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Prosthetics > AK Prosthetics > Flashcards

AK Prosthetics Flashcards

1
Q

Severing the adductor magnus attachment results in what % loss of adductor strength

A

70%

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2
Q

More time is spent on which side during TF gait

A

Sound side

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3
Q

How does walking speed in TF compare to TT

A

TF < half speed of TT

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4
Q

AMP Pro correlates with what

A

K level

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5
Q

Most common cause of TF amputation

A

Vascular

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6
Q

Benefits of a longer limb

A

Better control, suspension, and less gait deviations/energy

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7
Q

Benefits of KD

A

Longer lever arm
Self suspending
Adductor magnus preserved
Limited distal WB
No need for IC
Less EE (between TT and TF)

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8
Q

Disadvantages of KD

A

Cosmesis - bulbous end, knee centers don’t match
Limited component options

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9
Q

Candidates for KD

A

Active individuals w/o cosmetic concerns
Pediatrics

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10
Q

Benefits of KD vs TF in pediatrics

A

Reduces issues with bony overgrowth
Preserves length and growth plates
(Growth plates can be fused yo allow TF length with KD function)

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11
Q

Which muscle groups are severed in TF amputation? Which are rarely impacted?

A

Severed: quads, hamstrings, adductors

Hip flexors and abductors are more proximal

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12
Q

Which muscles stabilize the pelvis in SLS

A

Hip abductors (gluteus medius and minimus)

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13
Q

Common gait pattern in TF gait

A

Reverse trendelenburg (lateral lean) moves the COM over BoS so abductors don’t have to work as hard

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14
Q

What surgical technique can help stabilize the femur

A

Myodesis - adductors are attached laterally through femur

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15
Q

Benefits and indications for OI

A

Eliminates socket
For patients w/persistent socket and/or skin issues

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16
Q

Van Nes Rotationplasty common etiology

A

Osteosarcoma of the femur

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17
Q

Describe van nes rotationplasty, pros, cons

A

Foot and ankle rotated 180 deg so Ankle PF=knee Extension

Pro - functional
Con - cosmesis, can derotate

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18
Q

Two considerations in pediatric amputation

A

Preserve as much length as possible
Preserve growth plates to avoid bony overgrowth

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19
Q

Goals after TF amputation

A

Prevent contractures (hip flex and abd)
Reduce pain, edema, bulbous DE
Promote strength, balance, control
Prepare for prosthesis (desensitize and improve bed mobility)

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20
Q

Strategies to prevent contracture after TF amputation

A

No pillow under leg
Lie prone (if not overweight)
Extend limb off edge of bed
No pillow between legs

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21
Q

Issues w/shrinkers

A

Suspension due to shape
Lots of soft tissue
Encompass hip joint
Toileting/hygiene

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22
Q

What suspension options are available for an IPOP

A

Suspenders or belt

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23
Q

What motion provides voluntary prosthetic knee stability

A

Hip extension (effectiveness depends on surgical technique)

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24
Q

Boundaries of femoral / Scarpa’s triangle

A

Inguinal ligament, sartorius, adductor longus tendon

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25
Q

Which muscle group stabilizes the femur in the coronal plane

A

Hip Adductors

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26
Q

Many adductors attach to which bony landmark

A

Pubic ramus

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27
Q

Types of foam covers for AK

A

Continuous and discontinuous (gap at knee)

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28
Q

Drawback of continuous foam cover

A

Wrinkles behind knee and stretches on front of knee

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29
Q

Limitations of foam covers

A

Resistance to knee flexion
Tears, compression/degradation
Visual gaps
Hygiene
Skin can increase cost and is prone to punctures

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30
Q

Socket size relative to limb for skin fit suspension

A

Socket slightly smaller than limb so soft tissue compressed against socket for an air tight seal

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31
Q

Donning skin fit socket

A

One way air valve prevents air-in, can be release for doffing

Use pull sock, ace wrap, or quick dry lubricant (wet fit) for donning

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32
Q

Skin fit pros/cons

A

Least amount of pistoning, better proprioception, feels lighter, no straps or belts required

Difficult to don, hot, requires consisten RL volume

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33
Q

Skin fit indications

A

Stable RL volume
Long RL w/good skin
Good UL function

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34
Q

Types of suction suspension

A

Skin fit
Seal-in liner

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35
Q

Liner suspension indications

A

Most patients
Easier to don than skin fit

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36
Q

Skin reactions most common cause

A

Hygiene

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37
Q

Potential cause of discomfort w/liner

A

Skin traction distally

38
Q

Pros/cons liner

A

Effective, easy to don, reduces shear, can accommodate volume changes

Less rotational control (lanyard can help), added bulk/weight/cost/length

39
Q

Types of liner suspension

A

Lanyard
Pin lock
Seal-in

40
Q

Types of strap suspension

A

Silesian belt / TES belt
Shoulder suspenders

41
Q

Silesian belt / TES pros/cons

A

Common auxiliary suspension, additional rotational control, may improve adduction

Increases donning time, encircles waist (toileting inconvenience, etc)

42
Q

Shoulder suspenders indications

A

Previously satisfied user, nothing else will work (eg. Need to reduce forces around pelvis or severe abdominal scarring)

Shoulder elevation can extend prosthetic knee

Cumbersome

43
Q

Type of hip joint used for suspension

A

Single axis, laminated into socket and attaches to pelvic band

44
Q

Location of pelvic band

A

1/2 way between trochanter and iliac crest

45
Q

Typical interface used with hip joint and pelvic band

A

Sock fit

46
Q

Hip joint and pelvic band indications

A

Max ML stability required (weak abductors, extremely short RL), previously satisfied user

