Midterm Flashcards
Who was the first to develop a tourniquet to stop bleeding during an amputation?
Jean Louis Petit in 1718
Who was the first person reported to use a tourniquet for hemorrhage control after injury and for amputation?
French army surgeon Etienne Morel in 1674
What type of closure Encases the bone and transected muscle by closing the fascial envelop over the top of the muscles?
Myofascial Closure
What type of closure require the surgeon to position the muscle over the distal end of the bone and attaches to the opposing muscle?
Myoplasty
What type of closure take individual muscle groups and directly attached to the periosteum of the bone?
Myodesis
What type of closure takes the firm distal attachment of the severed tendon to the bone?
Tenodesis
Which is the least stable amputation technique Myoplasty Myofascial closure Tenodesis Myodesis
Myofascial closure
Which amputation technique is most stable? Myoplasty Myofascial Closure tenodesis Myodesis
Tenodesis
What are the 3 categories of prehension?
Precision
Power
Coal hammer
What are the 6 types of prehension?
Tip Cylindrical Lateral Palmer Hook Spherical
What procedure is performed in mainly 3rd world countries on specific populations such as bilateral amputations and the blind pts?
Krukenberg procedure
What type of amputation where the patient maintains pronation and supination
More pressure can be tolerated in distal aspect of the limb
Wrist unit and hand length are more difficult to match ContralAteral limb?
Wrist disarticulation
What is a Trans-Radial Amputation?
Amputation through radius and ulna
True or false?
The longer the residual limb: more control over the prosthetic, and more area to decrease pressure on the limb
True
True or false
Regarding Elbow Disarticulation amputations trimlines can be shorter on the socket
True
True or false
Regarding Elbow Disarticulation amputations: epicondyles can be utilized for suspension
True
The dual cable system (Fair-lead cable system) has what two types of movement?
Different movements allow for elbow for elbow flexion and extension
Alternative movements allow for terminal device opening and closing
A component for bilateral or involved ContralAteral limb that allows the elbow to lock and unlock by “nudging” the control with the chin is called what?
Nudge Control
What are some difficulties with forequarter Amputation?
~Loss of balance- balance can be increased with prosthetic use
~Prosthetic use is more difficult due to loss of muscle and proximal arm for control
~Lower compliance/ use rate
What is an acquired deformity?
Resultant of trauma or cancer: law mowers are a large contribution
Adjustment process is crucial to child and family members
Congenital deformities are a result of what idiopathic syndrome?
Amniotic Band Syndrome (ABS)
True or false congenital deformities have a higher chance of rejection compared to acquired prosthetic use
True
What are the three types of congenital etiologies?
Amniotic Band Syndrome
Longitudinal Deficiency
Transverse Deficiency
What are some complications that come from amniotic band syndrome?
~Syndactyly -Amputation of fingers or toes
~Severe cases can result in clubbed feet or limb amputations
An absence extending parallel with the long axis of the limb (forearm and/ or hand, or leg and/or foot), either pre-axial, post axial, or (as in the hand or foot) central in nature
Longitudinal deficiency
The limb has developed normally to a particular level beyond which no skeletal elements exist
There may be digital bud
Transverse Deficiency
What is a terminal device also referred as?
TD
What is the primary function of a terminal device ?
Primary function Is for prehension
Voluntary ______ terminal devices Open when the cable is pulled?
Voluntary opening (VO)
Which terminal devices are the most commonly used where spring tension is used to grip the object voluntary opening or voluntary closing?
Voluntary opening
Voluntary _______ terminal devices Closes when the cable is pulled?
Voluntary closing (VC)
Which of the following described a canted terminal device?
A. Offset which allows better line of sight to object or working surface: at an angle
B. Object is rolled into its grasp
C. Cannot pick up pins well
D. All of the above
D. All of the above
Which of the following applies to a Lyre terminal device? A. "Straight-approach" B. Object is pinched C. Allows user to pick up pins D. All of the above
D. All of the above
Which type of metal is best used for high level UE patients?
Aluminum
Which type of metal or material is best for longer trans-radial prosthetic use?
Stainless steel
Heavier than aluminum but lighter than stainless steel used for moderate work?
Titanium
What’s the name of the Caucasian rubber material used to coat the fingers of the hook , increase coefficient of friction, most commonly used for children, and his not heat resistant?
Plastisol
What is the acronym APRL stand for?
Army Prosthetic Research Laboratory
What does the acronym CAPP stand for?
Child Amputee Prosthetic Program
A Hosmer TD size 12 is for what patient populations?
Infants
A Hosmer TD size 10, 99 are for what patient populations?
Small Adult/Child
A Hosmer TD size 8, 88 are for what patient populations?
Medium Adult
A Hosmer TD size 5, 555 are for what patient populations?
Adults
Hosmer TD sizes 3, 6, 7, and 7LO are what types of terminal devices?
Work TDs
Very short residual limb length of less than _____ %
35%
Residual limb length of 35% to 55% is what type of amputation level?
Short
Residual limb length of 55% to 90% is what type of amputation level?
Long
Long TR greater than 55%
The long below elbow residual limb retains from 60 to 120 degrees of supination and pronation and the short below the elbow limb retains less than 60 degrees
What are the two types of socket design for a short < 33% socket?
Rigid hinge
Self suspending
The PML is “___ to ____” less than ML across epicondyles
3/8 to 1/2 “
What is the posterior trim-lines for a short < 33% socket and medium TR sockets 33% to 55%
1/2 -1”
What are the two types of socket types used for medium TR sockets 33% - 55%?
Rigid joints
Self suspension
What two types of materials or socket types used for long TR sockets > 55%
Flexible hinges
Self suspension
On the socket what is the angle from the angle and parallel to the ulna?
45 degrees
On the socket what is the angle for the verticle?
60-70 degrees
What is the build up over the olecranon?
3/16” to 1/4”
What is the verticle horizontal epicondyles build up?
1/8” to 3/16”
What is the proximal margin build up?
1/8”-3/16”
What is the distal end build up?
1/8”
Build up applied to just distal to anterior trimline?
1/4”
Anterior trimline reduced to about ____” radius at cubital fold
1/8”
Wrist disarticulation is greater than ____%
55%
When the hook is open the cable and harnessing should be at least ___” between triple swivel/ball retainer and distal end of housing
1/4”
When the hook closed and in max pronation and supination there should be at least ___” between hanger and proximal end of housing
1/4”
True or false
The cable should not rub the forearm ?
True
The base plate and retainer is placed distal to the proximal __ and in lateral anterior 1/3 (___o’clock or ___o’clock).
1/3
10 or 2 o’clock
What are the two types of lengths matter for cable and harnessing?
Length of lateral epicondyles to thumb tip
Length of arm - epi to thumb post
The housing at the elbow should cross which epicondyle?
Lateral
True or false the housing does not bind at the elbow or gap away from elbow?
True
What happens when the housing flexes with the elbow?
It crosses the epicondyle
In a figure 8 harness where is the cross bar is mounted?
Cross bar mounted middle of the numeral cuff
In a figure 9 harness where is the cross bar mounted?
Mid proximal posterior trimline of muenster socket
True or false the flexible hinges cross the epicondyle apex and allows maximum sup/pro
True
In a harness where is the cross point/ Northwest ring?
Inferior to C7 and slightly off set towards the non amputated side
True or false the hanger should be lateral enough not to impinge on the patients skin?
True
True or false the harness should not be laying flat on the back?
False the harness is laying flat on the back
What crosses over the involved side shoulder and through the deltopectoral groove?
Anterior suspension strap
In the forearm flexion test the total ROM with the prosthesis should be no less than; muenster = ___degrees
55% or longer = _____degrees
Muenster = 60 degrees
55% or longer = 135 degrees
What is common fault?
Improper or insufficient socket trimline
For length <35% what is the desired pre flexion angle that is recommended?
15-25 degrees
For lengths > 35% to < 55% what is the desired pre flexion angle that is recommended?
10-15 degrees
For lengths < 55% what is the desired pre flexion angle that is recommended?
5 degrees
When performing the forearm flexion resist test you should have the patient hold elbow firmly at angle?
90 degrees
How much medial canting should terminal device be in?
3-5 degrees
For the forearm extension resist test you should have patient hold elbow at what angle ?
90 degrees
For the humeral external rotation resist test you should have the patient hold elbow in what angle ?
90 degrees
For the humeral internal rotation resist test you should have the patient hold elbow in what angle ?
