Amputation and Prosthetics

Question 1

what percentage of US service members do not return to duty following an amputation

Answer 1

about 90%

Question 2

what are the four main reasons for amputation

Answer 2

disease, trauma, tumor, and congenital defects

Question 3

what is the primary etiology that leads to amputation of the LE

Answer 3

vascular disease/DM accounts for 80% of all amputations

Question 4

which subpathology of vascular disease is the likely cause of LE amputation

Answer 4

arterial pathology with gangrene

Question 5

what is the 5 year survival for a diabetic amputee and how does that relate to nondiabetic amputee

Answer 5

42% for DM, 86% for non-DM

Question 6

For those with DM and PAD, what is the 1 year, 2 year, and 3 year mortality rates

Answer 6

about 50%, 60%, and 70%

Question 7

what three comorbidities significantly increase mortality in amputation patients; which is the number one risk factor?

Answer 7

CAD (#1), CVA, and renal dysfunction

Question 8

___% of DM amputees require revision after 1 year ___% of DM amputees require revision after 5 years

Answer 8

30%; 60%

Question 9

about half of DM amputees are statistically likely to have the contralateral limb amputated after how many years?

Answer 9

5

Question 10

What are the major contributors to disease pathology of LE amputation

Answer 10

chronic infection such as osteomyelitis and gas gangrene and frostbite such as dry gangrene

Question 11

___% of amputations are due to vascular disease

Answer 11

70-90%

Question 12

what three things that could significantly reduce the risk of amputation in DM patients

Answer 12

education, clinic follow ups, and proper shoe fitting

Question 13

what is the primary cause of amputation in the younger populations <45yrs

Answer 13

trauma

Question 14

in what patient population (name one) are we most likely to see primary bone tumors (name two)

Answer 14

adolescents; osteogenic and/or Ewing’s sarcoma

Question 15

what is PFFD

Answer 15

rare non hereditary usually femur deformity that results from the lack of femur growth in utero

Question 16

discuss the differences between myoplasty, myodesis, and myofascial surgical stabilization techniques

Answer 16

• suture the ends of the muscle to the bone
• suture the ends of the muscle to the distal bone
• suture the ends of the muscle to the fascia

Question 17

what is neuroma and how does it develop

Answer 17

nerves are distracted, cut, and allowed to retract

Question 18

what combats neuroma pain

Answer 18

TMR/TNR procedures decrease neuroma pain and improve myoelectrical prostheses

Question 19

what is the most common and preferred surgical technique

Answer 19

trick question: for adults, primary closure is preferred but for kids they will preference a disarticulation if there is preservation of the growth plate

Question 20

what does phantom pain feel like

Answer 20

cramping, shooting, stabbing, burning

Question 21

what is the difference between a chopart and lisfranc amputation

Answer 21

chopart - mid tarsal cut leaving the talus and calcaneus intact

lisfranc - cut between the tarsals and metatarsals

Question 22

what is a symes and what is the advantage

Answer 22

ankle disarticulation that cuts through the talocrural joint and allows for good weightbearing

Question 23

what is the most common amputation linked to PVD

Answer 23

TTA approx 5.5 in below tibial plateau for average males

Question 24

what is an ERTL procedure

Answer 24

links distal tibfib together post-TTA - not usually performed in vascular amputations

Question 25

what are the documented benefits of post-op rigid dressing for amputees (4)

Answer 25

• controls edema
• promotes early maturation
• decreased post op pain
• decreased LOS and time to fitting

Question 26

if the benefits of rigid dressing post-amputation are well documented, how come its not the preferred method for post-op care? (2)

Answer 26

1. rigid doesn’t allow us to monitor wound healing
2. expensive with debatable reimbursement

Question 27

what reasons usually lead to a knee disarticulation

Answer 27

trauma, not usually vascular

Question 28

how does the anatomy shift in a TFA

Answer 28

anterior and posterior compartments are myoplasty-d together and the adductor magnus is myodesis’d to the femur

Question 29

in what population are we likely to see a rotation plasty

Answer 29

pediatrics

Question 30

when are hip disarticulations and hemipelvis surgeries indicated; what is a major consideration for this population

Answer 30

malignancy or severe trauma; high prosthetic rejection rate