Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

From Flashcardlet > -P11 P&OS1: AD&PF > Flashcards

-P11 P&OS1: AD&PF Flashcards

0
Q

Anaesthesia

A

-temporary state consisting of unconsciousness, loss of memory, lack of pain and muscle relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

James Syme (7)

A
  • 1799-1870
  • Professor of Clinical Surgery, University of Edinburgh
  • Amputation at the ankle joint 1st performed in 1842
  • Pre-anaesthesia
  • Pre-antisepsis
  • 22 years before Lister
  • His daughter married Joseph Lister (anti-septics)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Antisepsis

A

-Prevention of infection by inhibiting or arresting the growth and multiplication of germs (infectious agents)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Antiseptic

A

-antimicrobial substances that are applied to living tissue/skin to reduce possibility of infection sepsis or putrefaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Causes of AD amputation (5)

A
  • trauma and infection of forefoot
  • malignant tumour
  • vascular disease incl diabetes
  • congenital deformity eg fibula hemimelia
  • neurological lesions eg spina bifida occulta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Total no of ad amputations referred to uk pros service in 2005/06

A

12

Previous years on average 26 AD amputations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Malignant

A

-tendency of a medical condition to become progressively worse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Vascular disease

A

-any condition that affects the circulatory system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Fibular hemimelia

A
  • Congenital absence of the fibula

- most common congenital absence of long bone of the extremities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Spina Bifida Occulta

A

-Group of conditions affecting the spinal column

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Objectives of ad amputation (4)

A
  • intact, viable, end-bearing heel pad
  • heel pad firmly adhered to broad, horizontal tibial surface
  • healing by first intention
  • scar free from tenderness or adherence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Viable

A

-capable of working successfully

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Tender

A

-sensitive to pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

AD surgical technique (4)

A
  • The plane of the saw cut must be parallel with the ground so as to give a horizontal weight bearing surface
  • important that posterior tibial artery remains viable to ensure good blood supply to heel flap
  • suture line should be just above tibial margin
  • wound drainage essential to allow instillation of antibiotics and along with antiseptic dressings should allow the stump to heal by primary closure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Suture

A
  • commonly called stitches

- medical device used to hold body tissues together after an injury or surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Antibiotics

A

-medications used to treat, and in some cases prevent bacterial infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Causes of failure for AD amputation (7)

A
  • non-viability of heel pad
  • secondary death of heel flap eg due to thrombosis
  • poor fixation of the flap
  • surgical error resulting in migration of the heel pad… May be associated with
    • tibial surface not parallel with floor
    • neuroma of posterior tibial nerve
    • insecure dressings - rigid dressing essential to maintain position of heel pad during healing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Viability

A

-the ability of a living thing to maintain itself or recover its potentialities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Thrombosis

A

Formation of a blood clot inside a blood vessel obstructing the flow of blood through the circulatory system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Neuroma

A

Growth or tumor of nerve tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Ad stump characteristics (4)

A
  • retention of heel pad
  • distal end bearing
  • bulbous distal end
  • long stump
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Bulbous

A

Fat round or bulging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Advantages of ad (5)

A
  • good proprioceptive feedback
  • reduced energy costs cf. TT level
  • epiphyseal growth plate retained
  • good suspension
  • range of prosthetic feet now available
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Proprioception

A

A sense of how our bodies are positioned

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Cf.

A

Compare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Epiphyseal plate

A
  • Hyaline cartilage plate in the metaphysis at each end of a long bone
  • found in children and adolescents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Suspension

A

How a prosthesis is held onto your residual limb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Residual

A

Remaining after the greater part or quantity has gone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Disadvantages of AD (3)

A
  • Reduced range of prosthetic feet available cf. TT level
  • Reduced alignment options particularly where length discrepancy is minimal
  • Bulbous distal end uncosmetic (particularly for women)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Alignment

A

The process of adjusting parts so that they are in proper relative position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Discrepancy

A

Difference or inconsistency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Cosmetic

A

Relating to treatment intended to restore or improve a person’s appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Ad socket design requirements (5)

A
  • comfortable load transfer
  • total contact?
  • control rotation
  • provide suspension
  • cosmesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Ad socket design things to consider (3)

A
  • must be easy to don/doff
  • interface?
  • provide suspension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Don

A

To put on

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Doff

A

To remove

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Interface

A

A point where two things connect or interact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Ad socket designs (4)

A
  • push fit with pelite liner
  • panel (medial)
  • hard socket
  • zipped entry
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Ad Panel (medial) description (2)

A
  • retained by velcro fastening

- often requires carbon fibre re-inforcement around panel to reduce risk of socket failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Ad hard socket description (1)

A

-minimal bulbous end improved cosmesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Ad zipped socket description (1)

A

Polyurethane lamination with integral carbon fibre frame

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Lamination

A

Technique of manufacturing a material in multiple layers to make a composite material

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Integral

A

Essential

Belonging as a part of the whole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Ad socket suspension (3)

A
  • supramalleolar
  • supracondylar and/or suprapatellar…when????
  • locking liner…..when???
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Supra

A

Above

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Ad another type of liner

A

Custom made silicone liners

-when would this type of liner be useful?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Ad casting (2)

A
  • wrap casting

- slab castinf

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Ad wrap casting (1)

A

-additional casting sock or tubigrip required due to stump atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Ad slab casting (1)

A

-bivalve casting technique used to avoid use of tubing to remove cast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Tubigrip

A

Elasticated tubular bandage
Provides firm and comfortable support
Can also be used to reduce swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Atrophy

A

Partial or complete wasting away of part of the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Bivalve

A

Having 2 halves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Ad cast modification (2)

A
  • similar principles as tt modification

- but with much less aggressive approach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Ad prosthetic components (1)

A

-selection of components dependent on stump to ground clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Ad alignment mechanisms (2)

A

-low profile adaptors attached directly to distal end of socket to provide inv/eversion and pl/dorsiflexion plus rotation
OR
-where length discrepancy is minimal…socket may be bonded directly to foot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Ad prosthetic feet

A
  • pirigoff
  • seattle litefoot
  • energy storing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Ankle disarticulation in relation to congenital deformity (4)

A
  • congenital longitudinal deficiency of the fibula
  • proximal femoral focal deficiency (PFFD)
  • absent lateral ray of the foot
  • anterior tibial bowing of the tibia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Ad Prosthetic management of cldf

