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LL Px > MT: Transfemoral Surgery & Post Op Care > Flashcards

MT: Transfemoral Surgery & Post Op Care Flashcards

1
Q

Causes for TF amputations

A
  • older
  • more corborbidities
  • majority vascular
    * diabetes (10x more likely to have TF amp)
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2
Q

When is mortality rate 100% higher in TF than TT

A

within the first 30 days

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3
Q

Considerations and complications for TF amp

A
  • Tf expend more energy
  • longer limb = better suspension
  • muscle atrophy
  • more time sitting than TT
  • femur can protrude
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4
Q

Muscle atrophy in TF

A
  • inversely proportional to limb length (shorter limb = more atrophy)
  • hip extensors
  • hip adductors
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5
Q

Traditional TF Amputation

A
  • No consideration of muscular imbalance
  • no beveling of the femur
  • shorter surgery decreases risks of complications
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6
Q

Knee Disarticulation Pros

A
  • longer lever arm
  • more musculature preserved (adductor magnus)
  • less energy expenditure
  • some distal weight bearing
  • self suspending
  • no need for IC
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7
Q

Knee Disarticulation Cons

A
  • cosmesis
  • bulbous
  • knee centers do not match
  • limited componentry
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8
Q

Candidates for KD

A
  • peds
  • active individuals
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9
Q

Peds KD

A
  • disartics dont have issues with bony overgrowth
  • preserves length/growth plates
  • growth plates can be fused to allow TF length, with KD functionally
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10
Q

Once the amputation is proximal to the femoral condyles:

A
  • still no knee extensors
  • still weakened hip extensors
  • further weakened hip adductors
  • lack of stabilization of femur in all planes
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11
Q

What muscles are rarely impacted by TF amp

A
  • hip flexors
  • hip abductors
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12
Q

What is always transected in TF amputation

A

Quads

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13
Q

What anterior musculature is never transected

A
  • Iliopsoas
  • hip flexor strength unimpacted
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14
Q

What medial musculature will always be transected

A
  • adductor musculature
  • amputation of distal 1/3 femure results in 70% loss of adductor strength
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15
Q

How will loss of adductor strength impact the patients gait/control?

A

inability to stabilize femur in coronal plane

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16
Q

What lateral musculature are not transected?

A

gluteus medius

17
Q

When a TF amputee fires their unimpacted abductors, what happens?

A

Shift of the center of mass to closer to the femoral head to decrease the moment

18
Q

Trendelenburg Gait

A
  • femur of amputee is no longer attached to ground
  • abductor musculature is comromised
  • not musculoskeletal support for ML stability in the hip (no collateral ligaments)

I THINK I HAD THIS WRONG ORIGINALLY

19
Q

what is impacted with TF surgery

A

loss of hip extensor strength

20
Q

Where do hip extensors insert

A
  • hamstrings: posterior tibia
  • **glutes **: 1/4 gluteal tuberosity of femur; 3/4 in iliotibial tract

transfemoral amputations lose MOST of these important muscles

21
Q

Osseointegration

A
  • eliminates the socket
  • componetry is attached directly to bone
  • persistant socket and /or skin issues
22
Q

Van Nes Rotationplasty

A
  • usually done for osteosarcoma
  • foot/ankle are rotated 180 deg
  • ankle acts the knee
  • foot acts like transtibial residual limb
23
Q

Staged amputation

A
  • primarily when medical condition of patient is extremely poor
  • surgeon performs guillotine amputation initially
  • evaluates if it will heal
  • performs closure later
24
Q

Pediatrics

A
  • preserve as much length as possible
  • preserve growth plates if possible
  • perform disarticulations if possible
25
Q

Post Surgical Care Goals TF

A
  • **Prevent **contractures
  • Decrease pain, edema, bulbous distal end
  • Promote strength, balance, control
  • preparefor prosthetic care
26
Q

Issues with Shrinkers

A
  • thighs are conical
  • lots of soft tissue
  • going proximal to the next joint is an issue
27
Q

Issues with RRDs and IPOPs for TF

A
  • same as shrinker
  • must used belt or shoulder harness
  • suspension is a huge issue

LL Px (26 decks)

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