P&O Lower Extremity

Question 1

1/3 of LE amputations were of teh ___

Answer 1

toe

Question 2

Top four causes of LE amputation

Answer 2

1. PVD/infection 70%
2. Trauma 22%
3. tumor 5%
4. Congenital deformity 3%

Question 3

Most common locations of LE amputation (top 2)

Answer 3

1. transtibial 59%

2. Transfemoral 35%

Question 4

What is a normal ABI?

PAD ABI?

Answer 4

Normal 0.91 - 1.30
Mild PAD 0.71 - 0.90
Moderate PAD 0.41 - 0.70
Severe PAD 0.00 to 0.40

Question 5

ABI > 1.30 may suggest _____

Answer 5

calcified, noncompressible vessels which can produce falst negative results

• common in DM

Question 6

what is the gold standard imaging test for PAD?

Answer 6

interarterial contrast angiography

Question 7

Describe the difference between myodesis and myoplasty

Answer 7

myodesis - muscles and fasciae are sutured directly to bone through drill holes. Residual limb is more structurally sound. Contraindicated in severe dysvascularity in which the blood supply to the bone may be compromised

myoplasty - opposing muscles are sutured to each other and to the periosteum at the end of the cut bone with minimal tension. Generally takes less operating time. May be the procedure of choice in severe dysvascular residual limbs.

Question 8

What is a symes ampuation

Answer 8

ankle disarticulation with attachment of heel pad to the distal end of tibia and may include the removal of malleoli and distal tibial/fibular flares

Question 9

standard BKA is ____% of tibial length

Answer 9

20-50%

Question 10

If amputation line is within _____ below tibial tubercle, might as well do a disartic

Answer 10

1cm

Question 11

standard transfemoral AK is ____% of femur length

Answer 11

35-60%

Question 12

Short BK are at risk for ____

Answer 12

knee flexion contractures. If above 1cm below tibial tubercle, might as well do knee disartic.

Question 13

Very high AKAs are at risk for ____

Answer 13

flexion and abduction contractures at the hip joint

Question 14

____- amputation is through the transmetatarsal junction

Answer 14

lisfranc

Question 15

____ is an amputation at the midtarsal line. Only talus and calcaneus remain

Answer 15

chopart

Question 16

_____ is a resection of a portion of up to three metatarsals and digitis

Answer 16

partial foot/ray resection

Question 17

_____ is an amputation of both lower limbs and pelvis below L4/5 level

Answer 17

hemicorporectomy

Question 18

Transmetatarsal amputations are important because they preserve:

Answer 18

the attachment of the dorsiflexors and plantar flexors and their function.

Question 19

_____ amputaiton is a vertical calcaneal amputation

Answer 19

pirogoff

Question 20

___ amputation is a horizontal calcaneal amputation

Answer 20

boyd

Question 21

In both lisfranc and chopart amputations, the remaining foot often ____

Answer 21

develops significant equinovarus deformity resulting in excess anterior weight bearing with breakdown.

adequate dorsiflexor tendon reattachment with achilles tendon lengthening has been advocated to prevent this deformity.

Question 22

4 “pros” of symes amputation

Answer 22

1. maintains limb length
2. there is preservations of the heel pad, providing excellent weight bearing residual limb
3. early fitting of prosthesis is possible with excellent results
4. partial weight bearing of the residual limb is possible almost immediately after the procedure with a proper rigid casting (approx within 24H)

Question 23

Healing rate for dysvascular BK is ____%

Answer 23

80-90%

Question 24

In a BKA, fibula should be cut _____ and the tibia should be _____

Answer 24

2-3cm shorter than the tibia

beveled anteriorly

Question 25

4 advantages of a knee disartic

Answer 25

1. less traumatic to tissue 2. blood loss is minimal 3. a long strong residual limb with excellent end-bearing quality is produced 4. prosthetic suspension is facilitated by the bulbous contour of the residual limb end.

Question 26

Hip flexion contractures are common with AK's. Paticularly with _____limbs. ____ degrees of hip flexion can be accomodated in the socket

Answer 26

shorter limbs 20 degrees.

Question 27

During transfermoral amputation use of myodesis of _______ helps to maintain adduction position of the femur in the prosthetic socket

Answer 27

adductor muscles

Question 28

Ideal shape for TT residual limb is _____ and TF residual limb is ____

Answer 28

cylindrical conical

Question 29

in residual limbs, a chronically draining sinus may be the result of (3)

Answer 29

1. superficial abscess 2. bone spur 3. localized osteo

Question 30

A postoperative plaster or fiberglass rigid dressing does what? 3

Answer 30

1. prevents edema - occurs within a few minutes 2. protects from trauma 3. decreases post-op pain

Question 31

a rigid removable dressing for TT amputee consists of a plaster or fiberglass cast suspended by ______ and _____. Adjusted by ______. Provides good edema control with advantage of ____.

Answer 31

stocking & supracondylar cuff adding or removing socks to maintain compression. allowing daily inspection

Question 32

When using elastic bandages in figure-8 pattern, ____ should be used for TT limb, and _____ for TF limb

Answer 32

double length 4-inch bandages | double length 6-inch bandages

Question 33

May use shrinker socks after _____

Answer 33

staple/suture removal

Question 34

In the K0 non-prosthesis candidate ____ may help edema and pain with facilitated healing

Answer 34

shrinkage device

Question 35

Amputees should prone ____ to prevent hip flexion contractures

Answer 35

15 minutes TID an amputee who cannot lie prone should lie supine and actively extend the residual limb while flexing the contralateral limb.

Question 36

_______ with or without a prosthesis promotes good ROM and when feasible, is preferred over wheelchair mobility.

Answer 36

crutch walking

Question 37

appropriate cleaning of residual limb?