A

Exoskeletal prosthesis with s/c suspension or custom silicone locking liner

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Cldf

A

Congenital longitudinal deficiency of the fibula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Exoskeletal

A

External skeleton

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

S/c

A

Supracondylar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Ad prosthetic management of pffd (5)

A
  • extension prosthesis for pre-school years
  • future decisions required:
    • do nothing (poor function and cosmesis)
    • ankle disarticulation and knee arthrodesis (better cosmesis and function)
    • Van Ness rotationplasty (poor cosmesis, good function)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Pffd

A

Proximal focal femoral deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Arthrodesis

A

Artificial induction of joint ossification between two bones via surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Ad prosthetic management of pffd: Van Ness Rotationplasty (3)

A
  • substitution of the patients own biological ankle joint for the resected knee joint,
  • converting what would classically be an above-knee amputation to a functional below-the-knee amputation
  • with the benefits of voluntary control of joint motion at the knee level
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Resected

A

Cut out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Partial foot amputation principles (6)

A
  • preserve length
  • maintain ankle joint
  • result=improved function
    • better push off
    • more normal gait
  • but is this true?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

More partial foot principles (5)

A
  • disuse atrophy calf
  • power generation across ankle
    • mtp level - normal
    • proximal to mtp level - negligible regardless of the residual foot length
  • compensate for loss of power generation at ankle by use of hip
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Partial foot principles conclusion (3)

A
  • if cannot preserve the metacarpal heads to allow amputees to use ankle,
  • then the length of residual foot is much less important
  • than achieving good distal soft tissue coverage and healing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Partial foot classifications (6)

A
  • transverse
    • mtp level
    • proximal to mtp level
      • lisfranc
      • chopart
  • longitudinal ray amputation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Transverse

A

Extending across something

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Longitudinal

A

Running lengthwise rather than across

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Partial foot mtp level prostheses (3)

A
  • nothing
  • simple toe filler
  • moulded arch support
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Lisfranc/chopart prostheses (1)

A

-leather/silicone prosthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Longitudinal ray amputation prostheses (2)

A
  • nothing

- moulded arch support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Ad symes amp positives (3)

A
  • if good very good
    • only minimal increase energy consumption
    • mist satisfactory functional lower limb amputation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Ad symes amp negatives (5)

A
  • if bad then very bad
    • higher failure rate (15% v TTA 10%)
    • post tibial artery insufficiency - flap necrosis
    • heel pad migration - non weight bearing position
    • absolutely valueless requiring revision at a more proximal level
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Historical insights for symes (2)

A
  • not used in dysvascular due to poor stump healing

- objective tests of tissue perfusion plus better case selection - improved success rates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Perfusion

A

Process of a body delivering blood to a capillary bed in its biological tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Ad advantages (6)

A
  • end bearing
  • long lever arm
  • excellent proprioceptive feedback
  • tough, durable heel flap designed for weight bearing
  • minimal increase energy consumption
  • minimal functional deficit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Ad disadvantages (3)

A
  • increased failure rate (15%)
  • cosmesis due to tibial flare/ bulk
  • space for prosthetic ankle mechanism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Ad indications (6)

A
  • congenital
    • fibular hemimelia
  • acquired conditions of anterior foot
    • trauma
    • diabetic foot
    • pvd/gangrene
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Ad pre-assessment (5)

A
  • general health/ fitness for anaesthesia
  • objective tests to assess amputation level
    • need adequate posterior tibial blood flow tissue perfusion
    • need healthy-heel pad with normal tissue elasticity and turgor
  • multidisciplinary assessment/rehab team
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Turgor

A

Degree of elasticity of skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Classical ad technique (8)

A
  • incision
    • long posterior flap
  • excision tarsus
  • division of tibia and fibula
  • division of tendons/nerves/vessels
  • debridement and stabilisation heel flap
    • management of dog ears
  • dressing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Incision

A

A surgical cut made in skin or flesh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Excision

A

Surgical removal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Tarsus

A

Area of articulation between foot and leg comprising the 7 bones of the instep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Debridement

A

Medical removal of dead, damaged or infected tissue to improve the healing potential of the remaining healthy tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Dog ears

A

Redundancy at the end of a wound closure caused by repairing skin edges of unequal length

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Dressing

A

Sterile pad or compress applied to a wound to promote healing and/or prevent further harm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Two stage syme amp indications (2)

A
  • Gross infection

- good local vascularity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Gross

A

Total exclusive of deduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Two stage syme procedure (4)

A
  • simple disarticulation
  • symes type closure suction irrigation plus A/b irrigation until infection resolved
  • after 6/52 infection resolved and healthy flap 2nd stage remove; malleoli and narrows stump
  • nb additional indications and surgical techniques
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Suction

A

Flow of a fluid into a partial vacuum or region of low pressure. The pressure gradient between this region and the ambient pressure will propel matter toward the low pressure area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Irrigation

A

Washing of a body cavity or wound by stream of water or other fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

A/b

A

Acid base ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Nb

A

Note well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Sarmiento ad technique (2)

A
  • divides tibia/malleoli 13cm proximal to joint line therefore less bulbous stump suitable for plunge fit prosthesis
  • modifications include simply shaving bony flares to narrow width of stump
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Ad post operative management (6)

A
  • oedema control
  • physiotherapy input
    • little if any gait training required
  • early mobilisation using a volume acceptable walking aid
    • ppam aid proven to be successful commencing around 7 days post op
  • early referral for prosthesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Ad wrap casting preparation (6)

A
  • assessment
  • measurements
  • sock interfaces
  • markings
  • cast wrapping
  • cast removal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Ad wrap casting: assessment check (9)

A
  • heel pad
  • malleolar remnants
  • scar
  • distal pressure tolerance
  • fibula?
  • tissue consistency
  • skin condition
  • knee joint integrity
  • thigh and hip muscle strength
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Ad wrap casting: measurements (7)

A
  • vertical distance between end of stump and floor (patient weight-bearing, pelvis level)
  • m-l and a-p measurements at distal end
  • m-l measurement at knee (knee extended)
  • length of foot
  • widest circumference bulbous distal end
  • narrowest circumference proximal to bulbous end
  • cosmetic measures of sound side
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Ad wrap casting: sock interfaces (3)

