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Prosthetics > BK Prosthetics > Flashcards

BK Prosthetics Flashcards

1
Q

Largest cause of LL amputation

A

Dysvascular (followed by congenital, trauma, and cancer)

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2
Q

Largest LL amputation population (level of amputation)

A

Toes/foot

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3
Q

Percent chance a person will have contralateral limb also amputated within 3-5 years

A

55%

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4
Q

5 yr mortality rate for persons w/dysvascualr disease after amputation

A

50%

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5
Q

‘Ideal’ limb length

A

12 cm distal to knee (lever arm)

23 proximal to floor (room for components)

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6
Q

Myodesis vs Myoplasty

A 
Myodesis = muscle to bone (more stable)
Myoplasty = antagonist muscle to agonist muscle
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7
Q

Most common TT surgical technique

A

Posterior flap method

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8
Q

Fibula transacted this amount above end of tibia

A

1-1.5cm

Anterior tib beveled 45°

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9
Q

TMR vs RPNI

A 
TMR = nerve ending attached to intact muscle
RPNI = nerve ending wrapped in muscle graft
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10
Q

Potential benefits of RPNI and TMR in lower limb

A

Decrease neuromas & phantom limb pain

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11
Q

Ertl procedure, advantages, indications

A

Bone bridge between tibia and fibula

Creates wider base for prosthetic fitting, stabilizes the distal bone interval

Young, healthy individuals, fibular instability

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12
Q

Concerns in post op stage

A

Knee flexion contractures
Volume changes
Protection
Early ambulation

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13
Q

Post op goals

A

Protect limb for healing
Preserve/improve strength
Prepare limb for prosthesis

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14
Q

Post op protective dressing options

A 
Soft dressing
Non removable rigid
IPOP
Removable rigid (RRD)
Prefab prosthetic
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15
Q

Preferred choice of post op protective dressing and benefits

A

RRD

Reduce injury from falls
Reduce knee flexion contracture
Reduce edema
Reduce healing time
Reduce time to prosthetic fitting
Reduce pain
Inspection of incision
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16
Q

Post op edema management methods

A

Ace wrap
IPOP
Compression garment (shrinkers, compressogrip)

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17
Q

Pressure gradient for edema control

A

Pressure is high distally and less proximally (reduces distal to proximal)

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18
Q

Pros/cons of ace wrap

A

Good control and adjustment of compression if properly applied

Has to be reapplied every few hours

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19
Q

Pros/cons of shrinkers and recommended pressure amount

A

Class II 30-40 mmHg

Easy to don and wash

Higher cost, may require multiple sizes over time

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20
Q

Pros/cons of compressogrip

A

Customize size, low cost

Compression is NOT graded

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21
Q

What point after amputation can prosthetic fitting occur?

A

Staples/sutures removed
Wound healed
Volume stabilized*

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22
Q

Baseline anatomical landmark for length measurements

A

Midpatellar tendon

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23
Q

Which hamstring tendon attaches more distally?

A

Medial (Semitendinosus and semimembranosus)

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24
Q

Pressure tolerant areas of RL

A 
Patellar tendon
Medial tibial flare
Pretibial muscles (ant. compartment)
Gastrocsoleus
Popliteal fossa
Fibulae shaft
Distal end*
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25
Q

Pressure intolerant areas of RL

A 
Lateral tibial condyle/Gerdy’s tubercle
Tibial crest
Distal anterior tibia
Fibulae head / common peroneal nerve
Hamstring tendons
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26
Q

Function of socket

A

Contain, support, and protect RL
Rigid attachment to components
Energy/force transfer between pt and ground
Protect limb from damaging pressures / impact forces

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27
Q

Average surface area of TT RL

A

52 in^2

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28
Q

Force, pressure, and area relationship

A

Force applied over greater area reduces pressure

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29
Q

Potential result of lack of distal end contact

A

Verrucous Hyperplasia ‘wart like’ overgrowth

Edema->VH->cancer if untreated

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30
Q

Method to reduce verrucous hyperplasia

A

Total contact (distal end contact)

*DE contact, not DE weight bearing

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31
Q

PTB, PTBSC, PTBSC-SP, TSB stands for

A

Patellar tendon bearing
PTB supracondylar
PTBSC suprapatellar
Total surface bearing

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32
Q

Hybrid socket design combines what loading methods

A

PTB + TSB

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33
Q

Loading principle of PTB vs TSB

A

PTB = specific weight bearing (load pressure tolerant, relief for intolerant areas) with AP compression

TSB = pressure distributed equally across entire surface of RL

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34
Q

Describe AP force couple in PTB

A

High posterior brim counters the patellar bar

Posterior trim line should extend proximal to MPT level (~12mm, w/socket in appropriate flexion)

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35
Q

PTBSC suspension method and indication

A

Anatomical suspension over femoral condyles

ML knee instability (short RL, ligament laxity)

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36
Q

PTBSC SP suspension and indication

A

Anatomical suspension over femoral condyles

Knee hyperextension
If poor ROM and strength, consider joint/corset instead

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37
Q

Feature and function of PTBSC SP

A

High trim line over patella (1”) with quadriceps bar to resist knee hyperextension in late stance

Quad bar must be modified at correct angle and depth (~10°)

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38
Q

PTB indications

A

Limb has specific pressure/weight intolerant areas (atrophy, sensitive areas)

Anticipated volume changes

Donning, hygiene challenges (gel not recommended)

Previously satisfied user

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39
Q

Basic idea of hydrostatic theory

A

Soft tissues behave as an elastic solid with low stiffness when under load

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40
Q

TSB suspension

A

Skin fit or Gel liner

No voids crucial to maintain suction

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41
Q

Function of shank

A

Maintain spatial relationship (height and alignment) between socket and foot

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42
Q

Types of shank construction

A

Endoskeletal and exoskeletal

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43
Q

Exoskeletal design pros/cons

A

High strength, durability, less exposed componentry, can be fab’d for light or heavy duty use

Alignment is not adjustable, replacement is more difficult/costly

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44
Q

Endoskeletal design pros/cons

A

Modular, interchangeable components, alignment changes and adjustability, greater component selection

Higher strength requires heavier and more costly components, less durable, components are exposed

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45
Q

Common and standard pylon diameters

A

30mm (standard)

34mm

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46
Q

Protective cover coverage by Medicare

A

Medicare allows custom shaped foam cover for protection of components

Flexible outer protective surface (skin) considered not medically necessary - use stockings instead

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47
Q

Indications for protective cover

A

Protection of components (dust and debris, corrosive environmental agents, incontinence)

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48
Q

Function of foot

A

Transfer and absorb GRF

Absorb shock
Weight bearing stability
Progression through gait cycle

49
Q

Prosthetic feet are described by

A

Material
Heel
Keel
Functional properties

50
Q

Function of heel

A

Shock absorption in LR, knee stability

Varied by heel cushion, bumpers, hydraulic

51
Q

Function of keel

A

Semi rigid lever arm to control advancement of limb over foot and support weight after MS

52
Q

Keel stiffness based on

A

Weight and activity level

53
Q

SACH function

A

Solid ankle cushioned heel

Heel compresses in LR for shock absorption and PF, keel deflects in late stance

54
Q

Prosthetic heel compression simulated what normal mechanism

A

DF activity to control PF of ankle during LR

55
Q

SACH pros/cons/indications

A

Low maintenance, low cost, varying heel heights available

Deterioration of material, no coronal ground compliance

Limited ambulators, children (durability/size), need for durability

56
Q

Single Axis foot function

A

Passive PF/DF with bumpers for knee stability in LR by reducing knee flexion moment

57
Q

When do anterior and posterior bumpers compress in gait / what type of resistance is provided

A

Posterior bumper is compressed in LR for PF resistance

Anterior bumper is compressed in late stance for DF resistance

58
Q

Single axis foot pros/cons/indications

A

Promotes sagittal knee stability

More maintenance (moving parts)

Weak quads/poor control of knee flexion, limited ambulator (short distances at low speed)

59
Q

Flexible keel foot function

A

Flexible keel allows FF inversion/eversion and smooth rollover to improve transition to same side in TS

60
Q

Flexible keel foot pros/cons/indications

A

Smoother rollover, FF inversion/eversion (vs SACH)

Moderate increase in weight and cost (vs SACH)

More than limited ambulator - walk outside home but not at variable speeds

61
Q

Multiaxial foot function

A

Passive motion in 2+ planes, may be additional feature on another type of foot

62
Q

Multiaxial pros

A 
Ankle PF (knee stability in LR)
Ankle DF (softer rollover in TS)
Ground compliance (uneven terrain)
Absorption of rotational forces
63
Q

Dynamic response / energy storage and return / flex foot / flex walk function

A

Spring keel (carbon/fiberglass) deflects under load (absorbs energy) and rebounds when unloaded (return) for subjective sense of push off

64
Q

ESAR pros/indications

A

Reduced energy, reduced impact of cyclic vertical loading, lighter weight

At risk for overuse injury (contralateral), variable cadence (community ambulators)

65
Q

Hydraulic ankle function

A

Single axis feature with adjustable hydraulic dampening of PF and DF

Often combined w/ESAR or flexible keel

66
Q

Hydraulic ankle pros/cons

A

Variable resistance (dampens at high speeds), adjustable resistance

Increased weight and cost (vs single axis)

67
Q

Torsion adapter function, advantages, indications

A

Transverse plane rotation w/resistance

Replaces loss of rotation from foot and ankle, reduces shear at limb-socket interface

Helpful for bilateral, specific activities/sports

68
Q

Vertical shock absorber function, advantages, indications

A

Absorbs shock, may be individual component or part of a foot

Improves weight absorption at IC, reduces impact to at risk/damaged proximal joints

Activity specific/sports

69
Q

Function of suspension

A

Hold prosthesis on RL

70
Q

General categories of suspension

A

Anatomical
Mechanical
Atmospheric
Other (OI)

71
Q

Types of anatomical suspension

A

Joints and corset
Waist belt and fork strap
Supracondylar
Supracondylar cuff

72
Q

Describe joint and corset suspension

A

Mechanical joints and uprights attach socket to thigh lacer which can be tightened to help suspend and transfer load to thigh

Variations: knee brace, locking joints, hyperextension check/stop strap to reduce terminal impact sound

73
Q

Joints and corset pros/cons/indications

A

Durable, user adjustable, ML stability, hyperextension stop, can load through thigh to partially offload limb

Heavy, bulky, noisy, pistoning

ML instability (short limb, ligament laxity), heavy duty user

74
Q

Describe waist belt and fork strap suspension

A

Belt around waist suspends through connection via fork strap which attaches to the socket or a supracondylar cuff

Elastic webbing improves knee flexion comfort in swing

75
Q

Waist belt and fork strap pros/cons/indications

A

User adjustable, sensory feedback, visual verification

Pistoning, potentially bulky

Early fittings, auxiliary suspension

76
Q

Describe supracondylar suspension and requirements

A

Compresses soft tissue proximal to femoral condyles, requires min. ML-PML difference of 12mm

77
Q

Supracondylar - use of foam liner vs removable medial brim/wedge

A

12mm+ ML-PML -> foam liner

25mm+ ML-PML -> removable brim/wedge

78
Q

Supracondylar pros/cons/indications/contraindications

A

Self suspending, low profile w/o additional suspension components, better ML stability vs PTB

High trim lines (sitting)

ML instability (short limb, ligament laxity)

Excessive soft tissue or firm muscle in PML, high activity contraindicated

79
Q

Describe supracondylar cuff (strap) suspension

A

Leather cuff wraps around distal thigh above femoral condyles and suspends over the patella (not condyles)

Provides tension from full extension to ~60° knee flexion for suspension with reduced tension for sitting

80
Q

Attachment location for supracondylar cuff

A

1” proximal and posterior to lateral midline MPT level (can vary within a square inch)

81
Q

Supracondylar cuff pros/cons/indications/contraindications

A

User adjustable, sensory feedback, low cost

Pistoning

PTB socket with good ML stability

ML instability contraindicated

82
Q

Types of mechanical suspension

A

Knee sleeve

Locking liner

83
Q

Describe knee sleeve suspension

A

Sleeve adheres to outside of socket and thigh skin or exposed gel, suspension via friction

Elastic (more conforming but more pistoning), neoprene, gel

84
Q

Knee sleeve pros/cons/contraindications

A

Conceals socket trim lines

Heat, bulk around knee

Poor hand dexterity contraindicated

85
Q

Describe locking liner suspension

A

Gel liner with notched pin, lanyard, magnet, etc. adheres to skin and engages with mechanical lock in distal end of socket

86
Q

Locking liner pros/cons/contraindications

A

Audible click confirms suspension, quick and easy donning, accommodates volume changes

Relative pistoning, maintenance (cleaning, wear/tear or liner and lock components)

Hygiene concerns contraindicated

87
Q

Types of atmospheric suspension

A

Passive suction

Active vacuum

88
Q

Describe passive suction suspension

A

Cushion gel liner used with a knee sleeve that seals on socket and skin or exposed gel; can use socks

Or

Seal-in gel liner with embedded rings that compress against socket wall for seal, doesn’t require knee sleeve

One way valve, distraction force reduces pressure/increases suction force inside socket

89
Q

Difference between pressure in passive vs active suction

A

Passive suction = atmospheric pressure (reduces with distraction)

Active vacuum = negative pressure system with air actively extracted

90
Q

Passive suction pros/cons/contraindications

A

Relatively reduced pistoning, potentially reduced in-socket rotation

Chance of material failure, bulk and heat with sleeve

For seal in liner, expected volume changes are contraindicated

91
Q

Describe active vacuum suspension

A

Requires gel liner with sleeve or seal-in liner. Sleeve seals against exposed gel and not skin

Air actively extracted via mechanical or electronic pump

92
Q

Active vacuum pros/cons/contraindications

A

Minimized pistoning, rotation, and daily volume fluctuations

Counterintuitive for prosthetists, maintenance

Lack of cognition/acceptance and gross volume fluctuations contraindicated

93
Q

Osseointegration advantages and disadvantages

A

Eliminates need for socket, easy donning

High infection rate, other complications, sx risks, healing time

94
Q

Describe interfaces (in general)

A

Contacts skin, material between skin and socket

95
Q

Types of interfaces

A

Fitting socks
Gel liners
Foam liner (Pelite, Keasy cone)

96
Q

Sock thickness is referred to as

A

Ply

97
Q

Goal sock ply fit for sock-only interface

A

5 ply

98
Q

Types of gel liners and features

A

Locking liner (distal umbrella), cushion liner, seal-in liner

Fabric matrix stabilizes and increases durability, reduces longitudinal stretch/pistoning, allows circumferential stretch

Urethane liners may have no fabric matrix

Preflexed liners reduce stretch or patellar discomfort while sitting

Different thickness profiles, shapes, sizes

99
Q

How to don a socket with a liner with no outer matrix

A

Use lotion or spray alcohol to allow liner to slide into socket

100
Q

Factors for consideration in choosing an interface

A 
Preference
Limb profile/shape
Skin integrity
Hand dexterity
Perspiration/activities
Knee anatomy (prominent patella)
Hygiene
Contact allergies
101
Q

Differentiating contact allergy vs bacterial or fungal infection

A

Allergy: entire area of contact irritated with distinct border

Bacterial or fungal: inconsistent coverage (refer to dermatologist)

102
Q

TPE liner material properties (thermoplastic elastomer)

A

Poor memory
Easy to reflect for don/doff
Tends to pack out quickly, requires more thickness to absorb force
Tackiness (patella tension)

20-30 durometer

103
Q

Silicone liner material properties

A 
Memory
Less thickness required to absorb force compared to TPE
Easy don/doff
No coatings or fabric covers to wear out
Durable
Doesn’t protect bony anatomy as well
Doesn’t stretch out as quickly
Solidifies tissue (good for fleshy limbs)

30-50 durometer

104
Q

Urethane liner material properties

A 
Memory
Less thickness required to absorb force vs TPE
Least thinning with compression
Protects bony limbs
Less moisture build up
Doesn’t compress tissue as much
Some drag when pushing into socket
Good for fleshy limbs

30-50 durometer

105
Q

Liner property: compressive resistance

A

Change in thickness under load

High stiffness - less compression, less likely to offload peak pressures

Low stiffness - compressed more, distribute peak pressures

106
Q

Liner property: shear resistance

A

Ability to move from forces in parallel plane

High stiffness - higher stress on skin

Low stiffness - sensitive skin, less intimate fit

107
Q

Liner property: stretch resistance

A

Ability to lengthen when pulled

High stiffness - less likely to stretch/piston

Low stiffness - more stretch/piston

108
Q

Liner property: adherence

A

Force required to move liner along skin

High frictional coefficient - req. more force, less likely to slip, can cause shear

Low frictional coefficient - req. less force and more likely to slip

109
Q

What level of partial foot amputation do you lose ankle and calf musculature during walking

A

Transmet and higher

110
Q

Ankle disarticulation pros/cons and treatment

A

Good weight bearing area, anatomical suspension, longer lever arm

Poor cosmesis, limited component space/possible LLDcy

Window - medial or posterior
Stovepipe liner, expandable wall with cylindrical shape socket

111
Q

Symes vs Boyd vs Pirogoff

A

Symes = removal of calcaneus

Boyd = horizontal transaction of calcaneus

Pirogoff = vertical transaction of calcaneus

112
Q

Effects of PFA in gait

A

Reduced lever arm
Premature toe break
Reduced step length

113
Q

Lisfranc joint level vs Chopart level

A

Lisfranc = Tarsometatarsal (keep midfoot)

Chopart = Transtarsal (keep hindfoot only)

114
Q

Goal of toe amputation prosthesis

A

Restore normal foot mechanics/foot shape
Prevent toe migration
Treat underlying pathology

115
Q

Goal of ray resection prosthesis

A

Maintain foot position in shoe

Restore foot mechanics and shape (arches)

116
Q

Amputation of which ray(s) result in loss of forefoot motion

A

1st and 5th ray resection loses FF motion

117
Q

Goals of MTPJ amputation prosthesis

A

Maintain cosmetic appearance
Maintain foot position in shoe
Protect RL from shoe
Restore foot mechanics

118
Q

Goals of TMA prosthesis

A

*limited ambulation w/o prosthesis

Protect shoe from deforming forces w/walking
Maintain foot position in shoe
Protect RL
Restore foot mechanics

119
Q

Goal of lisfranc and chopart prostheses

A

*weight bearing with limited walking

Manage contracture
Suspend shoe
Protect RL
Restore mechanics

GRAFO + partial foot

Prosthetics (13 decks)

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