Answer 37

daily with bland soap and warm water, pat completely dry before application of shrinker.

Question 38

Gentle massage to residual limb decreases _____ | Deep friction massage perpendicular to the scar prevents ____

Answer 38

sensitivity to pressure | prevents scar adhesions

Question 39

What are the K levels for amputees

Answer 39

K0 - nonambulatory (bedbound) K1 - limited to transfers or limited household ambulator K2 - Unlimited household but limited community ambulator K3 - Unlimited community ambulator K4 - High energy activities (sports, work)

Question 40

Name the prosthesis/components allowed for the different K levels

Answer 40

K0 - no prosthesis allowed K1 - Manual lock or stance-control knee, SACH or single-axis foot K2 - Pneumatic or polycenctric knee, multi-axis foot K3/4 - hydralic knee, energy-storing foot

Question 41

Name the 3 prosthetic feet available for Syme's amputation

Answer 41

1. syme solid ankle cushion heel (SACH) 2. Syme stationary ankle flexible endoskeleton (SAFE) 3. Energy-storing carbon fiber foot (low profile)

Question 42

Components of a BKA prosthesis usually include what 4 things?

Answer 42

socket suspension shank prosthetic foot

Question 43

the standard socket for BKA is

Answer 43

total-contact patellar tendon bearing (PTB) socket characterized by bar in the anterior wall designed to apply pressure on the patellar tendon

Question 44

Trim line of PTB Anteriorly: medially/laterally Posteriorly

Answer 44

extends anteriorly to mid-patellar level may extend medially and laterally to femoral condyles, extends posteriorly to the level of the PTB bar

Question 45

In BKA Name the pressure tolerant areas in PTB socket (5) Name the pressure relief areas in PTB socket (5)

Answer 45

1. - Patella ligament - pretibial muscles (anterior compartment) - popliteal fossa (posterior compartment; gastroc-soleus muscles via gastroc depression) - Medial tibial flare - Lateral shaft of fibula 2. - Tibial crest, tubercle, and condyles - Patella - Anterior tibial tubercle - Crest of tibia - Distal end of tibia - Head of fibula and peroneal nerve - distal end of fibula - Hamstring tendons

Question 46

A PTB socket is arranged on the shank in 5 degrees of flexion. What advantages? 4

Answer 46

1. enhance loading of the patellar ligament 2. prevent genu recurvatum 3. resist tendency of the residual limb to slide down the socket 4. place quads in more efficient and mechanically advantageous position, facilitating its contraction

Question 47

a maximum of _____ degrees of flexion is possible to accommodate knee flexion contracture in PTB socket

Answer 47

25 degrees

Question 48

purpose of the liner (4)

Answer 48

1. protect fragile or insensate skin 2. reduce shear forces 3. provide more comfortable socket for tender residual limbs 4. accommodate for growth

Question 49

Lateral tilt of the socket alignment is needed for:

Answer 49

reduce pressure on the fibularhead

Question 50

liners can be made of (3) Customs are better for ____

Answer 50

1. closed-cell thermal plastic foams 2. rubber covered with leather 3. silicone gels custom gels without suspension pin have been helpful in managing shear problems that can occur with residual limbs covered in split thickness skin grafts or boney prominences

Question 51

Name the most freqently used suspension systems for BKA (6)

Answer 51

1. Supracondylar cuff suspension socket - consists of a cuff or strap that wraps circumferentially around the thigh, fitted immediately above the femoral epicondyles 2. Brim suspension - supracondylar vs supacondylar/suprapatellar which add proximal brim usually for short residual limbs or controlling recurvatum (patellar) 3. Rubber or neoprene sleeve 4. Pin suspension - used for patients with greater suspension demands such as athletes and short RL. expensive bc usually requires replacement annually 5. Suction suspension - silicone or other gel insert or liner with use of one-way expulsion valve in distal aspectof the socket. 6. Thigh corset - connects a leather thigh corset to PTB through metal joints and side bars to decrease distal residual limb weight bearing by 40-60%

Question 52

For what three reasons is neoprene sleeve suspension inadequate for BKA

Answer 52

1. decreased mediolateral knee stability 2. Very short residual limbs 3. when hyperextension control is required.

Question 53

Name the 5 types of prosthetic feet

Answer 53

1. SACH (solid ankle cushion heel) 2. Single-axis foot - PF/DF axis 3. multi-axis foot 4. Flexible keel foot 5. Energy storing/dynamic response foot

Question 54

Most common locations of boney overgrowth in peds with acquired amputation

Answer 54

1. humerus 2. fibula 3. tibia 4 femur

Question 55

5 indications for cane

Answer 55

``` improve balance decrease pain reduce weight-bearing forces on injured structures compensate for weak muscles scan the immediate environment ```

Question 56

Name the two types of wrist units

Answer 56

friction control locking

Question 57

name the two types of wrist flexion units

Answer 57

add on combination

Question 58

failure of total contact of residual limb in the distal socket wall may lead to:

Answer 58

distal residual limb choking syndrome. If untreated for a long period may then lead to verrucous hyperplasia which is wartlike skin overgrowth, usually of the residual distal limb, resulting from inadequate socket wall contact with subsequent edema formation

Question 59

in TF AKA, what occurs if a balanced myodesis is not achieved?

Answer 59

the femur may extrude through the muscle and present subcutaneously. If prosthetic adjustments, such as a flexible socket, are inadequate for extruded femur, then surgical intervention might be needed.

Question 60

Phantom pain appears to be related to neuron _____

Answer 60

deafferentiation hyperexcitability.

Question 61

In a symes amputation, gait speed is typically decreased by _____% and oxygen consumption increased _____%

Answer 61

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