A
  • apply tubigrip, then stockinette sock
  • tension can be applied proximally to stockinette using elastic webbing around waist of patient and secured with clips proximal to and medial and lateral to knee
  • tubing to be inserted before marking, between tibia and fibula. Tube to be as distal as possible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Ad wrap casting: markings (10)

A
  • patella
  • tibial tubercle
  • mid patella tendon
  • medial tibial flare
  • medial and lateral border of tibia
  • crest of tibia
  • head of fibula
  • anterior lateral aspect of tibial condyle (if prominent)
  • proximal edge of medial and lateral malleoli
  • any other bony prominences
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Ad wrap casting: cast wrapping (5)

A
  • Start proximally, just below edge of femoral condyles
  • concentrate on tension of non-elastic 15cm bandage (use 10cm if appropriate)
  • focus on triangular shape
  • second wrap must cover distal end. Mould bandages well to avoid delamination of cast upon removal
  • mould around bulbous end to recreate shape. Flatten posterior-proximal third of cast
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Ad wrap casting: cast removal (4)

A
  • cast is easier to remove if bandage is not allowed to set completely (when still a little warm)
  • using correct techniques for cast saw operation, cut along the entire length of tube, penetrating first stockinette layer (leave tubigrip layer intact)
  • part cast gently at narrowest point of distal end
  • slide cast distally as patient draws limb proximally
107
Q

Ad casting pre measures (3)

A
  • assess gait
  • assess ability to end bear
  • assess stability of end pad
108
Q

Ad casting procedure: take measures (6)

A
  • m/l at knee
  • m/l at distal end
  • a/p at distal end
  • m/l and circumference at narrowest part
  • end of stump to ground
  • length of foot and heel height
109
Q

Ad casting procedure: pre casting (5)

A
  • don a tubigrip sock (2 socks may be required)
  • don moisturised, stockinette cast sock
  • secure with elastics
  • insert cutting tube
  • mark the sock
110
Q

Ad casting technique: casting (2)

A
  • use 15cm non-elastic bandages (1,1.5 or 2 depending on stump)
  • pre shape the cast
111
Q

Ad casting techniques: post wrapping (3)

A
  • while the plaster is setting
  • cut off the cast
  • inspect cast and seal
112
Q

Ad casting: assess gait (2)

A
  • look at: walking base, turn out of toe, adduction angle of socket
  • this will help with bench alignment
113
Q

Ad casting: assess ability to end bear (2)

A
  • question amputee, careful palpitation of stump end, and ask amputee to demonstrate
  • this will help with decision on amount of proximal rectification necessary
114
Q

Ad casting: assess stability of end pad (2)

A
  • by palpation

- an unstable end pad indicates care is required when donning cast sock, to hold pad in correct position for casting

115
Q

Ad casting measures: m/l at knee (2)

A
  • with diameter stick

- snug fit at knee will aid m/l stability

116
Q

Ad casting measures: m/l at distal end (2)

A
  • with diameter stick and with some pressure, using a hand, pushing up on the distal end
  • the distal fit must not be too tight, particularly against the malleoli
117
Q

Ad casting measures: a/p at distal end (1)

A

-taken same way at m/l at distal end

118
Q

Ad casting measures: m/l and circumference at narrowest part (1)

A

-this area will provide suspension

119
Q

Ad casting measures: end of stump to ground (2)

A
  • amputee, with shoe off, stands on height blocks, which are adjusted until the pelvis is level
  • provides an accurate set-up height
120
Q

Ad casting measures: length of foot and heel height (1)

A

-for selection of prosthetic foot

121
Q

Ad pre casting: Don a tubigrip sock (3)

A
  • two socks may be required
  • by pulling on previously sewn sock snuggly on to stump
  • given the atrophied nature of the stump this gives allowance for the stump sock. A plaster model rectified to the correct shape may produce too tight a socket if the Tubigrip is not applied
122
Q

Ad Pre casting: don moistened, stockinette cast sock (2)

A
  • pull on carefully maintaining distal pressure

- moistened to take indelible marks

123
Q

Ad pre casting: secure with elastics (2)

A
  • round waist of amputee

- this sock may move during casting

124
Q

Ad precasting: insert cutting tube (3)

A
  • push down, between tubigrip and stockinette, so that it lies in the soft tissue area between tibia and fibula. Make certain tube is as distal as possible.
  • this avoids most of the bony prominences
  • if tube is not distal the cast will not open easily, once cut…to allow removal
125
Q

Ad precasting: mark the sock (2)

A
  • patella, top of tibial tubercle, mid patellar tendon, medial tibial flare and border of tibia, lateral tibial flare and border of tibia, crest of tibia, head of fibula, malleolar prominences, any other features as required.
  • all will be useful marks during modification
126
Q

Ad casting: use 15cm nonelastic bandage (6)

A
  • 1,1.5 or 2 depending on stump
  • start at mid-patella
  • three turns of bandage at this level, then proceed down the leg wrapping circumferentially or in a figure of eight style.
  • wrap loosely and mould plaster round the cutting tube
  • three turns to ensure top of cast is strong enough
  • to avoid bridging across the tube, which would give a distorted shape
127
Q

Ad casting: pre shape the cast (4)

A
  • maintain the triangular shape of the anterior cross section and emphasize the medial flare where possible
  • cup the distal end of the cast before the plaster hardens and push upwards keeping the hand in a position to reflect the correct adduction/flexion angle
  • some of the weight support may come from the proximal cast
  • to flatten gently the stump end into a shape that will occur upon weight bearing
128
Q

Ad casting post wrapping: while the plaster is setting (2)

A
  • mark the line of the cutting tube and draw on cross hatch lines
  • as a precaution against distortion of cast when it is cut off
129
Q

Ad casting: cut off the cast (1)

A

-release the elastics, use cast saw to cut down line of the tube, withdraw the tube and finish cut with bandage scissors, leaving the tubigrip on the stump

130
Q

Ad casting post wrapping: inspect cast and seal (1)

A

-using a narrow strip of plaster bandage

131
Q

Ad modification notes (8)

A
  • remove tube line between tibia and fibula
  • reinforce indelible marks
  • compare measurements of cast to those taken of limb
  • flatten slightly the distal end (perpendicular to the long axis of limb)
  • decide on areas of plaster removal (dependant on required pressure distribution). If more proximal weight bearing is required, utilise cast modification principles for trans-tibial prosthetics
  • remove: behind medial flare
  • build up: crest of tibia
  • panel position
132
Q

Ad mod remove behind medial flare (4)

