Limb

Question 1

Describe the classification of lower limb amputations

Answer 1

Hemipelvectomy - entire lower limbs and partial removal of pelvis
Hip disarticulation - entire lower limb including proximal femur
Transfemoral - shaft of femur
Knee disarticulation - through knee join
Transtibial - shaft of tibia
Ankle disarticulation (Syme) - through ankle joint

Partial foot amputations include through the level of calcaneocuboid joint (Chopart) amputation

Question 2

Surgical management techniques

Answer 2

Myofascial closure - closure of muscle fascial envelope without attachment to the bone.
Myoplasty - suturing of muscle fibres and fascia.
Myodesis - muscle and fascia are directly sutured to the periosteum of the bone

Question 3

Skin problems

Answer 3

Verrucous hyperplasia - occurs when there is inadequate socket pressure on the distal end of the residual limb. Thought to be a reversible condition related to oedema and sometimes bacterial overgrowth.
Epidermoid inclusion cysts.
Hyperhydrosis.
Heterotrophic ossification.

Question 4

Medicare Functional Classification Level (MFCL)

Answer 4

K0 - non ambulatory; cosmetic prosthesis
K1 - household distances or level services at FIXED cadence; solid single axis component
K2 - limited community distance; multiaxial weight activates stance control
K3 - unlimited community distance with VARIABLE cadence; energy storing hydraulic devices
K4 - exceed normal activities; specialty made

Question 5

Upper limb embryology

Answer 5

Most common congenital amputation is at the left short transradial level.
Most cases have NO hereditary implications.
Deficiencies occur because of failure of limb bud formation in the first trimester, from 3rd to 8th week gestation during which differentiation occurs

Question 6

Transradial amputations

Answer 6

Length based on measurement from the longest residual bone(radius or ulnar) to medial epicondyle. 50% of supination (180 normal) and pronation (120 normal) is transmitted to the prosthesis.
Long: 55-90% with 60 sup/pro
Medium: 35-55% but sup/pro lost
Short: 0-35% preservation

Question 7

Carlyle formula for determining proper upper limb length in bilateral amputees

Answer 7

Bilateral transradial amputee: distance from the apex of the lateral epicondyle to thumb tip (forearm) is patient’s body height x 0.21.

Bilateral transhumeral amputee: distance from acromion to lateral epicondyle (arm) is patient’s body height x 0.19

Question 8

Erb’s palsy

Waiters tip position

Answer 8

Paralysis of the arm caused by injury to C5-6. The most commonly involved nerves are the suprascapular nerve, musculocutaneous nerve, and the axillary nerve (atrophy of the deltoid, biceps, and brachialis muscles).
The position of the limb, under such conditions, is characteristic: the arm hangs by the side and is rotated medially; the forearm is extended and pronated. The arm cannot be raised from the side; all power of flexion of the elbow is lost, as is also supination of the forearm.

Question 9

Klumpke’s paralysis (claw hand: c8-T1)

Answer 9

Signs and symptoms include weakness and loss of movement of the arm and hand. Some babies experience drooping of the eyelid on the opposite side of the face as well. This symptom may also be referred to as Horner syndrome.

Question 10

Aitken Classification of PFFD (proximal focal femoral deficiency), now known as LDFP (longitudinal deficiency of the femur, partial)

Answer 10

A -femoral head present with normal acetabulum
B - femoral head in acetabulum but no bony connection between head and shaft
C - ossicle/absent with proximally tapered femur
D - absent femoral head with short deformed femoral segment