PVD, Tumors, and Trauma

Question 1

What are the main causes of amputation?

Answer 1

• Vascular disease (54%),
• Trauma (45%)
• Tumors (less than 2%)

Question 2

What are common etiologies of vascular disease leading to amputation?

Answer 2

• Diabetes
• peripheral arterial disease (conditions under the umbrella of PVD)

Question 3

How is PVD organized based on pathology?

Answer 3

PVD is organized into…

• arterial occlusive
• inflammatory
• vasomotor
• venous disorders

Question 4

PVD

What are the common arterial and venous symptoms associated with PVD?

Answer 4

Arterial:

• Sharp pain, diminished pulses, cool skin, dry and shiny skin, hairless areas, and trophic changes.

Venous:

• Aching, heavy legs, swelling, varicose veins, hemosiderin deposits, fibrosis

Question 5

How can you differentiate arterial vs. venous wounds?

Answer 5

• Arterial wounds are dry, pale, painful, and often distal
• Venous wounds are often on the lower leg, have drainage, granulation, and hyperpigmentation.

Question 6

What subjective clues indicate arterial vs. venous disease during evaluation?

Answer 6

• Arterial: Cramping with walking, rest pain relieved by dependency, hairless skin, and cool extremities.
• Venous: Aching, heavy legs relieved by elevation, and swelling.

Question 7

What is chronic venous insufficiency (CVI) and what are the symptoms?

Answer 7

• Chronic Venous Insufficiency (CVI) is a condition where damaged valves in veins cause venous hypertension, reverse blood flow, and chronic edema.
• Symptoms = Dilated veins, leg pain, edema, and stasis dermatitis.

Question 8

What causes CVI?

Answer 8

Venous occlusion, valvular defects, and problems with the muscle pump.

Question 9

What is peripheral neuropathy?

Answer 9

Degeneration of peripheral nerves, affecting sensory, motor, or autonomic functions.

Question 10

What are the main pediatric bone tumors types?

Answer 10

• Osteosarcoma (56%)
• Ewing’s sarcoma (34%)
• Chondrosarcoma (6%)

Question 11

What are the common symptoms of osteosarcoma and Ewing’s sarcoma?

Answer 11

Osteosarcoma:

• Sharp or dull pain, swelling, redness, limping, and decreased movement of the affected limb.

Ewing’s sarcoma”

• Pain, swelling, fever, weight loss, fatigue, and neurological symptoms if spinal involvement.

Question 12

Where are osteosarcomas typically located?

Answer 12

Lower end of femur, upper end of tibia, upper end of humerus, and upper end of femur.

Question 13

What is the radiographic appearance of osteosarcoma?

Answer 13

Sun-burst appearance, periosteal lifting, permeative bone destruction, and osteolysis.

Question 14

Where is Ewing’s sarcoma most commonly found?

Answer 14

• femur (45%)
• pelvis (20%)
• upper limb (13%)
• spine/ribs (13%)

Question 15

What are the radiological features of Ewing’s sarcoma?

Answer 15

Permeative bone destruction, laminated periosteal reaction, sclerosis, Codman triangles, and bone expansion.

Question 16

What are the four key questions in deciding limb salvage vs. amputation?

Answer 16

• Will survival be the same?
• Will morbidities be the same?
• Will function improve?
• Will quality of life improve?

Question 17

How does survival compare between limb salvage and amputation?

Answer 17

Survival rates are generally similar between limb salvage and amputation.

Question 18

How do morbidities differ between limb salvage and amputation?

Answer 18

Limb salvage tends to have more immediate and late morbidities compared to amputation.

Question 19

Is function improved more by limb salvage or amputation?

Answer 19

Limb salvage has a tendency toward improved function, but not overwhelmingly.

Question 20

How does limb salvage impact quality of life (QOL)?

Answer 20

Limb salvage has not been proven to offer significantly better psychosocial outcomes than amputation.

Question 21

What are the key symptoms of peripheral neuropathy?

Answer 21

Numbness, tingling, weakness, loss of sensation, and autonomic changes.

Question 22

What is the role of the muscle pump in venous return?

Answer 22

The muscle pump helps propel blood back to the heart, reducing venous hypertension.

Question 23

What is intermittent claudication?

Answer 23

Cramping pain in the legs due to reduced blood flow, typically triggered by exercise.

Question 24

What is rest pain in arterial disease?

Answer 24

Pain that occurs at rest, typically relieved by leg dependency, indicating advanced arterial disease.

Question 25

What are trophic skin changes?

Answer 25

Loss of hair, dry skin, and thickened nails due to inadequate arterial blood flow.

Question 26

What skin changes are seen in venous disease?

Answer 26

Hyperpigmentation, hemosiderin deposits, thickened skin, and possible stasis ulcers.

Question 27

How does trauma lead to amputation?

Answer 27

Severe tissue damage, often due to accidents, frostbite, or crush injuries, may require amputation to preserve life.

Question 28

What is the difference between arterial occlusive and venous disease?

Answer 28

Arterial occlusive disease is marked by sharp pain and diminished pulses, while venous disease is associated with aching pain, edema, and present pulses.

Question 29

Why are pulses absent in arterial disease but present in venous disease?

Answer 29

Arterial disease reduces blood flow due to blockages, while venous disease maintains arterial flow but affects venous return.

Question 30

What factors increase the risk of amputation in PVD?

Answer 30

Advanced age, diabetes, smoking, hypertension, and prolonged ischemia.

Question 31

What is stasis dermatitis?

Answer 31

Inflammation of the skin caused by chronic venous insufficiency, leading to itching, redness, and thickened skin.

Question 32

What are the most common sites for venous ulcers?

Answer 32

The medial malleolus and lower leg.

Question 33

What are the most common sites for arterial ulcers?

Answer 33

The toes, feet, and areas distal to the ankle.

Question 34

What is the prognosis for pediatric osteosarcoma with treatment?

Answer 34

Generally good if diagnosed early, with limb salvage being possible in many cases.

Question 35

How does Ewing’s sarcoma differ from osteosarcoma in symptoms?

Answer 35

Ewing’s often presents with systemic symptoms like fever and weight loss, while osteosarcoma primarily causes localized pain and swelling.

Question 36

How does limb salvage impact long-term functional outcomes?

Answer 36

It tends to preserve more function compared to amputation, but with potential complications like infection and mechanical failure.

Question 37

What are potential complications of limb salvage surgery?

Answer 37

Infection, prosthetic failure, mechanical issues, and need for further surgeries.

Question 38

Why might limb salvage not improve quality of life?

Answer 38

Due to prolonged rehabilitation, potential complications, and similar survival outcomes compared to amputation.

Question 39

What is the role of radiography in diagnosing bone tumors?

Answer 39

Radiography helps identify tumor type, location, and features like periosteal reactions and bone destruction.