A
  • between crest of tibia and medial flare
  • behind lateral flare
  • between fibula head and lateral malleoli
  • create subtle tibial flare above tibial tubercle
133
Q

Ad modification build up crest of tibia (4)

A
  • anterior lateral prominence of tibial condyle
  • head of fibula
  • medial and lateral malleoli (if prominent or painful)
  • create subtle posterior shelf at level of tibial tubercle
134
Q

Ad modification panel position (5)

A
  • using spring callipers, ascertain widest point of distal end (m-l or a-p of malleoli)
  • mark this proximally on medial side. Add up to 1.5cm if necessary
  • anterior long side of panel is marked 1cm medial to crest of tibia
  • posterior long side of panel is marked 1cm medial to posterior midline
  • long sides of panel must run parallel to long axis of limb
135
Q

Ad modification (7)

A
  • strip plaster bandaging
  • reinforce any indelible marks which are too faint
  • remove tube line between tibia and fibula
  • compare and check measures of cast against measures taken from stump
  • decide on extent of plaster removal
  • plaster removal
  • plaster build-ups
136
Q

Ad modification: strip plaster bandaging (1)

A

-remove sealing strip and pare off bandages and sock

137
Q

Ad modification: reinforce any indelible marks which are too faint (2)

A
  • by removing bandages very carefully, the underlying indelible marks can be identified and remarked, if required
  • if the marks are lost the modification will be part guesswork
138
Q

Ad modification: remove tube line between tibia and fibula (1)

A

-carefully with a knife or surform

139
Q

Ad modification: compare and check measures of cast against measures taken from stump (2)

A
  • both sets of measures should be written down

- to allow a plan to be formed as to the way to proceed and in order to accurately follow the procedure as it evolves

140
Q

Ad modification: decide on extent of plaster removal (2)

A
  • from the patient examination will have come an idea of the required distribution of the weight transfer, proximal/distal
  • only correct distribution of weight transfer between proximal and distal will provide maximum comfort for the amputee
141
Q

Ad plaster removal areas (7)

A
  • medial flare area
  • behind medial border of tibia
  • medial aspect of tibia
  • length of fibula
  • lateral flare area
  • between tibia and fibula
  • between patella and tibial tubercle
142
Q

Ad plaster removal (2)

A
  • plaster is removed in a manner similar to that used for transtibial plaster models, only to a reduced extent
  • the goals are similar to transtibial: some weight transfer, resistance to rotation, and protection of vulnerable tissue
143
Q

Ad plaster removal: between patella and tibial tubercle (2)

A
  • a very shallow indentation

- to provide a flared anterior proximal edge to socket

144
Q

Ad modification plaster build ups (6)

A
  • crest of tibia
  • head of fibula
  • malleoli
  • posterior shelf
  • establish proximal socket edge
  • smooth cast
145
Q

Ad plaster build-ups: crest of tibia (3)

A
  • unlike trans-tibial work, the crest receives a slight build up
  • because of the extreme atrophy of the stump, the crest is very exposed.
  • The socket tends to rotate around the stump giving a further possibility of tissue damage if the crest is not protected
146
Q

Ad plaster build ups: malleoli (1)

A

-only if prominent or painful, or if the m/l diameter of the model is undersized

147
Q

Ad plaster build ups: posterior shelf (3)

A
  • at the level of mid tibial tubercle
  • because of the suspension over the bulbous end, the stump does not retract from the socket when the amputee sits, as happens in transtibial.
  • Hence the need for a more distal shelf than at transtibial level
148
Q

Ad build ups: establish proximal socket edge (2)

A
  • at front, just above indent between patella and tibial tubercle.
  • Trim line sweeps up on either side of the knee and comes down at the back to meet posterior shelf.
149
Q

Ad plaster buildups: smooth cast (2)

A
  • a very gently rub with screening or wet and dry

- it would be easy, given such thin models, to polish too enthusiastically and finish with an undersized cast

150
Q

Ad measurement sheet first section (10)

A
  • surname (Mr, Mrs etc)
  • first name
  • p/o unit no.
  • date of birth
  • sex: M or F
  • status: primary or established
  • side: L or R
  • height
  • weight
  • date of amputation
151
Q

Ad measurement sheet second section (4)

A
  • new prosthesis
  • new socket
  • repair
  • if new socket/repair give details
152
Q

Ad measurement sheet: specification of prosthesis (6)

A
  • socket type:
    • panel opening : specify
    • push fit: specify
  • foot/ankle: specify
    • size
    • heel height
153
Q

Ad measurement sheet stump measures (4)

A
  • stump description
  • hip musculature: residuum (0-5) : flexion, extension, adduction, abduction
  • Knee musculature: residuum (0-5) : flexion, extension
  • condition of knee joint: stability, range, patella, contracture
154
Q

Ad measurement sheet: dates etc (8)

A
  • prosthetist/orthotist
  • lecturer
  • technician (to fitting stage), date
  • technician (to delivery stage), date
  • date of casting/measuring, date to workshop
  • date required for fitting, date of fitting
  • date required for 2nd fitting (if applicable), date of 2nd fitting
  • date required for delivery, date of delivery
155
Q

Ad measurement sheet: patient measurements (11)

A
  • distance from end of stump to floor (weight bearing, pelvis level)
  • distance from tibial plateau to end of stump (weight bearing)
  • distance from tibial plateau to floor (sound side)
  • stump circumference distal end (largest part)
  • stump circumference at narrowest part
  • medio-lateral width at distal end
  • antero-posterior width at distal end
  • width at narrowest point
  • calf circumference sound side, distance from floor
  • ankle circumference sound side, distance from floor
  • length of foot, heel height
156
Q

Ad measurement sheet: last section (1)

A

-finishing instructions

157
Q

Ad casting assessment (3)

A
  • if your pt is an established prosthetic user, assess their gait whilst they are wearing their existing prosthesis
  • examine the distal end pad for stability and ability to end bear
  • take the required measurements
158
Q

Ad casting assessment measurements (7)

A
  • vertical distance between end of stump and floor (patient weight-bearing, pelvis level)
  • m-l and a-p measurements at distal level
  • m-l measurement at knee (knee extended)
  • length of foot
  • widest circumference bulbous distal end
  • narrowest circumference proximal bulbous end
  • cosmetic measures of sound side
159
Q

Ad pre casting (4)

A
  • don, dry pre-sewn tubigrip sock, followed by wet stockinette sock, taking care to position end pad as required
  • correct tension applies through the length of sock
  • secure proximally with elastics, and insert cutting tube on lateral side, between the crest of the tibia and the shaft of the fibula (if present)
  • mark at least ten anatomical landmarks on the sock
160
Q

Ad casting anatomical landmarks markings (10)

A
  • patella
  • tibial tubercle
  • mid patella tendon
  • medial tibial flare
  • medial and lateral border of tibia
  • crest of tibia
  • head of fibula
  • anterior lateral aspect of tibial condyle (if prominent)
  • proximal edge of medial and lateral malleoli
  • any other bony prominences
161
Q

Ad casting process (3)

A
  • begin to wrap from proximal to distal, starting mid-patella level. Mould and smooth throughout. Ensure distal coverage, no bandage tension, and define the tube.
  • pre-shape the anterior proximal flare, and cup the distal end gently
  • gently flatten the posterior proximal third of the cast. How does this pre-shaping differ from that at trans-tibial level?
162
Q

Ad post casting (6)

A
  • mark the line of the cutting tube, and cross-hatch
  • using a plumb line, determine build-down lines (alignment reference lines)
  • this is only accurate if your patients weight is as centred as possible, with their pelvis level
  • use an oscillating cutting device to cut through the plaster bandage, beginning proximally
  • plaster shears are used to complete the cut, once the cutting tube has been removed
  • the cast us carefully removed without force and inspected. The stockinette should remain laminated inside the cast
163
Q

Ad pre-modification (3)

A
  • the cast is sealed using small circumferential strips, followed by a longitudinal strip
  • a suitable length of pole is selected, which is flattened at the distal end. The pole is placed into the negative cast, before the plaster mix is poured
  • be prepared, the rectification equipment you will require
164
Q

Ad modification pre removal (8)

A
  • the bandage is removed, and indelible marks reinforced if required
  • remove tube line on the lateral side
  • take measures from your positive model
  • and compare them with those taken at the casting stage
  • decide on the extent of your plaster removal before you begin
  • mark on trim lines-anteriorly, mediolaterally and posteriorly. How do they differ from those at trans-tibial level?
  • anteriorly, at the inferior border of the patella
  • posteriorly, the trim line can be lower than the level of the anterior trim, so long as suspension of the prosthesis is maintained in sitting
165
Q

Ad modification removal section (11)

A
  • define trim and remove any excess plaster above this line
  • the shallow patella tendon indentation,creating the anterior socket flare. Gently does it…it is not as deep as that for the trans-tibial model
  • removal medial flare, behind medial border of tibia, and the medial aspect of tibia
  • medial flare
  • behind the medial border
  • lateral flare
  • lateral flare, behind lateral border of tibia, shaft of fibula, and between tibia and fibula
  • shaft of fibula
  • supramalleolar area, if more suspension is required
  • the posterior proximal third of the model is gently flattened
  • plaster is removed at the distal end of the cast extremely cautiously, to slightly pre-compress the distal end pad
166
Q

Ad modification build ups (10)

A
  • mix the plaster. One part water to one part plaster. Do not stir!
  • tibial tubercle and the length of the tibial crest
  • anterior distal aspect. Think about stump-socket interface forces at initial contact phase of gait cycle. Also addition to lateral malleoli if required
  • smooth build-ups with water soon after applying
  • fibula head. Should not resemble mount everest!
  • determine the width and height of posterior flare
  • building the posterior shelf
  • leave shelf for a few minutes, then shape as required using surforms
  • radii of shelf should resemble that of a one pence piece
  • remark the trimlines and identify your patients cast on posterior build up
167
Q

Ad cast modification: marking the position of the medial panel on a rectified positive model (11)

A
  • identify the anterior and posterior midlines and mark these on the cast
  • using spring callipers, ascertain widest diameter of distal end. Bear in mind that the widest point may be anterior-posterior rather than medial-lateral. The panel will be positioned medially even if the A-P diameter is larger than the M-L diameter. Mark the widest diameter on the medial distal side. Set the callipers to this widest diameter.
  • move callipers proximally, and mark the point on the medial side where the callipers contact the cast. This should correspond to the distal widest diameter. Add a mark 1.5cm proximal to this again.
  • again long side of panel is marked 1cm medial to crest of tibia and parallel to it.
  • posterior long side of panel is marked 1cm medial to posterior midline
  • long sides of panel must run parallel to long axis of limb
  • complete oblong panel shape by joining proximal, distal, anterior and posterior marks. The corners of the panel should not be sharp but gently curved. If the posterior proximal corner of the panel is in close proximity to the posterior flare, reduce the size of the outline panel in this area. This will maintain the strength of the socket.
  • identify the anterior and posterior midlines of the model
  • determine widest distal diameter (be mindful that it could be AP or ML) and transfer this to a point medial and proximal. Mark 1cm proximal to this.
  • panel edges marked proximal and distal
  • anterior and posterior long edges of panel, showing them parallel to anterior and posterior axes
168
Q

Why is it important to appreciate q good quality manufacture? (4)

A
  • carefully manufactures devices ensure safety and comfort for the patients who give up time to come in to help. Shoddily made items may break, putting our guests at risk of falling, or may have sharp edges liable to injure the patients
  • good manufacturing is part of the culture of neatness and precision that becomes necessary for a student who is to become good at p&o
  • pride in a job well done is a great reward for a student, but one which can only be enjoyed if a degree of effort is put into the job
  • a neatly fashioned device creates a good impression with the people who come in to help and reflects well on the student
169
Q

Ad manufacturing at nc (2)

A
  • working with PeLite and laminated plastic

- a panel may have to be cut in the plastic

170
Q

PeLite ad manufacture (5)

A
  • the seam should be well adhered, posteriorly situated and straight
  • there should be no chisel marks, indelible pencil stains, excess glue marks or other stains from workshop activities
  • edges should be smooth in contour with the edges well rounded
  • the proximal edge must be at least 5mm proud of the laminated socket edge
  • any PeLite added to the outside of a liner to provide suspension or a practical profile must be neatly finished and well adhered
171
Q

Ad acrylic laminate manufacture (6)

A
  • there should be no wrinkles in the lay-up
  • there should be no bubbles in the laminated plastic
  • care should be taken to ensure a sensible and appropriate colouring of the resin
  • PVA sheets and bags should be applied in the correct fashion to give a low sheen
  • edges of the plastic should be smooth in contour and well rounded
  • great care must be taken when cutting out a panel, with no ugly gashes caused by a poorly controlled oscillating saw
172
Q

