Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

פרםתיסיס > מבחן ריאשון > Flashcards

מבחן ריאשון Flashcards

1
Q

LE Amputations

• Statistics

A

o 2 million people in US with some type of amputation (UE/LE, digit, toes)
o 185,000 amputations per year in US (could be traumatic or surgical)
o vascular amputees – survival rate is compromised
• 50% don’t survive beyond 5 years post amputation
• patients that on dialysis, cardiac history, multiple system failures
• a lot of them are likely to become bilateral amputees within a 5 year period – 55% within 2 years
• why patient education is so important in inspected that intact leg
• decreased ability to hop because of vascularity to intact leg
• lot of them in w/c
• work on functional distances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

• Vascular Disease (diabetes and PAOD

A

1 cause

Could be diabetes, but the ones that don’t have peripheral arterial occlusive disease

PAOD
• Ex: affecting lower extremity, have chronic wounds
• May try and do bypasses to establish blood flow
• angioplasty to open up occluded blood vessels
• pharmacological agents
• if these treatments don’t work and patient has a low

ABI, chances for healing are not good) – they end up doing an amputation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Cause of Amputation

A
  • Vascular Disease (diabetes and PAOD
  • Infections
  • Trauma
  • Cancer
  • Congenital
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Trauma Amputations

A

o war vets
o bombings
o MVA - #1 traumatic event that leads to amputations
o Industrial accidents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Congenital: Amputations

A

o people that are born with malformed or missing limbs

o years ago – women taken medications before pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Toe amputation

A
  • Distal, proximal phalange
  • Metatarsal head is intact
  • Can determine if it is a vascular issue based on wound – callus wound

• Will not give them a LE prosthetic device but they will put a filler in the shoe to take up space of phalanges that have been removed
o Prevents other toes from drifting
o Good orthopedic shoe + filler

• Most critical toe to amputate – big toe
o Affects push off
o Benefit from rocker bottom shoes

• Causes
o Frost bite
o Vascular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What toes amputated

A
  • Distal, proximal phalange

* Metatarsal head is intact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What to give for toe amputated

A

• Will not give them a LE prosthetic device but they will put a filler in the shoe to take up space of phalanges that have been removed
o Prevents other toes from drifting
o Good orthopedic shoe + filler

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Most Critical Toe amputation

A

• Most critical toe to amputate – big toe
o Affects push off
o Benefit from rocker bottom shoes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Causes toe ampuation

A

• Causes
o Frost bite
o Vascular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Trans metatarsal Amputation

  • -what is it
  • -what do we need to be careful about maintaining
A

1) Amputate proximal to metatarsal heads

Also called a “partial foot amputation”

2) Be careful to maintain dorsiflexion
3) Tendons – surgically attach it to remaining bone or muscle

***Would get a special shoe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Shoe for Trans metatarsal Amputation

A

1) Rocker bottom
They have lost MTP joints which allow us to get good push off
Moves the fulcrum proximal on the shaft
Good for RA
2) More involved shoe than someone with a toe amputation
Filler in shoe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Trans metatarsal Amputation: Who heals better? Who doesnt?

A

1) People that have traumatic trans metatarsal amputations do okay

2) Vascular people tend to go back for revisions
o Don’t heal as well
o Depends on individual whether they want to just start with BKA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What surgery done for trans metatarsal amputation?

A

2 techniques
1) Myodesis: Suture muscle/tendon to bone

2) Myoplasty: Suture it to other soft tissue (another muscle belly)
o Sometimes they just let it retract if it is not a critical muscle or tendon

As we go further up leg with amputation – typically do some sort of myodesis where thLisfranc Amputationey attach the anterior tib to a part of the limb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Lisfranc Amputation

  1. what is it

what is preserved

  1. what do we give them
A

1) Between metatarsal shafts and the distal tarsals

Keep cuneiforms, cuboid but metatarsals and everything distal is amputated

“partial foot amputation” – but specific to location of metatarsal shaft

2) special shoe with a filler, rocker bottom, and cushion heel for some shock absorption

cushion heel – compress it, allows the rest of the foot to plantarflex

ex: lost part of insertion on anterior tib and don’t have eccentric control, compress heel and allows rest of foot to go down in a controlled fashion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Chopart

  1. what is it
  2. what do they lose, what surgery?
  3. what do we give them
A

1) Keep the talus and calcaneus but everything distal is removed (cuneiforms, navicular)
• Partial foot amputation

2) Lost insertion on metatarsal but also anterior tib on medial cuneiform
o Lost insertions of fib brevis
o Lose a lot of extrinsic and intrinsic attachments
o Surgically reattach tendons to stabilize and fix muscles

3) `Cushion in shoe for shock absorption, shoe filler, rocker bottom shoe

17
Q

chopart and lisfranc: what are they susceptible to?

