prosthetic design Created internal pipe structure that allowed for acceleration of fitting process for pt and adjustments could be made more easily
53
History - Ossur Kristinsson
Icelandic roll on suction sockets 1980s Silicone liner Distribute pressure more evenly over entire residual limb
54
History - dynamic response prosthetic foot
introduced in 1980s | utilization of carbon fiber - lightweight, strong, return energy as walker uses it
55
History - materials
``` up to 1950 - wood and steal 1960s - polyester laminates 1970s - plastics 1980s - carbon fiber, Al 1990s - Silicon, Ti 2000s- composites, computer assisted ```

Practice Topics Exam 4 (9 decks)

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