Mike's Lecture Flashcards
Most common place for a sore to develop on a transtibial amputee?
Anterior-Distal Tibia
What are the possible causes for a anterior-distal tibia sore in a transtibial amputee?
- Not enough socks (BIG ONE)
- pt wearing shoes with too high of a heel
- foot placed too posterior
- too much flexion in the socket
- heel of foot is too stiff
- posterior shelf is too shallow
- not enough relief int he socket
What are the 3 goals of post-op care?
- facilitate healing
- reduce edema
- prevent contractures
What is the purpose of the preparatory prosthesis?
- early ambulation
- shape of the residual limb
- cost effective
What are the most common components for a transtibial amputee?
- SACH foot
- Endoskeleton pylon
- PTB socket (with pelite insert)
- Suspension (waist belt/cuff strap, and suspension strap)
Transtibial: pressure TOLERANT areas?
- patella tendon
- medial tibial flare
- medial tibia
- pre-tibial muscles
- shaft of fibula
- gastroc (posteriorly)
Transtibial: pressure SENSITIVE areas?
- tibial tubercle
- tibial crest
- anterior-distal tibia
- fibular head
- peroneal nerve
- distal fibula
- HS tendons (posterior)
For a PTB socket, where does the posterior shelf have to be?
If PTB, then you need a counter-force in back - so posterior shelf has to be just above the patella tendon (pt might not like it - remember mike’s story)
For a total surface bearing socket, where does the posterior shelf have to be?
Total surface bearing posterior shelf can be below patella tendon, because it does not need a counter-force.
Components of a preparatory prosthesis?
- prosthetic socks
- socket suspension
- socket insert
- socket
- pylon
- foot
What contractures are you concerned about forming post-op?
hip flexion and abduction
- could be due to positioning in hospital or muscle imbalance of iliopsoas (hip flex)/HS(hip ext) or glut med (ABD)/gracillis,etc (ADD)
What does a pt’s limb weigh compared to prosthetic?
limb = 8-10 lbs prosthesthesis = 3-4 lbs
What is the duration of the prepatory stage?
- Generally 4-6 months
- When to move on: constant residual limb volume, pt wearing excessive socks –> then you need to consider socket replacement
What are the advantages and disadvantages of exoskeletal prosthesis for a transtibial amputee?
Advantages: - Durable - Lightweight - Cost effective Disadvantages: - Cosmesis - Not alignable - Limited component selection
What are the advantages and disadvantages of endoskeletal prosthesis for a transtibial amputee?
Advantages: - Cosmesis - Alignable - Component selection Disadvantages: - Cost - Durability - Weight
What are the possible socket selections for a transtibial amputee?
- Open end
- Patella Tendon Bearing
- Total Surface Bearing
- Knee joints and Thigh Lacer
What are the possible suspension techniques for a transtibial amputee?
- Waist belt
- Supracondylar Cuff
- Suspension Sleeve
- Supracondylar Wedge
- Suction Suspension
- Pin Suspension
- Sub-Atmospheric Suspension
What are 2 ways suction suspension can be achieved?
- Expulsion valve
2. Suspension sleeve
Sub-Atmospheric suction is created by > ___ kPa vacuum. What does this produce? How does this affect fluid refill?
52 kPa
- This produces a large constant suspension and eliminates pistoning.
- This pulls fluid down into limb and keeps it there, so pt does not have fluid refill at night. However, it can be dangerous, because it makes it possible for awater blister to form.
What are the possible socket liners for a transtibial amputee?
- Hard socket
- Pelite Liner
- Multidurometer
- Gel Liner