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PTRS 746 Exam 1 > Amputation > Flashcards

Flashcards in Amputation Deck (140):
1

Q: 1 out of every ______ Americans will undergo an amputation.

200

2

T/F: Amputations rates decrease with age and are twice as common in women.

False: increase, men

3

Q: Over ____% of lower extremity amputations are due to ___________ disease and/or _________.

80, vascular, neuropathy

4

Q: Over ____% of upper extremity amputations are due to _____

70, trauma

5

Q: What are 3 other causes of amputation?

1. Cancer 2. Infection 3. Congenital limb defects

6

Q: Who is peripheral vascular disease (PVD) most common in?

African Americans followed by Native Americans and Hispanics, then Caucasians

7

T/F: Peripheral vascular disease is associated with diabetes and/or smoking.

True

8

Q: Diabetes alone increases the risk of intermittent claudication by _______x, even after controlling for HTN, smoking, and cholesterol

4-5

9

Q: What comorbidities increase risk for PVD and amputation? (4)

1. Obesity 2. HTN 3. Hyperlipidema 4. Nephropathy

10

T/F: 40% of amputations in those with diabetes are preceded by a foot ulceration.

False, Most ~85%

11

Q: ____% of those with PVD results in amputation will eventually undergo _________ amputations.

55, bilateral

12

Q: What is the 30 day mortality rate follow a major leg amputation?

As high as 40%

13

Q: What is the 5 year mortality for amputation?

As high as 70%

14

Q: Who is traumatic amputation more common in?

Younger men

15

Q: Within what window must re-plantation of a traumatic amputation occur?

12 hour window

16

Content: Traumatic Amputation Causes (4)

1. MVA 2. Violence related combat injuries 3. Severe burns 4. Electrocution

17

Q: The lifetime cost of amputation is as much as ___ times higher than salvage.

3

18

T/F: The risk of subsequent hospitalization is lower after salvage.

False: greater

19

T/F: Amputations may result in better functional outcomes

True

20

T/F: Amputation may be more psychologically acceptable.

False, Salvage

21

Content: Malignancy and Amputation (2)

1. Can be due to primary cancer or metastatic disease 2. More commonly involve the lower limbs

22

Q: Why are amputation rates declining? (3)

1. Earlier diagnoses 2. Improved chemotherapy 3. Limb salvage/reconstruction techniques

23

T/F: Children are miniature adults.

False

24

Q: What is ratio of male to female pediatric amputations?

3:2

25

Q: _____% of pediatric amputations are congenital and _____% are acquired.

60, 40

26

Content: Acquired pediatric amputations (3)

1. 90% are single limb 2. 60% are LE 3. Most result from trauma

27

Content: Pediatric amputation (4)

1. Disarticulation minimizes growth plate disruption 2. Must consider longitudinal and circumferential growth 3. Excellent circulation enhances wound healing 4. Superior tissue tolerance may allow early post-op prosthetic fitting

28

LE Amputation Term: Excision of portion of 1 or more toes

Partial toe

29

LE Amputation Term: Disarticulation at MTP joint

Toe disarticulation

30

LE Amputation Term: Resection of 3rd, 4th, and/or 5th, MTs and digits

Partial foot/ray resection

31

LE Amputation Term: Amputation through long axis of all MTs

Transmetatarsal

32

LE Amputation Term: Ankle disarticulation with preservation of heel pad

Syme's

33

LE Amputation Term: Retains > 50% of tibial length

Long transtibial

34

LE Amputation Term: Retains < 50% of tibial length

Short transtibial

35

LE Amputation Term: Amputation through knee with intact femur

Knee disarticulation

36

LE Amputation Term: Retains > 50% of femoral length

Long transfemoral

37

LE Amputation Term: Retains < 50% of femoral length

Short transfemoral

38

LE Amputation Term: Amputation through hip joint, pelvis intact

Hip disarticulation

39

LE Amputation Term: Resection of half of the pelvis

Hemipelvectomy

40

LE Amputation Term: Amputaiton of both LEs and pelvis below L4-5

Hemicorporectomy

41

UE Amputation Term: Excision of one or more fingers

Partial digit

42

UE Amputation Term: Disarticulation at MCP joint

Digit disarticulation

43

UE Amputation Term: Resection through long axis of MTCs

Transmetacarpal

44

UE Amputation Term: Amputation of hand with preservation of wrist

Transcarpal

45

UE Amputation Term: Amputation of hand and carpals

Wrist disarticulation

46

UE Amputation Term: Amputation through radius and ulna

Transradial

47

UE Amputation Term: Disarticulation of elbow

Elbow disarticulation

48

UE Amputation Term: Amputation through humerus

Transhumeral

49

UE Amputation Term: Amputation through shoulder joint

Shoulder disarticulation

50

UE Amputation Term: Amputation of humerus, scapula, and clavicle

Forequarter amputation

51

Content: Surgical Principles of Amptuation (5)

1. Maintain adequate circulation for wound/incision healing 2. Remove damaged or involved tissues 3. Preserve as many anatomical joint as possible, esp. knee 4. Preserve maximal bone length 5. Provide residual limb that will accept prosthesis and tolerate WB

52

Content: Surgical considerations for dysvascular patients often present with (4)

1. Comorbidities 2. Neuropathy 3. Vascular compromise 4. Infection/osteomyelitis

53

Content: Surgical considerations for traumatic injuries often involve (2)

1. Open, comminuted fx with soft tissue loss 2. Vascular/nerve disruption

54

Content: Surgical considerations for cancer-related amputation is indicated in (4)

1. High grade neoplasms 2. Proximal lesions 3. Risking pathologic fx or neurovascular involvement 4. Recurrent disease

55

T/F: Amputation is among the oldest medical procedures

True

56

Q: Why must muscle length be preserved with amputation?

To prevent contracture and atrophy

57

Content: Muscle Stabilization (Closure) Techniques (5)

1. Myodesis 2. Tenodesis 3. Myofascial 4. Myopasty 5. Open (guillotine), provisional, or delayed closure

58

Term: Transected muscles are re-attached by suturing through drill holes at distal end of the bone.

Myodesis

59

Term: Intact tendon(s) re-attached to bone

Tenodesis

60

Term: Fascial envelope is sutured over transected muscles

Myofascial

61

Term: Suturing of one muscle group to its antagonist

Myoplasty

62

Content: Osteomyoplasty (3)

1. Used in transtibial amputation 2. Bone bridge harvested from tibia 3. Bridge connects distal ends of tibia and fibula

63

Q: What are the benefits osteomyoplasty? (2)

1. Prevents chopsticking of distal bone ends 2. Improves WB on residual limb

64

Content: Post-Op complications of amputation (5)

1. Contracture 2. Edema 3. Phantom limb sensation or pain 4. Personal grief/depression 5. Sx complications (i.e. pain, infection, respiratory compromise, DVT, etc)

65

Content: Acute Post-Sc Exam (14 - general idea)

1. Medical history 2. Social situation 3. Pain level 4. Sensation / Proprioception 5. A/AROM or PROM 6. Strength 7. Bed mobility 8. Sitting / Standing balance 9. Transfers 10. Locomotion: gait and/or wheelchair 11. Endurance 12, Home and work environment 13. Barriers to care or adjustment 14. Knowledge: limb care and prosthetic use

66

Content: Goals of acute rehab (5)

1. Prevent complications and allow healing 2. Develop limb strength and ROM for prosthesis 3. Maximize independence in mobility and ADLs 4. Pre-prostehtic training and limb preparation 5. Endurance training and initiation of HEP

67

Content: Amputation Education (5)

1. Positioning 2. Residual limb care 3. Protection of contralateral limb 4. Prosthetic info and time frame 5. Support smoking cessation

68

Content: Post-surgical phase (4)

1. Compression 2. ROM 3. Positioning 4. Endurance

69

Q: When does the post-surgical phase end?

When pt. is provided with a definitive prosthesis

70

Content: Post-op Dressing - Rigid dressing (2)

1. Immediate Post Op Prosthesis (IPOP) 2. Plaster socket with removable pylon and foot

71

Content: Advantages of Rigid Dressing (6)

1. Limits edema 2. Reduces pain 3. Prevents contracture 4. Allows early WB/gait 5. Easier move to definitive prosthesis

72

Content: Disadvantages of Rigid Dressing (3)

1. Difficult to apply 2. Requires very close supervision 3. Cannot visualize wound or residual limb

73

Content: Post-op Dressing - Rigid Removable Dressing (RRD) (2)

1. After suture/staple removal, a polypropylene or cast is fist from an impression of the residual limb 2. The RRD is worn over the wound dressing or compression socks

74

Content: Advantages of RRD (4)

1. Allows skin inspection 2. Provides consistent pressure 3. Easily donned 4. Protects residual limb

75

Content: Disadvantages of RRD

May require frequent refitting

76

Content: Post-Op Dressing - Semi-Rigid Dressing (2)

1. Zinc-oxide, gelatin, glycerin, and calamine compound 2. Applied in OR or PACU

77

Content: Advantages of Semi-Rigid Dressing (6)

1. Controls edema 2. Adheres to skin 3. Allows some ROM 4. Breathable 5. Inexpensive 6. Easy to contour

78

Content: Disadvantages of Semi-Rigid Dressing (3)

1. Loses effectiveness as edema resolves 2. Not as protective 3. May permit contracture formation

79

Content: Post-Op Dressing - Soft Dressing (2)

1. Incision dressed with 4x4s and Kerlix 2. Compression provided with ACE bandages or elastic shrinker

80

Content: Advantages of Soft Dressing (3)

1. Inexpensive 2. Lightweight 3. Readily available

81

Content: Disadvantages of Soft Dressing (4)

1. Inconsistent, weak compression 2. Requires frequent re-wrapping and replacement 3. Does not prevent contracture 4. Difficult for pt. to self apply

82

Content: ACE Wrapping Amputations (4)

1. Must be rewrapped every 4-6 hrs 2. distal to proximal pressure gradient 3. Figure 8 pattern to prevent tourniquet effect 4. Pt. and caretaker education

83

Q: How should an ACE wrap be applied to a BKA?

Pull in medial to lateral, posterior to anterior direction

84

Q: How should an ACE wrap be applied to AKA?

Include adductor tissue (prevent adductor roll) and pull into extension and adduction

85

Defn: Limb Shrinkers

Elastic socks that help decrease edema and assist in shaping the residual limb

86

Q: What is the pressure gradient for limb shrinkers?

Distal to proximal

87

T/F: AKA socks do not require waist belts.

False do

88

T/F: Intermittent claudication is very predictable.

True

89

Defn: claudication

Not enough vascular supply to support the demand, results in pain typically in the calf

90

Defn: Limb socks

Used between residual limb and prosthetic socket for protection, friction absorption, and to fill socket volume

91

Content: Limb sock (4)

1. Absorbs perspiration 2. Allows optimal socket fit and contact 3. Cotton, wool, or blended fabric 4. 1, 3, and 5 ply socks can be layered up to 15 ply

92

Video: AKA Post-Op Bandaging

http://www.youtube.com/watch?v=zaGgLlK0kGE&feature=related

93

Video: Residual Limb Care

http://www.youtube.com/watch?v=KUf66OgRqY0&list=UUlp8fuyor5U_GwWzfQc4utg

94

Video: BKA Prosthetics

http://www.youtube.com/watch?v=1_8Io-L2PAo

95

Video: AKA Prosthetics

http://www.youtube.com/watch?v=u_ltzVd1zQw&feature=related

96

Video: Bilateral AKA

http://www.youtube.com/watch?v=D49YKNM1Kr8

97

T/F: Phantom sensation is normal.

True

98

Content: Phantom Limb Sensation (4)

1. Painless awareness of the amputated body part 2. Incomplete sensation, often mild tingling 3. Occurs in over 90% of the traumatic/Sx amputees 4. Usually persists throughout life

99

Defn: Phantom Limb Pain

Painful sensation of amputated body part, described as cramping, squeezing, burning, or shooting

100

Content: Phantom Limb Pain (4)

1. Can be consistent or intermittent, with varying intensity 2. 30-75% incidence 3. Uncommon in individuals with congenital amputation 4. More common after crush injury or amputation in later life

101

Content: Interventions for Phantom Pain (6)

1. Desensitization and massage 2. Compression 3. Exercise 4. Limb handling and use 5. Modalities: TENS, US, icing 6. Psychological counseling

102

Content: Mirror Therapy (3)

1. Pt. performs a movement with the unaffected limb 2. Movement is viewed in mirror positioned in front of pt. 3. Simultaneously, pt. attempts to perform the movement with their residual or phantom limb

103

Q: How long does scar maturation continue?

Up to 1 year

104

Q: Skin integrity andpressure tolerance is only ____% of normal.

40

105

Content: Desensitization and MAssage (3)

1. Initiate gentle touch and textural stimulation after wound is closed 2. Initiate scar and deep friction massage after the incision is fully healed 3. Massage to residual limb should be used as an adjunct to daily skin inspection and care routine

106

Content: Positioning - Initiate the following as soon as allowable (3)

1. ROM 2. Prone positioning 3. Wrapping/shrinker

107

Content: Positioning (3)

1. Should start immediately 2. Optimize both in and out of bed 3. Monitor edema and limb volume fluctuation

108

Content: Modern Amputation Technique (5)

1. Skin/muscle flaps made anterior and posterior 2. dissect, clamp, cut A&V 3. Dissect nerve and retract back into tissue 4. Severe bone, make a smooth edge 5. Close muscle and skin flaps

109

Content: TherEx (4)

1. Maintain full ROM 2. Strengthen hip ext, add, and knee ext 3. CC exercise and functional activites 4. CV endurace

110

Q: Unilateral BKA increases energy cost of ambulation by ____%.

20

111

Q: Unilateral AKA increases energy cost of ambulation by ____%.

49-65%

112

Q: Energy cost for ambulation of a bilateral BKA is ______ than a unilateral AKA.

less

113

Q: Hip disarticulation increases energy cost of ambulation by ____%.

200

114

Q: Bilateral AKA increases energy cost of ambulation by ____%.

280

115

Q: When should you begin transfer training?

POD1 if medically stable

116

T/F: Transfer prosthesis is not useful for non-ambulatory pts.

False, may be useful

117

Q: How should position roller walker?

Pts. elbow in full extension

118

Q: What is the largest factor in determining WC use for amputees?

Energy cost of ambulation

119

Content: WC setup considerations (3)

1. Offset rear axis 2. Power system 3. Anti-tip system

120

Q: What is dehissing?

When an amputation incision reopens

121

Q: What are the 2 best predictors of prosthetic potential?

1. Level of amputation 2. Pre-Sx function

122

Q: What 2 types of amputations can be functionally independent with prosthesis?

Unilateral BKA Bilateral BKA

123

T/F: Most bilateral AKA amputees are prosthetic users.

False

124

Content: Contraindications to prosthetic use (5)

1. Dementia 2. Institutionalization 3. Adv cardiopulm or neurologic disease 4. Bilateral transfemoral amputation with inability to transfer/stand 5. Unacceptable energy expenditure for ambulation

125

T/F: You can develop contractures with amputations no matter how far out you are.

True

126

Content: Residual Limb Requirements (5)

1. Fully healed incision 2. No signs of infection 3. No drainage from incision site 4. Ability to tolerate to WB 5. Frequent skin inspection

127

Content: Components to selection of prosthetic parts (4)

1. Age 2. Activity level/vocational demands 3. Funding sources 4. Compliance

128

T/F: Pt. and PT must have understanding of selected components and their functional implications.

True

129

T/F: Temporary prostheses are intended for full time wear until the permanent prosthesis is available.

False

130

Q: When is the definitive socket provided?

Volume stabilized

131

Content: Temporary Prosthesis (5)

1. Shapes residual limb 2. Allows early gait training and independence 3. Evaluation for potential prosthetic use 4. Allows endurance training 5. Discourages contracture development

132

Content: Progression of gait training (3)

1. Parallel bars: sit to stand, SLB, weight shifting 2. Walker: stand to stand, hopping, stepping 3. Functional tasks: reaching, bending, turning

133

Q: What should be emphasized with gait training?

Stance and stability on prosthesis

134

Content: Advanced Gait Training (8 - general idea)

1. Step up/downs onto prosthetic leg 2. Resisted ambulation 3. Running and jumping 4. Transfers to and from the floor 5. Uneven terrain, congested community ambulation 6. Curb and stair training 7. Reaching 8. Lifting and carrying objects

135

Content: When to refer to the prosthetist (4)

1. Weight gain 2. Volume changes 3. ROM 4. Functional changes

136

T/F: As a PT you can make significant adjustments to prosthesis without input from the prosthetist

False

137

Q: What 2 types of prostheses are typically used with UE?

1. Harness 2. body powered cable control systems

138

Q: What is often and issue with UE prosthetics, esp. with pediatric pts.

Acceptance

139

Q: What type of control systems are becoming increasingly prevalent in UE prosthetics?

Myoelectric

140

Term: indicated if severe infection or toxicity are present

Open/guillotine/provisional/delayed closure