After ad socket manufacture (3)

A
  • when a socket has been manufactured to a high standard it may have to be attached to a foot/ankle
  • all screws must be tight, with 5% turn out of the prosthetic toe
  • only when all of the above has been adhered to will a student be allowed to take a device to a patient
173
Q

Ad manufacture prior to layup (14)

A
  • outline of panel + 1cm for PeLite insert
  • cut circle of 5mm thickness PeLite + 2cm diameter. Place in oven for 2-3 minutes
  • when soft, place on top of cast
  • pull over PVA sheet to mould shape into closely fitting end cap
  • mark the cap at the same level as the panel opening
  • trim and router edges to a taper
  • apply a thin coat of glue to the PeLite, which will allow the Plastazoate to bond
  • take a circle of 10mm plastazote and apply a thin coat of glue. Allow glue to dry
  • when the glue is dry, place the plastazote in the oven until it becomes sponge like
  • using a piece of PVA sheet, again mould the cap into place
  • take the blank insert (former) and mark around cap approximately 3-4mm larger. Trim and router edges
  • to form blank for panel, cut piece of 5mm PeLite to the panel size + 2cm overall on all sides. Place in oven until soft (approximately 2 minutes)
  • form to cast with a PVA sheet
  • mark and trim 1cm larger than the panel opening on all sides
174
Q

Ad socket layup with panel (15)

A
  • soak PVA bag
  • cap end of cast with 6mm PeLite
  • pull over PVA bag
  • soak 2nd PVA bag
  • 2 layers stockinette
  • 2 layers nyglass
  • 2 layers fibreglass stockinette
  • 2 nyglass
  • position Pelite insert for panel location
  • 2 nyglass
  • 2 fibreglass stockinette
  • 2 nyglass
  • 2 stockinette
  • pull over outer PVA bag
  • now refer to instructions for cutting out panel.
175
Q

Ad manufacture socket layup without panel (8)

A
  • sock PVA bag
  • the liner dimensions are marked out of 5mm PeLite. Skive and glue as for trans-tibial liner manufacture
    • distal circ as measured
    • length of cast +18cm
    • proximal circumference +6cm. For building up of liner see workshop supervisor
  • pull over PVA bag
  • soak 2nd PVA bag
  • lay-up material in the following order:
    • 2 nyglass
    • 2 fibreglass stockinette
    • 2 nyglass
    • 2 fibreglass stockinette
    • 2 stockinette
  • pull over the outer PVA bag
176
Q

Ad manufacture lamination mix (3)

A
  • 500grammes 80/20 resin
  • 10grammes pigment (2%)
  • 15grammes hardener (3%)
177
Q

Ad manufacture cutting the panel (3)

A
  • mark the cut line of the panel and carefully cut through the first layer of the lamination until the saw touches the PeLite.
  • only remove the outer layer, and then remove the PeLite
  • now cut 1cm approx from the edge to remove the waste material
178
Q

What is included in ankle disarticulation alignment? (5)

A
  • gait assessment
  • preparation
  • static alignment
  • dynamic alignment
  • sitting position
179
Q

Ad alignment: gait assessment (3)

A
  • ask patient to walk in current prosthesis
  • peculiarities of gait
  • examine stump
180
Q

Ad alignment:preparation (3)

A
  • shoe fit
  • observe pylon post from side
  • check screws and gluinf
181
Q

Ad alignment: static alignment (8)

A
  • sock fit mention nylon sock also
  • pelite liner fit
  • panel position and fit of soft tissue
  • ap alignment
  • ml alignment
  • prosthesis length
  • efficiency of suspensiom
  • toe out
182
Q

Ad alignment: dynamic alignment (7)

A
  • prosthetic foot flat on the floor at mid-stance
  • plantar/dorsiflexion angle
  • walking base
  • toe out
  • AP position of foot
  • pistoning
  • recheck length
183
Q

Ad alignment:sitting position (2)

A
  • knee flexed to 90 degrees

- trim lines

184
Q

What are the ad checkout stages? (6)

A
  • initial
  • with the patient standing
  • with the patient sitting
  • with the patient walking
  • with the prosthesis off
  • following from above
185
Q

What are the initial ad checkout stages? (2)

A
  • is the prosthesis as prescribed with an appropriate suspension method and foot?
  • can the patient don the prosthesis easily and properly
186
Q

Ad checkout: with the patient standing (5)

A
  • is the socket comfortable
  • is the anteroposterior alignment of the prosthesis satisfactory
  • is the mediolateral alignment satisfactory
  • is the prosthesis the correct length
  • is piston action minimal when the patient raises the prosthesis
187
Q

Ad checkout: with the patient sitting (1)

A

-can the patient sit comfortably with minimal bunching of soft tissues in the popliteal region

188
Q

Ad checkout: with the patient walking (7)

A
  • indicate gait deviations that require attention
  • is piston action between stump and socket minimal
  • can the patient go up and down stairs and inclines satisfactory
  • is the prosthesis comfortable
  • does the prosthesis function quietly
  • can the patient kneel
  • does the patient consider the prosthesis satisfactory
189
Q

Ad checkout: with the prosthesis off (4)

A
  • is the patients stump free from abrasion, discolouration and excessive perspiration immediately after the prosthesis removed?
  • does weight bearing appear to be distributed over the proper areas of the proximal stump?
  • does there appear to be an appropriate proportion of weight borne by the distal end of the stump?
  • is the general workmanship satisfactory?
190
Q

Ad checkout: following from the above (1)

A

-is the prosthesis satisfactory

191
Q

Partial foot prosthetics indications for local amputation at the foot (7)

A
  • diabetes
  • rheumatoid arthritis
  • tumour
  • trauma
  • osteomyelitis
  • congenital
  • frostbite
192
Q

Partial foot prosthetics national statistics database (3)

A
  • 2005/06
  • 67 referrals to the prosthetic service for treatment
  • many more partial foot amputations carried but probably referred for orthotic treatment
193
Q

Nervous system (2)

A
  • somatic

- autonomic

194
Q

Somatic nervous system (5)

A

-awareness of external environment

  • touch
  • pressure
  • pain
  • temperature
195
Q

Autonomic nervous system (2)