47
Q

Hip joint and pelvic band cons

A

Bulky, heavy, restricts abd/add (sit to stand, exiting car), pistoning in swing

48
Q

What is the effect of total contact

A

Reduces distal end edema which can progress to verrucous hyperplasia and cancer if untreated

49
Q

What is the effect of not fully accommodating hip extension ROM (flexion contracture)

A

Short step on sound side due to prosthetic side not being able to extend hip further in terminal stance

Can also create knee instability or postural changes (excessive lordosis, forward lean)

50
Q

Trim lines of TF socket tend to be higher on which walls

A

Anterior and lateral tend to be higher

51
Q

Types of TF sockets

A

Quadrilateral
Ischial containment
Sub-ischial

52
Q

Shape of quad socket

A

Rectangular with 4 defined walls
Narrow AP

53
Q

Where is the ischium located in quad socket

A

IT sits on top of posterior shelf/brim

~1” from medial wall

54
Q

Shape of IC socket

A

Triangular cross section
Narrow ML

55
Q

Shape of sub-ischial socket

A

Round, ischium does not contact brim

Typically elevated vacuum

56
Q

Sub-ischial socket pros/cons

A

Comfort, hip ROM

May not contain tissue, provide ML stability, or accommodate volume changes

57
Q

Quad socket limitations

A

Excessive brim pressures
Limited ML stability

58
Q

If quads are not accommodated in socket, what will happen when they activate

A

Muscle activation will cause socket rotation if channel is too shallow or not acommodated

59
Q

Orientation of medial wall in quad socket

A

In LOP

60
Q

Posterior brim in quad socket is oriented in what relation to the ground

A

Parallel

61
Q

Quad socket indications

A

Long, firm RL with firm adductor musculature
Previous satisfied users

62
Q

What happens if medial soft tissue is not contained

A

Adductor roll

63
Q

Consideration for the height of the anterior wall

A

Follow inguinal crease, should not impede hip flexion

Avoid pinching or pubic impingement when arising from chair

Shorter limbs will require higher trim line

64
Q

What helps maintain IT location in socket (IT counterforce)

A

Anterior wall pressure (scarpa’s)

65
Q

Excessive pressure in Scarpa’s triangle may cause what

A

Numbness from excessive pressure on nerve bundle

66
Q

Orientation of lateral wall in quad socket

A

In LOP, flat

67
Q

Function of lateral wall in socket

A

Stabilize femur in coronal plane

68
Q

Potential gait causes of pain at distal lateral femur

A

Abducted gait
Trunk lean

69
Q

Burning of hamstrings while seated may be due to what

A

Undercut of posterior wall, radius too tight, posterior shelf too wide

70
Q

IC socket axial support accomplished via 3 methods

A

Ischial support
Gluteal support
Hydrostatic support

71
Q

Inadequate IT support may result in

A

Ramus pressure, discomfort (slide too far into socket)

72
Q

What type of support is key for shorter RL: ischial, gluteal, or hydrostatic

A

Gluteal - short limbs lack surface area for loading and hydrostatic pressure

More proximal or more aggressive shelf = more gluteal loading

73
Q

How is hydrostatic support achieved

A

Volume reduction of socket relative to limb

74
Q

Primary vertical WB in quad vs IC

A

Quad: ischial shelf

IC: combination of ischial, gluteal, and hydrostatic support

75
Q

Boundaries of sub ischial triangle

A

Inferior pubic ramus
Semitendinosus
Gracilis

76
Q

Relief in anteromedial corner of socket is for

A

Adductor longus tendon

77
Q

Adductor longus attaches to what

A

Pubis

78
Q

IT counterforce in IC socket

A

Contour and compression of rectus femoral in anterior wall

Scarpa’s pressure

79
Q

Rectus channel can help control/prevent what

A

Rotation by allowing room for functioning muscles

80
Q

Orientation of medial wall in IC socket

A

Internally rotated relative to the LOP

81
Q

What function does the internal rotation of the medial wall serve

A

Precompresses the adductors to facilitate early stance phase loading and prevents lateral shifting of socket

82
Q

Sub ischial triangle compresses what

A

Adductor musculature

83
Q

Potential causes of adductor roll

A

Tight socket or inadequate flaring
Tissue not contained

84
Q

Feature of medial brim relieves what

A

Ramus relief

IT is inside socket and pubis is outside socket, the ramus connects the two

85
Q

Orientation of lateral wall in IC socket

A

Externally rotated relative to LOP

86
Q

What function does external rotation of the lateral wall serve

A

Applies pressure to the femur in stance for ML and femur stability (help keep in adduction)

87
Q

Inward angulation of socket proximal to trochanter is called

What is the function

A

Cupping
Reduces gapping in midstance

88
Q

Is quad socket considered ischial containment

A

No, ischium is not contained within socket

89
Q

Ischial containment can assist with what type of stability

A

ML stability

90
Q

Purpose of aligning socket in flexion

A

Allows for even step length on sound side

Puts hip extensors on stretch and therefore at a functional advantage

91
Q

Purpose of aligning socket in adduction

A

Allows for loading of lateral femur

Puts hip abductors on stretch and therefore at a functional advantage

Places femur in anatomical alignment to help stabilize pelvis

Prosthetics (13 decks)

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