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Lower Extremity III > Week 3-TransFemoral > Flashcards

Week 3-TransFemoral Flashcards

1
Q

What are the different amputation levels for transfemorals?

A

Long
Medium
Short
Very Short = Subtrochanteric

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2
Q

What are the different muscle compartments?

A

posterior
middle
anterior

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3
Q

What is part of the posterior muscle compartment?

A

Extensors of the Hip & Flexors of the Knee

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4
Q

What is part of the middle muscle compartment?

A

Adductors

Femoral Triangle

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5
Q

What is part of the anterior muscle compartment?

A

Flexors of Hip, Flexors of Knee & Extensor of Knee

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6
Q

What is part of the gluteal region?

A 
Gluteus Maximus 
Gluteus Medius 
Gluteus Minimus 
Tensor Fasciae Latae 
6 Deep Lateral Rotators
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7
Q

What are the 6 deep lateral rotators?

A

piriformis,
obtorator internus/externus,
gemellus superior/inferior,
quadratus femoris

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8
Q

What are the socket design goals?

A

Contouring for functioning muscles
Stabilize skeletal structures
Broad pressure over neuro-vascular bundles
Forces distributed over wide area

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9
Q

What are three important aspects in the design of the quadrilateral socket?

A

Four well defined walls
Rectangular in shape
Ischial-gluteal weight bearing

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10
Q

What reliefs are required for the quadrilateral socket?

A

Hamstring tendon
Gluteus maximus
Adductor longus
Rectus femoris

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11
Q

What are three aspects important for the ischial containment socket?

A

Femur held in adduction
Very intimate fit
Triangular shape

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12
Q

What are the advantages of the quadrilateral socket?

A

Well documented

Consistent procedure for fabrication

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13
Q

What are the disadvantages of the quadrilateral socket?

A

Not custom shape
Femur not held in adduction
Lack of support in medial wall

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14
Q

What are the advantages of the ischial containment socket?

A

Enhanced biomechanical stability
Increased medial wall support
Strong gluteal and hydrostatic loading
Restoration of pelvic-femoral angle

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15
Q

What are the disadvantages of the ischial containment socket?

A

Too many inconsistent designs

Requires skill to fabricate

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16
Q

What are the advantages of the ischial containment socket over the quadrilateral socket/

A

Bony lock

Counter force-In Quad socket there is distal pressure while in ischial containment it is distributed

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17
Q

What are the different types of suspension systems for transfemorals?

A 
Suction 
Silicone Sleeve 
Silesian Belt 
Hip joint & pelvic band 
Suspenders
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18
Q

How does suction suspension work?

A

Socket and interface are smaller than limb
Patient is pulled into the socket
Valve is screwed in, doesn’t let air in, only out
Positive-negative pressure pump

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19
Q

What are the indications for suction sockets?

A 
Long limbs 
Stable volume 
Good skin integrity 
Good upper limb strength 
Majority of patients
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20
Q

What are the contraindications for suction sockets?

A

Patients with volume fluctuation
Short residual limbs
Severe scarring
Upper extremity involvement

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21
Q

What are the indications for silicone suction?

A

Longer residual limbs
Stable limb volume )can add socks)
No upper limb involvement

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22
Q

What are the contraindications for silicone suction?

A

Unstable limb volume
Upper limb involvement
Skin sensitivity to material

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23
Q

What are the advantages of silicone suction?

A

Provides positive suction suspension-can add socks
Does not limit range of motion
Reduces shear forces

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24
Q

What are the disadvantages of silicone suction?

A

Difficult to don-seal can pinch and create air channel
Skin reaction to material
Rotation Control-due to cylindrical shape

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25
Q

What can a Silesian belt be made of?

A

Webbing, cotton or TES

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26
Q

What components make up a Silesian belt?

A

Belt, elastic strap, neoprene belt with leg section

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27
Q

Where does the Silesian belt attach?

A

Attached lateral and fastened anteriorly

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28
Q

What’s the difference between the true silesian and the modified silesian belt?

A

True has a double anterior attachment while the modified only has one

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29
Q

What are the indications for the silesian belt?

A 
Auxiliary suspension is required 
Rotational control needed 
When suction cant be used 
May aid in coronal control 
Patient security
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30
Q

What are the contraindications for the silesian belt?

A

When there is no need for frontal plane control (long limbs with good strength primarily)

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31
Q

What are the advantages of the silesian belt?

A

Easy to don
May add coronal stability
Adjustable

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32
Q

What are the disadvantages of the silesian belt?

A

Increased straps and buckles

Increased bulk around waist

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33
Q

What are the five aspects of the HIP JOINT & PELVIC BAND?

A 
Single axis joint at hip 
Laminated into the socket 
Pelvic band is located between the iliac crest and trochanter 
Leather belt with buckle 
Usually worn with socks
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34
Q

What are the indications for the HIP JOINT & PELVIC BAND?