A
  • regulates, coordinates and adjusts visceral function

- CNS & PNS components

196
Q

Diabetic peripheral neuropathies in relation to partial foot (4)

A
  • thickening of walls of nutrient vessels which supply nerve
  • vessel ischemia
  • demyelination of schwann cell
  • slowing of nerve conduction
197
Q

Partial foot. Chronic complications of autonomic system affects (4)

A
  • retina
  • blood vessels
  • kidneys
  • peripheral nervous system
198
Q

Partial foot. Chronic complications of autonomic system presents as (5)

A
  • impaired sweating
  • impaired control of heart rate
  • impaired gastric and esophageal motility
  • impotence
  • papillary disturbances of eye
199
Q

Partial foot. Chronic complications of somatic system (4)

A
  • loss of feeling, touch and positional sense
  • increases risk of falling
  • impairment of temperature and pain sensation
  • increases risk of burns, foot injury or ulceration
200
Q

Partial foot. Diabetic complications of the somatic nervous system. (3)

A
  • mononeuropathies
  • polyneuropathies
  • amyotrophy
201
Q

Partial foot amputation advantages (7)

A
  • talocrural, subtalar and midtarsal joint integrity is maintained (dependent on amp level)
  • variable portion of toe-lever is intact (dependent on amp level)
  • limb length maintained
  • normal proprioceptive feedback
  • not dependent on prosthesis for ambulation
  • less drastic alteration of body image
  • less conspicuous and more cosmetically acceptable prosthesis (matter of opinion)
202
Q

Partial foot disadvantages (4)

A
  • Muscle disruption often leads to equinovarus deformity (weak intrinsic muscles)
  • digital contractures possible due to toes not being stabilised at MTP joints
  • displacement and atrophy of fat pad
  • high friction forces and pressure
203
Q

Why is there an increase in partial foot amputations? (6)

A
  • increase in incidence of diabetes
  • antibiotics
  • limb blood flow can now be measured
  • evolution of the operating microscope
  • development of new materials for functional and cosmetic prostheses
  • energy consumption studies
204
Q

Prosthetic/orthotic aims for partial foot (3)

A
  • redistribute plantar pressures
  • prevent or control deformity
  • prevent shoe deformity
205
Q

Partial foot levels of amputation (5)

A
  • mid tarsal
  • tarsometatarsal
  • transmetatarsal
  • metatarsophalangeal
  • ray resection
206
Q

Bones of the foot (7)

A
  • phalanges
  • metatarsals 1-5
  • cuneiforms 1-3
  • navicular
  • cuboid
  • talus
  • calcaneus
207
Q

Metatarsophalangeal. Congenital deformity, missing 2 3 and 4 phalanges possible treatment (2)

A
  • silicone partial feet

- eva insoles with toe fillers

208
Q

Transmetatarsal. Pt is bilat. rt ad lt tarsometatarsal. Possible prescription. (1)

A

-toe filler

209
Q

What is more important than preventing ‘shoe curl’ in partial foot amputees?

A

Prevention of stump breakdown

210
Q

Examples of ankle disartic prostheses (4)

A
  • Springlite II standard
  • springlite low profile symes
  • springlite super low profile symes
  • springlite chopart II
211
Q

What is another prescription for ad/partial foot?

A

Leather boottee with sensible lacing footwear with high heel counter

212
Q

What is important for pf/ad? (2)

A
  • cosmetic requirements

- functional gait

213
Q

Design characteristics for pf/ad (11)

A
  • current prescription
  • functional loss
  • trimline level
  • donor foot
  • toe out
  • footwear
    • width
    • length
    • depth
    • design
    • heel height
214
Q

What are ways to cast pf/ad? (5)

A
  • Alginate
  • pop
  • measurements
  • casting with joint correction and partial weight bearing
  • casting method described by ottobock
215
Q

Pf cast reduction values (4)

A
  • diagonal heel circumference 4%
  • ankle circumference 5%
  • horizontal circumference: smoothing only
  • m-l ankle diameter 20%max
216
Q

Material for pf check socket

A

Pastasil

217
Q

Next stage after pf check socket

A

-colour matching the silicone

218
Q

General advantages of partial foot silicone feet (8)

A
  • cosmesis
  • callosities
  • cutaneous condition
  • suspension
  • stability
  • proprioception
  • water resistant
  • memory of material
219
Q

General disadvantages of tarsometatarsal amp (8)

A
  • trim
  • perspiration
  • donning prosthesis
  • donning footwear
  • weight
  • cramping sensation
  • anterior distal interface discomfort
  • calcaneal discomfort
220
Q

Key points for treating pf (8)

A
  • correct mobile deformity if present though difficult with ottobock method
  • accomodate any fixed deformity
  • medial plantar support
  • proximal trim
  • depth of shoe
  • cosmesis of lesser importance but
  • footwear can be adapted
  • use pastasil check socket
  • consider ‘spread’ of stump when weight bearing
221
Q

Pf shoe adaptations (4)

A
  • steel or carbon fibre sole plate
  • wedge filler
  • SACH modification on sole
  • rocker sole
222
Q

Pf prescription objectives (2)

A
  • anatomically and physiologically balanced foot

- a comfortable socket

223
Q

Transmetatarsal prosthesis heel strike biomechanics (4)

A
  • R - ground reaction force (back of heel up)
  • d- distance between R and weight transfer
  • weight transfer line (down through stump)
  • rotation due to couple Rd (clockwise arrow anterior to stump)
224
Q

Pf heel strike forces on transmetatarsal stump (3)

A
  • W-weight support (up at heel)
  • Sp (posterior to stump above heel pushing in)
  • Sa (anterior to stump pushing diagonally into stump)
225
Q

Pf biomechanics. Transmetatarsal prosthesis heel off (4)

A
  • W-weight transfer(pointing down on proximal anterior section of stump)
  • e-distance between W and R
  • R-ground reaction force (pushing up diagonally to anterior section of shoe)
  • rotation due to couple Re (anticlockwise arrow anterior to stump)
226
Q

Pf forces on transmetatarsal stump at toe off (3)

A
  • Sp - into heel posteriorly
  • Sa - into crease at ankle joint anteriorly
  • W - weight support - diagonally up at anterior foot
227
Q

Pf forces on chopart prosthesis at heel strike (4)

A
  • W-weight transfer (pointing down through stump)
  • d-distance between R and W
  • R-ground reaction force (pointing diagonally up at heel)
  • rotation due to couple Rd (clockwise anterior to stump)
228
Q