90 degrees
For the forearm axial load test you should have the patient hold elbow in what angle ?
90 degrees
For the forearm rotation resist (>55% and flexible hinges only) ROM should be at least ____% of the ROM without the socket
50%
For the forearm rotation (>55% and flexible hinges only) ROM should be at least ____% of the ROM without the socket
50 %
For the tension stability test the prosthesis should not slip more than ___” in relation to the residual limb, and no part of the prosthesis or harness should fail when a 50 lbs. distal load is applied
1”
For the Hook-Opening Facility (normal use) the wearer should be able to obtain full range of terminal device operation actively with the forearm flexed to ___degrees.
90 degrees
For the Hook -Opening Facility (at mouth and perineum) the wearer should be able to obtain at least ___% of full range of terminal device operation actively at the mouth and perineum.
70%
What are the four general types of Transradial elbow joints?
Flexible
Rigid
Step up
Locking
Flexible joints
Soft- fabric and leather
Metal
Allow free pronation and supination
What are the two types of rigid joints?
Single axis -
Poly centric
What does the single axis rigid joints do?
Stabilizes socket preventing pronation and supination
What does the poly centric rigid joints do?
Increased distance from epicondyle axis to anterior socket trim
There by limiting tissue bunching in the bicipital fold
Therefore increasing elbow flexion
Rigid friction joints functions as what?
Trans-humeral prosthetics
And allow positioning of elbow flexion/extension for small children
What patient population does the rigid friction joints used for?
Very short TR
Elbow disarticulation pediatric amputees
Step -up joints allows for what?
Allows for increased flexion as the short residuum recedes into the humeral tissues beyond 90 degrees of flexion
Used with split socket
Step up joints are an alternative for what?
Alternative for very short <35% length
Residual limb activated locking hinge joints are used for who?
Very short TR with split socket
Uses split housing fair lead control cable
Functions as an elbow disarticulation system
Carlyle Formula
A= .19 x BH humerus length
B + C = .21 x BH forearm length
Forearm = .19/ .21 x Apt
Economy wrist
One of the least costly
Economy wrist with straps
Most durable wrist that can be purchased
Who is the economy wrist with straps indicated for?
Can be used for individuals with non functioning hand as the frame can be contoured around the hand
Who is the oval constant friction wrist
Long trans-radial patients
Which wrist is the shortest wrist unit in the market?
Wrist disarticulation friction wrist- allows for least space for a TD post.
Who does the CAPP Derlin Wrist indicated for?
For adults and children
Ideal for cosmetic hands
What wrist is the shortest quick disconnect?
Wrist Disarticulation Quick change Wrist
Who is the wrist disarticulation quick change wrist indicated for?
Long TR or WD patients
Who is the wrist disarticulation contra indicated for?
Bilateral Amputees
Requires PT to be able to grab and twist the ring for locking and unlocking the wrist
Which wrist unit is the shortest add-in flexion unit?
APRL child flexion unit
Who is the APRL child flexion unit indicated for?
Good for bilateral pediatric or long residuum adults that need flexion and rotation but don’t have enough room for the full length Sierra wrist
Which is the most commonly prescribed wrist option?
Friction wrist
Who is the friction wrist indicated for?
Wrist disarticulation pts
Who is the flexion wrist indicated for?
Very important for bilateral patients
Unilateral patients
Useful for midline activities: eating, shaving, toileting
Who is the Sierra wrist flexion unit indicated for?
Bilateral patients who need additional assistance reaching midline activities to complete ADLs
Four function wrist
Combines the rotational wrist to create the four functions of wrist: wrist flexion, extension, supination, and pronation
Who is the four function wrist indicated for?
Bilateral considerations: allows for easier propositioning of the TD’s
What’s a contraindication for the four function wrist?
Low gadget tolerance
Five function wrist (Texas Assistive)
Combines a rotational wrist and flexion wrist, and quick disconnect to create the five functions of : wrist flexion, extension, supination, pronation, quick disconnect feature
Who is the five function (Texas Assistive) indicated for?
Bilateral considerations
Who is the five function (Texas Assistive) contraindicated for ?
Low gadget tolerance requiring extra training and coordination
Hands free tool changing station ( Texas Assistive Device) can be used with what device?
Texas Assistive Device quick disconnect set ups.
