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Prosthetics/Orthotics > Introduction to Amputation > Flashcards

Introduction to Amputation Flashcards

1
Q

What is an amputation?

A

Surgical removal of a body part, partial, or full extremity, due to disease, trauma or injury

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2
Q

What is a prosthesis?

A

replacement of all or part of the extremity removed

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3
Q

Which are more common LE or UE amputations?

A

LE > UE

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4
Q

What are predisposing factors for amputation?

A
  • Diabetes
  • Hypertension
  • Dyslipidemia
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5
Q

Name some non-traumatic cause of amputation

A
  • Dysvascular (PVD)
  • Diabetes
  • Limb deficiencies
  • Congenital
  • Infections
  • Tumors
  • Disease
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6
Q

Name some traumatic causes of amputation

A
  • High energy trauma
  • Burns
  • electrocution
  • Motor vehicle accident
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7
Q

What are some reasons that adults may need an amputation?

A
  • Diabetes
  • Peripheral vascular disease
  • Tumors
  • Trauma
  • Burns
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8
Q

What are some reasons that children may need amputations?

A
  • Congenital limb deformities
  • Tumors
  • Trauma
  • Infection
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9
Q

What are some ways that limb preservation or limb salvage may occur?

A
  • Re vascularization
  • Bone grafting
  • Local/free flap coverage
  • Repair of major nerve
  • Compartment syndrome
  • Skeletal stabilization
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10
Q

What are the 3 factors that determine the level of amputation?

A
  • Ability to heal successfully at the incision based on adequate circulation
  • Removal of all non viable tissues, structures, especially in presence of infection
  • Achieve long term functional residual limb, restore patient to some level of activity without pain
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11
Q

What is the principles and goals of surgeons when performing an amputation?

A
  • Maintain the most adequate length of residual limb
  • Protection of severed neuromuscular structures
  • Muscle stabilization
  • Non-tender/ non adherent scar/skin
  • Functional shape of residual limb
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12
Q

Describe the general surgical technique for amputation

A
  • Major nerve are cut high & retract into soft tissue to prevent neuromas
  • Ligation (tied or closed off) of major arteries & veins
  • Cauterization for smaller vessels
  • Distal bone is beveled to help with prosthetic fit
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13
Q

The scar will (anterior or posterior) and skin flap will be (anterior or posterior)

A
  • Scar will be anterior
  • Skin flap will be posterior (posterior flap) because tissues typically have better blood supply
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14
Q

What is a myofascial closure?

A

muscle to skin

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15
Q

What is a myoplasty?

A

Muscle to muscle

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16
Q

What is a myodesis?

A

Muscle to bone

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17
Q

What is tenodesis?

A

Tendon to bone

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18
Q

What is a neuroma?

A
  • Complication following amputation
  • Bundle of nerve ending that group together & produce pain due to scar tissue, pressure from the prosthesis or tension on the residual limb
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19
Q

What is the physiological impact following amputation?

A
  • Denial, grief, anxiety, depression or suicidal feelings
  • Intensity of thoughts may be elevated in patients following emergency amputation since they had insufficient time to mentally prepare for loss
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20
Q

Why can wound infections be a complication following amputation?

A

Due to surgery or future wounds

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21
Q

Why can contractures form following amputation?

A
  • Failure to initiate full ROM early in post-op phase and poor positioning significantly increased risk of contracture
  • Joint immediately proximal to amputation is most susceptible
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22
Q

What are the most common type of contractures?

A
  • Transtibial knee flexion
  • Transfemoral hip flexion & abduction
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23
Q

What is a DVT?

A

Blood clot that forms in a vein with potential to dislodge as an embolism

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24
Q

What is phantom limb?

A
  • Painless sensation where the patient feels that the limb is present
  • Commonly immediately after amputation & will usually subside with desensitization & prosthetic use, however it may continue for extended periods of time for some patients
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25
Q

What is phantom pain?

A
  • Patients perception of some form of painful stimuli as it related to the residual limb
  • Continuous or intermittent, local or general, short term or permanent
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26
Q

What are some treatment options for phantom pain?

A
  • TENS
  • Ultrasounds
  • Icing
  • Mirror therapy
  • relaxation techniques
  • Desensitization techniques
  • Prosthetic use
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27
Q

Why is hypersensitivity an issue following amputation?

A
  • Can impede or even prevent the appropriate fit & functional use of prosthesis
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28
Q

What are treatment options to combat hypersensitivity after an amputation?

A
  • Specific de-sensitization techniques & early fitting of a temporary prosthesis are key components
  • Weight bearing, massage, tapping, & residual limb wrappings are all commonly utilized
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29
Q

What are some risk factors for amputation?

A
  • Male
  • Smoking
  • Poor glycemic control
  • Depression
30
Q

What are some risk factors for re-amputation, re-ulceration, mortality?

A
  • Previous amputation
  • Level of amputation
  • Comorbidites
31
Q

Name some reasons for amputations

A
  • Diabetes
  • PVD
  • Tumors
  • Infections
  • Burn injuries
  • Trauma
32
Q

What is a PVD?

A

Any abnormal condition affecting blood vessels peripheral to the heart

33
Q

What can a PVD be caused by and lead to?

A
  • Caused by: embolism, thrombosis, trauma, vasospasm, inflammation, arteriosclerosis
  • Leads to: Deficits in arterial, venous, lymphatic systems
34
Q

How do electrical burns occur?

A

Direct contact with high-voltage electrical current

35
Q

How can thermal burns occur?

A
  • Extreme heat
  • Frostbite
36
Q

Name some examples of trauma that can cause amputations

A
  • MVA
  • non-union fractures
  • Military conflicts
  • Work accidents
37
Q

Why has the number of wartime amputations decreased?

A
  • Recent wars have lowest fatality rates
  • Improvement in body armor
  • Tourniquet use
  • Surgeons deployed
38
Q

What is limb deficiencies?

A
  • Congenital amputation
  • Partial or total absence of a structure along the long axis of a segment
39
Q

How can limb deficiencies be treated?

A
  • Possible surgical intervention (Ilizarov-Limb lengthening procedure)
  • amputation
40
Q

What are the goals of PT with limb deficiencies?

A
  • Maintain ROM above & below fixation
  • Strengthen the limb
  • Encourage weight bearing
  • Increase endurance
  • Restore function
41
Q

What are the general principles of amputation in children?

A
  • Preserve proximal joints (hip, knee)
  • Preserve length (growth plates)
  • Amputate through the joint if vital bone can not be salvaged
  • Proximal osteotomies or external fixation techniques may be needed to accommodate growth
42
Q

What is the level of amputation dependent on?

A
  • Vascular status of limb
  • Neuropathy
  • Infection
  • Necrosis
  • Malignancy
  • Bone & joint condition
  • Age
  • Function & rehab potential
43
Q

What is a tarsometatarsal (lisfranc) amputation?

A
  • Removal of metatarsals
  • Preserved the dorsiflexors & plantar flexors
44
Q

What is a transverse tarsal (chopart) amputation?

A
  • Amputation through the talonavicular & calcaneocuboid joints
  • Preserves the plantar flexors but sacrifices the dorsiflexors often resulting in equines contracture
45
Q

What is symes amputation?

A

Removal of the foot & ankle joint with removal of malleoli

46
Q

What is a transtibial amputation?

A

Removal of the lower extremity below the knee joint

47
Q

What is the knee disarticulation amputation?

A

Removal of the lower extremity through the knee joint

48
Q

What is a transfemoral amputation?

A

Removal of the lower extremity above the knee joint

49
Q

What is hip disarticulation amputation?

A

Surgical removal of the lower extremity from the pelvis

50
Q

What is a hemipelvectomy?

A

Removal of 1/2 of the pelvis & lower extremity

51
Q

What is a hemicorporectomy?

A

Removal of the pelvis & both lower extremities

52
Q

What is digital amputation?

A

Removal of a digit at either the metacarpophalangeal, proximal interphalangeal, or distal interphalangeal level

53
Q

What is a partial hand amputation?

A

Removal of a portion of the hand and the digits at either the trans carpal, transmetacarpal, or transphalangeal level

54
Q

What is wrist disarticulation amputation?

A

Removal of the hand through the wrist joint

55
Q

What is a transradial amputation?

A

Removal of the upper extremity distal to the elbow joint

56
Q

What is an elbow disarticulation amputation?

A

Removal of the upper extremity through elbow joint

57
Q

What is a transhumeral amputation?

A

Removal of the upper extremity proximal to the elbow joint

58
Q

What is a shoulder disarticulation amputation?

A

Removal of the upper extremity through the shoulder

59
Q

What is a forequarter amputation?

A

Remove of the upper extremity including the shoulder girdle

60
Q

Describe K0 level

A

Patient is not able or does not have the potential to ambulate or transfer safely with or without the assistance and a prosthesis does not enhance mobility

61
Q

Describe K1 Level

A
  • Patient has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces a fixed cadence
  • Household ambulator
62
Q

Describe K2 Level

A
  • Patient has the ability potential for ambulation to transverse low-level environmental barriers such as curbs, stairs, uneven terrain
  • Community ambulator
63
Q

Describe K3 Level

A
  • Patient has the ability or potential for ambulation with variable cadence
  • Community ambulator with activity level beyond simple locomotion
64
Q

Describe K4 Level

A
  • Patient has the ability or potential for ambulation beyond basic ambulation exhibiting high impact, stress, or energy levels
  • Typical child, active adult or athlete
65
Q

What is the purpose of the L Test?

A

Assess function & dynamic balance

66
Q

What is the MCID of the L Test?

A

4.5 seconds

67
Q

What is the AMPnoPRO used for?

A

Greatest potential to asset in prosthetic prescription

68
Q

What is the MDC for AMP test?

A

3.4 points

69
Q

What is included in the Prosthesis Evaluation Questionnaire (PEQ)?

A

Most question use a VAS scale to assess satisfaction, well-being, frustration, pain & residual limb health

70
Q

What does the Orthotics Prosthetics User Survey consist of?

A

Functional status, quality of life & satisfaction modules

71
Q

What is the Trinity Amputation and Prosthesis Experience Scales - Revised examine?

A

Multi-dimensional instrument designed to examine the psychosocial process of amputation & prosthesis

Prosthetics/Orthotics (12 decks)

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