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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
Q

Below knee amputations - Long below knee

A

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
Q

Below knee amputations - Standard below knee

A

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
Q

Considerations that have to be made when determining length for amputation

A

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
Q

Soft dressings

A

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
Q

ACE wrap - adv

A

Inexpensice

Accessibility of wound

30
Q

ACE wrap - disadv

A 
Requires skilled application - blisters, maceration, wounds
Inconsistent pressure gradient
Falls off limb easily
Does not prevent knee contractures
No protection from falls
31
Q

Shrinkers provide

A

Graded compression
More compression distally than proximally
Encourage edema to go up towards heart

32
Q

Shrinkers adv

A

Consistent compression
Less expensive than RRD or IPOPS
Little skill required for application
Can be custom made for odd shapes

33
Q

Shrinker disadvan

A 
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
Q

Shrinkers - common brand

A

Juzo

35
Q

How long should a stump shrinker be worn

A

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
Q

How to apply a stump shrinker

A

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
Q

How to apply a stump shrinker - what NOT to do

A

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
Q

Shrinker with transfemoral

A

NEED to include the hip

and make sure to go up to the perineum

39
Q

Residual limb shaping/maturation

A

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
Q

Prosthetic goals -

A

Functional restoration

  • safety
  • mobility
  • independence
  • balance (physical, mental, cosmetic)
41
Q

Brief history - ortho docs came from

A

being brace makers

42
Q

History - the verduyn leg

A

The first hinged knee joint TTA prosthesis

1696

43
Q

History - ambroise pare

A

trans femoral prosthesis heavy metal, first knee joint
1561
Allows for functional knee swing

44
Q

History - Angelsey leg

A

Cord system that DF the ankle as the knee flexed

1800s

45
Q

History - Douglas Bly legs

A

Ball and socket joints (ankle)
Leather cord to limit motion and rubber cushions to decrease impact
Mid 1800s

46
Q

History - JE Hanger

A

1861 - Eliminated the cord in feet and used rubber bumpers instead

47
Q

History - Early 1900s what happened

A

Plug fit TTA with knee joints and thigh suspension

A lot of suspension devices to hold prosthesis on

48
Q

History - PTB prosthetic design

A

PATELLAR TENDON BEARING
1946
Getting smarter about where we put pressure in the socket
Deep carve in at patellar tendon

49
Q

History - Quadrilateral socket

A

1946
for transfemoral
Ischial tuberosity sits in it - so like sitting on bench

50
Q

History - SACH foot designed by

A

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
Q

History - Hans Mauch

A

Introduced hydraulic knee control
1986
Faster they walked, the more resistance they would have
Helped control knee flexion with swing

52
Q

History - Otto Bock

A

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
Q

History - Ossur Kristinsson

A

Icelandic roll on suction sockets
1980s
Silicone liner
Distribute pressure more evenly over entire residual limb

54
Q

History - dynamic response prosthetic foot

A

introduced in 1980s

utilization of carbon fiber - lightweight, strong, return energy as walker uses it

55
Q

History - materials

A 
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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