Pf biomechanics. Forces on chopart stump at heel strike (3)

A
  • Sp (into stump posteriorly above heel)
  • Sa (into stump anteriorly at condyle)
  • W-weight support (pointing diagonally up on stump)
229
Q

Pf forces on chopart prosthesis heel off (4)

A
  • w- weight transfer (pointing down stump)
  • e- distance between w and R
  • R- ground reaction force (pointing up and diagonally at front of shoe)
  • rotation due to couple Re (anticlockwise arrow anterior to stump)
230
Q

Pf biomechanics. Forces on chopart stump at toe off (3)

A
  • Sa- anterior to stump pointing in
  • Sp- posterior to stump pointing in
  • W- weight support (below stump pointing up)
231
Q

Pf biomechanics rocker sole (3)

A
  • posterior displacement of rocker sole ensures that line of action of the ground reaction force passes closer to the weight transfer applied by the stump
  • the distance e reduces and hence the couple R*e reduces
  • the resistance moment applied by the stump reduces and hence stump forces Sa and Sp reduce
232
Q

Motion at the ankle (2)

A
  • dorsiflexion

- plantarflexion

233
Q

Dorsiflexors (2)

A
  • tibialis anterior

- peroneus tertius

234
Q

Plantarflexors (3)

A
  • gastrocnemius
  • soleus
  • tibialis posterior
235
Q

Subtalar motion (2)

A
  • supination

- pronation

236
Q

Supinators (2)

A
  • tibialis anterior

- tibialis posterior

237
Q

Pronators (2)

A
  • peroneus longus

- peroneus brevis

238
Q

Toe motions (2)

A
  • flexion

- extension

239
Q

Toe extensors (2)

A
  • extensor hallucis longus

- extensor digitorum longus

240
Q

Toe flexors (2)

A
  • flexor hallucis longus

- flexor digitorum longus

241
Q

Tibialis anterior origin and insertion (2)

A
  • tibia-upper half of lateral surface

- insertion-medial side of medial cuneiform and Met. I

242
Q

Peroneus tertius origin and insertion (2)

A
  • fibula-lower quarter and anterior surface

- shaft of met V

243
Q

Gastrocnemius origin and insertion (2)

A
  • medial head-popliteal surface, lateral head-lateral epicondyle
  • by tendocalcaneus into calcaneus
244
Q

Soleus origin and insertion (2)

A
  • fibula-head and upper 1/3 shaft, tibia-middle 1/3 of medial border
  • with gastrocnemius into calcaneus
245
Q

Tibialis posterior origin and insertion

A
  • interosseus membrane

- navicular tuberosity, medial cuneiform

246
Q

Peroneus longus origin and insertion (2)

A
  • fibula upper 2/3 of lateral aspect

- lateral aspect of medial cuneiform and base of met I

247
Q

Peroneus brevis origin and insertion (2)

A
  • fibula lower 2/3 of lateral aspect

- met V styloid process

248
Q

Extensor hallucis longus origin and insertion (2)

A
  • middle of anterior surface of fibula

- terminal phalanx of big toe

249
Q

Extensor digitorum longus origin and insertion (2)

A
  • upper-of anterior surface of fibula

- middle and distal phalanges of four toes

250
Q

Flexor hallucis longus origin and insertion (2)

A
  • fibula- lower 2/3 of posterior surface

- base of distal phalanx of big toe

251
Q

Flexor digitorum longus origin and insertion (2)

A
  • medial posterior surface of tibia medial to vertical line

- distal phalanx of toes 2-5

252
Q

Pf patient assessment sheet (6)

A
  • student name
  • patient name
  • history (social, medical, prosthetic/orthotic)
  • functional loss
  • gait analysis (relate to functional loss)
  • prescription (include casting/moulding techniques, design, manufacturing process, and material/shoe selection)
253
Q

Manufacture of silicone partial feet (3)

A
  • box mould
  • ob electronic rollers

-cosmeses

254
Q

Manufacture of silicone partial feet: the cast (4)

A
  • trim line
  • rotation
  • heel height
  • foot size
255
Q

Manufacture of silicone partial feet: donor feet (2)

A
  • multiflex foot

- dynamic foot

256
Q

Manufacture of silicone partial feet: model of toes (5)

A
  • alginate model
  • wax foot
  • fitting wax toes to cast
  • matching to rotation
  • positioning to correct length
257
Q

Manufacture of silicone partial feet: creating wax model (4)

A
  • modeling foot
  • adding detail
  • as much detail as required
  • model ready for mould
258
Q

Manufacture of silicone partial feet: mould manufacture (3)

A
  • preparing the mould
  • cleaning
  • greasing the mould
259
Q

Silicone partial feet manufacture: setting the mould (11)

A
  • crystacal plaster
  • mixing and pouring plaster
  • positioning the model
  • accuracy of position
  • preparing for second part of mould
  • closing the mould
  • fastening the mould
  • pouring the plaster
  • removing air
  • patient name
  • oven
260
Q

Silicone Partial Feet Manufacture: the definitive foot (2)

A
  • wax is lost

- ready for silicone

261
Q

Silicone partial feet manufacture: colouring the silicone (23)

A
  • colour swatches
  • pigments and flocking
  • mixing the colours
  • building the colour
  • flocking
  • time consuming
  • preparing for silicone
  • release agent
  • filling with silicone
  • ensuring no air
  • replacing cast
  • ensuring correct position
  • filling cast
  • coating cast
  • ensure thoroughly covered
  • filling opposite half
  • closing cast
  • ready to cure
  • cast removed from mould
  • extrinsic colouring
  • flashing removed
  • cut to trimline
  • ready for delivery
262
Q

Silicone Partial Feet Manufacture: Otto Bock Silicone Rollers (10)

A
  • chlorosil
  • shore hardness
  • two part mixture
  • two parts mixed using rollers
  • remove air
  • time consuming
  • adding colour
  • method similar to that of Box Mould
  • gradually adding colour
  • modelling the foot
263
Q

Silicone Partial Feet Manufacture: cosmetic appearance variations (4)

A
  • conventional
  • laminated
  • sprayed
  • pull on cover
264
Q

Silicone partial feet manufacture: cosmetic (4)

A
  • shaping
  • conventional: cosmesis shaped and finished with stocking
  • laminated
  • sprayed

From Flashcardlet (43 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions