Prosthetics overview Flashcards
What causes most amputations in the US?
disease causes 82%
- peripheral vascular disease
- diabetes
- infections
T/F: Over half of diabetics with LE amputations will require amputation of the second leg within 2-3 years.
True :(
55% require amputation of the second leg
What race is up to 4 times more likely to have an amputation than white americans?
African americans
Causes of peripheral vascular disease (PVD) include…
arteriosclerosis (occlusive artery disease) embolism thrombosis trauma infection
Insufficient blood flow d/t decreased arterial diameter is known as…
intermittent claudication
This disease causes 82% of disease related amputations
PVD
Decreased return of venous blood from the legs to the trunk is known as…
chronic venous insufficiency
Signs of chronic venous insufficiency
Edema, dilated veins and stasis ulcers, dermatitis.
“weepy wounds,” ulcers above the maleoli
Early signs of chronic venous insufficiency (CVI) include
varicose veins -> swollen leg -> purplish reddish staining of the skin -> ulcers
Half of PVD amputations are due to this disease
diabetes
When a patient comes to you with an amputation and diabetes, ask them about these comorbidities…
renal failure (ask about urination)
cardiac disease
stroke
retinopathy (ask how their vision is)
Signs of diabetic neuropathy
decreased temp in feet
stocking glove sensory loss
decreased DTRs
dry scaly skin d/t decreased circulation
skin breakdown
intrinsic weakness, structural changes in the foot (Charcot)
This type of bone tumor is found in males 10-25, often in the metaphysis of long bones
osteosarcoma
This type of bone tumor is found in 5-30 year old males, the bone cortex erodes and a mass is produced
Ewing’s sarcoma
This congenital birth defect has
no distal structure
transverse
This congenital birth defect has
total or partial absence with normal skeletal structure beyond
longitudinal
This congenital birth defect is an
absence of the whole limb
amelia
This congenital birth defect is an
absence of hand or foot
apodia
This congenital birth defect is an
absence of limb segment, flipper limb
phocomelia
What is the goal of surgical amputations?
preserve as much of the functional healthy limb as possible
What is a neuroma?
painful collection of nerve axons near the skin, can be palpated and is very sensitive!
Amputation procedures:
Attachment of muscle to muscle
myoplasty
Amputation procedures:
attachment of muscle to fascia
myofascial flap
Amputation procedures:
attachment of muscle to periosteal bone
myodesis
T/F: a typical transtibial amputation includes myoplasty, myofascial flap, AND myodesis
True. Typical amputation includes all 3.
What type of flap is preferred on a transtibial amputation?
long posterior flap, provides a good weight bearing surface
In severe dysvascular situations, medial and lateral tissue is used to create this type of flap
skew flap
What type of flap is used when conserving bone length or vascular issues is not a concern?
equal length flap
What is the ideal shape of a residual limb?
cylindrical
Where is the transfemoral amputation ideally performed?
4” or 10 cm above anatomical end of knee
An autograft from the proximal tibia or iliac crest which creates a BRIDGE between distal tibia and fibula is called…
ERTL procedure
What is the goal of an ERTL procedure?
prevents separation of fibula from tibia
permits greater end bearing
What is the advantage of a rotationplasty?
- preserves the ankle joint to act as a knee joint
- provides a longer lever for prosthetic control vs a very short AKA
What are advantages of osseointegration?
Lighter
No socket
greater motion
more precise control
What are disadvantages to osseointegration?
2 surgeries
high risk of infection
What is osseointegration?
- More prevalent in Europe
- direct skeletal attachment of prosthetic limb
What are some problems with short transfemoral amputations?
more skin breakdown
hard to get enough hip extension since there’s less leverage
Levels of amputation::
hemipelvectomy
loss of Ilium, ischium or pubis
Levels of amputation:: hip disarticulation
loss of entire femur
Levels of amputation: Transfemoral classifications
short <35 % of femur
medium 35-60%
long >60%
Levels of amputation::
supracondylar
patella left for better end bearing
may delay healing
Would you recommend a knee disarticulation to an adult patient?
No! Results in abnormal gait, difficulty with swing phase.
Why would a knee disarticulation be performed?
To maintain femoral length in growing children
Levels of amputation::
Transtibial classifications
very short <20% tibial length present
standard 20-50%
long >50%
What level of transtibial amputation is typically best?
Standard!
if very short, short lever arm and knee ext difficult
if long there may not be adequate circulation
What is a syme amputation?
ankle disarticulation
tibia and fibula shaved, and a thin layer of the calcaneus is fixed to the distal tibia
Advantages of a syme amputation
long lever arm
ability to ambulate without a prosthesis
Disadvantages of a syme amputation
neuroma of posterior tibial nerve
poor cosmesis
unstable heel flap
What is a Lisfranc disarticulation?
- disarticulation of all five metatarsals and digits
- performed at tarsometatarsal joint
What is a Chopart disarticulation?
- through the midtarsal joint, leaves the calcaneus and talus
- performed at the talonavicular and calcaneocuboid joints
Why are Chopart and Lisfranc disarticulations not performed as often today?
They lead to equinovarus deformity
and skin breakdown! Important to stress dorsiflexion stretching to avoid equinovarus.
What orthotics might someone use if part of their foot is amputated?
- a shoe filler to hold hindfoot in the shoe
- a rocker bottom
What foot amputation has a 30% failure rate?
transmetatarsal
d/t loss of weightbearing area and decreased ability to plantarflex well