A

A lot of these patients (chopart and lisfranc) are very susceptible to plantarflexor contraction (muscle imbalance due to loss of attachments of muscles)
o Inform patient families to do ROM

18
Q

Syme’s Amputation

What surgery

what device

A

1) Another name “ankle disarticulation”

Take out talus and calcaneus, preserve heel pad, wrap the heel pad around distally and suture it anteriorly

2) Use a prosthetic device – foot
–Most common is the SACH Foot
• Solid ankle cushioned heel

  • Simple, inexpensive
  • Cushioned heel allows for nice plantarflexion
  • Has a shell, bivalved (Can take it apart in two pieces, Velcro closed, Do this because you tend to have bulbous shape in the residual limb)
  • Patella tendon shelf (Look inside, a little indentation that goes into the socket, Puts some of the weight bearing forces on the patella tendon so not all weight is going down into the bulbous limb)
19
Q

Boyd’s Amputation

A

Same as Syme’s but they maintain calcaneus

20
Q

Transtibial (TT) Amputation

A
  • BKA
  • Keep a long posterior flap (gastroc, and soft posterior tissue) and wrap it around anteriorly: A lot of the time, you will see the suture line distally and anteriorly
  • Keep the fibula – normally cut it shorter than tibia
  • Never do a transtibial amputation in the lower quarter of the leg
  • –Because there is not a lot of soft tissue distally and a lot of time have a problem with skin breakdown due to prosthesis
  • –Want it as long as possible but in this case, cannot make it super long

• A lot of patients will be BK’s

  • –About 96% will be BK or AK
  • –Probably about 65% of them being BK

• Very important to maintain knee extension, very susceptible to flexion contractures
—Have the board under their leg in W/C

21
Q

Knee disarticulation

A
  • Not common, see more in children
  • Take tib and fib, sometimes they leave patella, sometimes not

• More challenging for prosthetic fitting
—Symmetry between anatomical and prosthetic knee is hard to achieve

• Spasticity and susceptible to knee flexion contracture, do this instead of BKA
—Or someone with non-functional knee

  • Rationale for children as opposed to adults – don’t want to amputate near growth regions of bone, growth tends to be more normal with this
  • Not common for vascular amputees
22
Q

Transfemoral

A
  • No rules, can go as long as you want but do not want it to be shorter than the lesser trochanter (then you don’t have a functional lever to control device)
  • A lot less issues with skin breakdowns

• Longer lever – good for sitting and pressure distribution
—The longer the residual limb, the more control you have over prosthetic device

• Don’t see suture line as much

• Opposite of BKA – do a longer anterior flap and wrap it posteriorly, see suture line at the bottom of the residual limb
—Myoplasty and myodesis techniques

23
Q

Hip Disarticulation

A
  • Could be traumatic, cancer, severe osteomyelitis,
  • Remove femoral head from acetabulum
  • Person puts a lot of weight bearing on soft tissue
  • Wont get a prosthetic device right away
  • Has to do pelvic tilting to control the prosthetic device
  • A lot do hip hiking but it is not as energy efficient – train them to do pelvic tilting to control device
  • A lot of weight bearing on ischial tuberosity and overlying gluteal tissue
24
Q

Hemipelvectomy

A
  • Disarticulated from SI joint and symphysis pubis (removing half of pelvis)
  • Device very similarly but don’t have ischial tuberosity
  • Weight bearing on residual limb side will be inside the socket
  • Pelvic tilting and trunk movements to control prosthesis
25
Q

Hemicorporectomy

A 
•	Survival rate is not good
•	Amputate between L4 and L5
•	Have to reroute GI, urinary tract
---Ilieostomy (from small intestine)
[Colonoscopy is from the large intestine]
o	Urostomy – redirect urethra so you have an external device
Remove all external genitalia 
Pelvis is gone

• Devices

  • –Prothetic buckets
  • –Cold put buckets in wheelchair and attach prosthesis – not functional, cosmetic
  • A lot of family education, not a lot of prosthetic training
  • UE important for functional push ups
  • Vital signs will be different, not as much body
  • Hormonal supplements – lose hormones because of genital removal
26
Q

Surgical Amputation

Goal

A

o Remove all non-viable, diseased, infected, traumatized tissue and to maintained as much healthy viable tissue as possible
o Only exception is BK
o Want to maximize sensory intactness, motor capabilities
o Less amputation is better

27
Q

Surgical Amputation

Length

A

o If you’re a BK – measure the intact leg from the medial tibial plateau to the medial malleoli (distal), compare measurement to medial tibial plateau and distal end of residual limb

  • Take this value on amputated side and divide it by measurement on residual side and divide it to get percentage
  • 50% of intact leg
  • less than 40% is considered a short residual limb
  • between 40-60% medium percentage
  • greater than 60% - longer residual limb
  • wouldn’t wan to see greater than 75% in BK
  • Do it part of evaluation just for your information
  • May have an impact on prosthetic device – short person may need more suspension
  • Or AK with short residual limb, may need a locked knee unit

o Length has impact on prosthesis and prosthetic training

28
Q

• Surgical gap

A

o AK

o BK – long posterior flap that is brought around anteriorly

29
Q

Bone shaving / bv ligation / nerve retraction

A

•
o Shave any sharp edges on bone
o BK – fib shorter than tib
o Individually cortorize and ligate any blood vessels (bleeding)
o Nerves – imbed them back into soft tissue, don’t want any lose nerve endings or get them caught up into scar tissue

30
Q

Myodesis / myoplasty

A

•
o Usually myodesis better at keeping muscle at its normal resting length and being able to put more pressure on it?
o Think about muscles action on more proximal joints
o Suspension – not allowing them to just retract away from insertions

פרםתיסיס (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions