Rehab after amputation

Question 1

what are the chances of amputation after an ulcer in pts w DM?

Answer 1

25% chance of amputation

Question 2

if a child with PFFD is born with longitudinal fibular absence, what kind of surgical conversion is performed?

Answer 2

Syme’s (ankle disarticulation)

Question 3

when is independent gait expected for children with PFFD?

Answer 3

15-22 mos

Question 4

what amputation has the poorest healing rate?

Answer 4

partial foot (44-70%)

Question 5

what factor, in addition to having a dx of DM, greatly increases a patient’s chance of amputation?

Answer 5

losing DF because incr P on met heads

Question 6

where do you tend to see callouses in pts with DM?

Answer 6

2nd/3rd met

Question 7

tissue is deemed “viable” if the ABI is..

Answer 7

> 0.9

Question 8

what length of a TTA makes it SIGNIFICANTLY weaker?

Answer 8

<15.1 cm

Question 9

the anterior incision line of an amputation should appear..

Answer 9

about 1 cm above bone end

Question 10

which LE amputation has the highest rate of post-op mortality?

Answer 10

TFA (13.3%)

Question 11

what type of dressing has the SLOWEST healing rate?

Answer 11

soft dressing; also gives INCONSISTENT P

Question 12

if a pt has DM, what type of dressing is recommended?

Answer 12

semi-rigid (NOT RIGID – incr risk of infection

Question 13

rigid dressings work particularly well with what type of amputations?

Answer 13

TFA (less bony prominences)

Question 14

3 contraindications for using rigid dressing + IPOP

Answer 14

vascular disease, decr sensation, risk of infection ;

Question 15

What dressings can you use a temporary prosthesis with?

Answer 15

rigid (IPOP) and Semi-Rigid

Question 16

when can you put on a shrinker?

Answer 16

staples are removed, NOT if a large amt of edema present;

Question 17

what can you do in an ACUTE CARE setting to prevent WBing of a wound?

Answer 17

DIY rocker bottom & avoid stand-pivot

Question 18

trans-metatarsal amputees are at risk of — contractures

Answer 18

PFers

Question 19

what are some examples of therex to use NOT IN ACUTE

Answer 19

CKC stump exercises: bridge on bolster, hip abd/add/hit ext; balance tx, arm bike, swimming, CKC PNF, other quadruped activities

Question 20

IMMEDIATE post-op strengthening:

Answer 20

isometrics : glutes, quads, hamstrings;
AROM
UE exercises

Question 21

when should you debride/mobilize a scar?

Answer 21

incision line ADHERENT scab & scar

Question 22

if pt has EDEMA & PAIN, PoC is..

Answer 22

wear shrinker (ONLY if no staples!), limb dressing (SRD), or socket (during pre-prosthetic tx)

Question 23

how much is energy expenditure increased during prosthetic gait?

Answer 23

about 4/3 as much energy to walk 2/3 as fast

Question 24

CRITERIA for prosthetic fitting:

Answer 24

incision sufficiently healed: 
-adherent scab
-min serosanguinous drainage
stable girth: 
- conical (preferred) or cylindrical
-NOT BULBOUS
ambulatory on sound limb (or I in xfers if B)