A 
Maximum ML control 
Weak hip Abductors or short residuum 
Ease of donning is important, 
Previous wearers 
Easy Hip Dislocation
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35
Q

What are the contraindications for the HIP JOINT & PELVIC BAND?

A

When not needed/indicated

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36
Q

What are the advantages for the HIP JOINT & PELVIC BAND?

A

Easy to don, Good swing phase control, Increased ML stability

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37
Q

What are the disadvantages for the HIP JOINT & PELVIC BAND?

A

Extremely bulky, Inherent pistoning, Increased weight

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38
Q

What two aspects make up the suspender suspension?

A

Suspension over the shoulders

May operate knee unit

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39
Q

What are the indications for suspender suspension?

A

Last resort
Previous wearer
Need to reduce forces around pelvis
Patient with abdominal scarring

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40
Q

What are the contraindications for suspender suspension?

A

Whenever anything else will do

Really bulky

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41
Q

What are the different categories for knee systems?

A 
Outside Hinge 
Constant Friction 
Weight Activated 
Polycentric 
Manual Locking 
Microprocessor Controlled
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42
Q

What are the two most important factors of knee systems?

A

Voluntary control

Inherent stability

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43
Q

What is the order for inherent stability from least to most with the knee systems?

A 
Outside hinges 
Single Axis – Constant Friction 
Weight Activated Stance Control 
Polycentric 
Manual Locking
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44
Q

What is the order for voluntary control from least to most?

A 
Manual Locking
Polycentric
Weight Activated Stance Control
Single Axis – Constant Friction
Outside hinges
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45
Q

What is voluntary control?

A

Stability a patient can willfully control
Limb length
Limb musculature

46
Q

What is inherent stability?

A

Prosthetic Knee Type

Alignment&raquo_space; TKA Line (trochanter-knee-ankle line)

47
Q

What are the knee friction goals?

A

Primarily for swing phase
To control knee friction
Limit heel rise
Prevent terminal impact

48
Q

What are the knee friction types?

A

Mechanical Friction
Fluid Friction
Outside Friction

49
Q

What is mechanical friction

A 
Simple in design 
Adjustable 
Constant friction 
Static resistance to force 
Offers no stance phase stability
50
Q

What is fluid friction?

A 
Complex in design 
Heavier, more maintenance 
Dynamic resistance to force 
Offers some stance phase stability 
Smooth gait 
Patients with varying cadence
51
Q

What are outside hinges for knee joints?

A

Free swinging

Required back-check and extension assist

52
Q

What are the advantages of outside hinges?

A

Avoid knee length discrepancy

Durable

53
Q

What are the disadvantages of outside hinges?

A

No inherent stability-no ML stability
No inherent friction control
Poor cosmesis

54
Q

What is the K-level for single axis-constant friction knee system?

A

K 2-4

55
Q

What are the indications for single axis-constant friction knee system?

A

Single speed walkers
Pt. with good hip extensors
Heavy duty use

56
Q

What are the contraindications for single axis-constant friction knee system?

A

Highly active patients
Weak patients
When px weight is important
Variable speed walkers

57
Q

What are the advantages for single axis-constant friction knee system?

A

Durable, Inexpensive, Reliable

58
Q

What are the disadvantages for single axis-constant friction knee system?

A

Low stability, difficult to adjust

59
Q

What K-levels are required for the single axis-Hydraulic/Pneumatic Controlled knee?

A

K 3-4

60
Q

What are the indications for the single axis-Hydraulic/Pneumatic Controlled knee?

A

Active walkers (120 steps/min)
Variable cadence walkers
Pts with good strength
Pt have voluntary control

61
Q

What are the contraindications for the single axis-Hydraulic/Pneumatic Controlled knee?

A

Single speed walkers

Weak patients

62
Q

What are the advantages for the single axis-Hydraulic/Pneumatic Controlled knee?

A

Possible manual stance locking feature
Highly adjustable
Smooth extension assist and gait

63
Q

What are the disadvantages for the single axis-Hydraulic/Pneumatic Controlled knee?

A

High cost, weight and maintenance

64
Q

What are the K-levels for the Weight Activated - Stance Control?

A

K 2-3

65
Q

What are the indications for the Weight Activated - Stance Control?

A

Geriatrics
Low px weight is required
Increased knee stability

66
Q

What are the contraindications for the Weight Activated - Stance Control?

A

Pts needing heavy duty option

Variable cadence walkers

67
Q

What are the advantages for the Weight Activated - Stance Control?

A

Easily adjusted, durable, stance locking features
Low weight, cost, and maintenance
Stable because it has extension assist-adjustable tension

68
Q

What are the disadvantages for the Weight Activated - Stance Control?

A

Only allows single speed cadence

Pt. must unload to break knee

69
Q

What are the K-levels for the polycentric knee?

A

K 2-4

70
Q

What are the indications for the polycentric knee?

A

Long TF amputations

Children

71
Q

What are the contraindications for the polycentric knee?

A

Pt. needs variable cadence knee

72
Q

What are the advantages for the polycentric knee?

A

Excellent stability, adjustable stability
Cosmesis for long limbs
Possible stance control feature
Possible inherent stance locking feature
Durable

73
Q

What are the disadvantages for the polycentric knee?

A

Increased weight, cost, maintenance

May take pt. long time to master usage

74
Q

What happens at each instant of flexion?

A

There is a different center of rotation

75
Q

What K-levels are indicated for manual locking knees?

A

K 1-2

76
Q

What are the indications for the manual locking knees?

A

Max knee stability

Knee of last resort

77
Q

What are the contraindications for the manual locking knees?

A

Active patients

Community ambulators

78
Q

What are the advantages for the manual locking knees?

A

Pt. knows the knee is locked

79
Q

What are the disadvantages for the manual locking knees?

A

Difficulties sitting
Un-cosmetic gait
Increased energy expenditure

80
Q

What are different types of microprocessors?

A

Rio, C-Leg, Power Knee, X3 knee

81
Q

What are the indications for microprocessor knees?

A

Active patients, good cognitive ability

Has mastery with hydraulic or SNS knee

82
Q

What are the contraindications for microprocessor knees?

A

Weak musculature
Limited cognitive ability
Unable to vary cadence over 300 yards

83
Q

What are the advantages for microprocessor knees?

A

MPC controlled
Knee sense chance in cadence and adjusts
Hydraulic control or comparable

84
Q

What are the disadvantages for microprocessor knees?

A

Battery powered, expensive, maintenance

Not for heavy duty use

85
Q

What does SNS stand for?

A

Stance and Swing

86
Q

Where should ML stability of the pelvis during mid-stance be placed?

A

On the prosthetic side

87
Q

How can you conserve energy?

A

By minimizing excessive lateral

displacement

88
Q

When should AP stability of the pelvis of the prosthetic knee joint occur?

A

During Initial contact and Terminal stance

89
Q

For ML stability, what are the forces controlled by?

A

The hip Abductors

90
Q

What 8 things influence ML stability?

A
  1. Ischial weight bearing
  2.   Foot position
  3.   ADduction of the lateral wall of the socket
  4.   Proper contouring of the lateral wall
  5.   High medial wall
  6.   ML dimension
  7.   AP dimension
  8.   Belt/band/hip joint
91
Q

What occurs because of Ischial weight bearing?

A

Displaces the fulcrum medial, reducing the magnitude of the moment. Less force is needed to move the leg.

92
Q

What is the proper position of the foot for the quad socket?

A

0-65mm outset

93
Q

What is the proper position of the foot for the ischial containment socket?

A

25-37mm outset

94
Q

What does the proper alignment of the foot cause?

A

A Varus moment at the knee

95
Q

What does adduction of the lateral wall of the socket do?

A

Re-establishes the normal

angulation of the femur (6-7o) and Puts the hip ABductors on stretch – better mechanical advantage for the limb

96
Q

What does Proper contouring of the lateral wall do?

A

Allows for even distribution of forces over the lateral aspect
of the residual limb

97
Q

What does a High medial wall do?

A 
applies the counter pressure to maintain good contact between the femur and the lateral wall of the socket
Counter pressure to lateral wall 
Distributive pressure system 
Restrict ML movement 
Take pressure on ischium 
Sub-ischial triangle
98
Q

What does an improper ML dimension do?

A

Too large an ML will reduce the effectiveness of the lateral and medial walls to stabilize the femur

99
Q

How do you measure the skeletal ML?

A

At the angle of the Ramus-ramus to trochanter

100
Q

What does proper AP dimension do?

A

Keeps ischium on the seat

101
Q

What does an too large AP dimension do?

A

IT is displaced anteriorly
Painful ramal contact
Gait deviations
•  antalgic gait, lateral trunk bending, abducted gait

102
Q

What is anther name for skeletal AP?

A

Antero-Lateral Measurement

103
Q

When should a silesian belt or hip joint be use?

A

When hip ABductors are weak
When working with someone that has a short residual limb
High walls are not enough, they gap away and loose
stability
Maximum stability is achieved through a hip joint and pelvic
band

104
Q

How can you conserve energy?

A

By minimizing excessive lateral
displacement
Narrow base of support

105
Q

When should you compromise energy consumption?

A

For comfort

106
Q

What are the Compensatory Motions for finding comfort?

A

Lateral Trunk Bending

ABducted Gait

107
Q

How can you make sure that the GRF remain anterior to the knee through IC to TS?

A 
Knee alignment 
Foot alignment and selection 
Component selection 
Voluntary control (hip extensor power output)
108
Q

What happens with a too soft heel durometer?

A

Will reach foot flat too quickly

Moving the GRF force ahead too quickly

109
Q

What happens with a too hard heel durometer?

A

May cause instability at the knee joint

May cause lateral rotation

110
Q

When is a softer heel durometer desired?

A

High amputation patients because it allows them to reach foot flat.

111
Q

Why is the keel needed?

A

Anterior support

112
Q

What happens when the keel is too stiff?

A

a sideward gait

Lower Extremity III (9 decks)

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