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Integ Patho (PTH 701) Quiz #1 > Amputations > Flashcards

Flashcards in Amputations Deck (32):
1

Where is Ben Branch from?

Chicago

2

What are the 5 different Etiologies and Pathophysiologies for Amputees?

Traumatic
Dysvascular
Elective
Cancer
Congenital
(CC-TED)

3

What are reasons for the Dysvascular etiology?

DM
PVD (A/V)
Atherosclerosis
Tobacco use
Peripheral Neuropathy (loss of protective sensation - DFE)

4

What are the stats for the Elective etiology?

High rate of compound, open tib/fib fracture patients (85% in 5 years post Fx)

CRPS, RSD (Complex regional pain syndrome, also called RSD - Reflex Sympathetic Dystrophy)

Revision surgeries (fit, function, wound)

5

What are the facts about the Cancer etiology?

Sarcoma, lyoma
Amputation level determines by local tissue destruction, nerve effect
Soft tissue injuries more common, skin breakdown if RT
Neuropathy more common with CT

6

Congenital facts?

Limb dysplasia
Agenesis
Typically most adaptive

7

What percentage of amputees are over Age 40

81.3%

8

What percentage of amputees had their lower limb affected?

90.3%

9

Are prosthetics efficient?

According to the graphics, no.

10

What is the energy expenditure cost for a Unilateral BKA?

25% (125%)

11

What is the energy expenditure cost for a Bilateral BKA?

45% (145%)

12

What is the energy expenditure cost for a Unilateral AKA?

100% (200%)

13

What is the energy expenditure cost for a AKA and BKA?

120% (220%)

14

How does a BKA/Transtibial work?

Tibia transected and fibula 3-5 cm shorter
Posterior muscle flap
Nerve traction and resection
PT goals
Patient exercises
Cylindrical shape

15

What is the ERTL Procedure?

Osteomyoplastic amputation
*Prevention of excess tibia/fibula motion*
Maintain intramedullary P across distal end
Distal end bearing, bone remodeling
PREVENTS CHOPSTICKS

16

How does an AKA/Transfemoral amputation work?

Femur transected
Distal flap using adductors
Nerve traction and resection
PT goals
Patient exercises
Tapered shape

17

What makes up early Post-op care?

Limb shape
Edema reduction
Pain control
Protection
Ctx prevention
Education

18

What makes up Late Post-op care?

Scar massage/mob
Selective strengthening
Balance/Core
Education
Gait efficiency
Fit issues

19

What % of the gait cycle is stance?

60%

20

What is the early 2015 MMC data?

BKA 90% (AKA 10%)
Unilateral 85%, Bilateral 10%, Other 5%
NONE had coordinated care at time of consult
Most have only ONE specialist involved (Vascular, General Surgery, Trauma)
Post-discharge follow-up = PCP or none

21

What % of gait cycle is swing?

40%

22

What does the Amputee Longitudinal Care Pathway do?

Improve delivery of care for amputees
Reduce # of Urgent care, ED, Hospital visits
Reduce unnecessary PCP, prostheist, surgery visits
Provide a resource in the community for amputee care (pre and post-op)
Advocate for amputee patient care needs

23

What is the amputee care model?

MMC --> Rehab --> MMP Physiatry --> PCP/surgery

*Don't let the cycle repeat. Make it end after surgery

24

When do you begin prosthetic rehab after surgery?

4-6 weeks after surgery - when initial prosthesis is installed

25

When are staples removed after surgery?

3 weeks after surgery

26

When do you see the Physiatrist? (4)

Before surgery, after surgery, when staples are removed/before prosthesis is installed, after prosthetic rehab has been started (6-8 weeks after surgery)

27

Brighton Rehab clinic stats?

Unilateral 70%, Bilat 30%
AKA 25%, BKA 75%
UE 15%, LE 85%
Dysvascular is most common!
Dysvascular 80%, Traumatic 15%, Elective 5%

*Coordinated care efforts amongst prosthetist, therapists, PCP, endocrinology, podiatry, surgery

28

What are 4 common clinical issues?

DISTAL limb vs Phantom Limb Pain
Fit and Function
"Clinical blinders"
Medical comorbidities
*Use holistic approach

29

Do most people get amputations on the R or L?

It's about equal

30

What % of amputee patients get a prosthesis?

95% - most of other 5% just don't want it or use an AD

31

What % of those with a prosthesis choose not to wear it?

11% - most of them find it easier to perform daily tasks without one

32

Does wearing a prosthesis have an effect on phantom limb pain?

For most, no it does not have an effect.

But protheses make residual limb pain, joint pain, and muscle pain worse