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Prosthetics- H > Prosthetics overview > Flashcards

Prosthetics overview Flashcards

1
Q

What causes most amputations in the US?

A

disease causes 82%

  • peripheral vascular disease
  • diabetes
  • infections
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2
Q

T/F: Over half of diabetics with LE amputations will require amputation of the second leg within 2-3 years.

A

True :(

55% require amputation of the second leg

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3
Q

What race is up to 4 times more likely to have an amputation than white americans?

A

African americans

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4
Q

Causes of peripheral vascular disease (PVD) include…

A 
arteriosclerosis (occlusive artery disease)
embolism
thrombosis
trauma
infection
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5
Q

Insufficient blood flow d/t decreased arterial diameter is known as…

A

intermittent claudication

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6
Q

This disease causes 82% of disease related amputations

A

PVD

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7
Q

Decreased return of venous blood from the legs to the trunk is known as…

A

chronic venous insufficiency

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8
Q

Signs of chronic venous insufficiency

A

Edema, dilated veins and stasis ulcers, dermatitis.

“weepy wounds,” ulcers above the maleoli

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9
Q

Early signs of chronic venous insufficiency (CVI) include

A

varicose veins -> swollen leg -> purplish reddish staining of the skin -> ulcers

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10
Q

Half of PVD amputations are due to this disease

A

diabetes

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11
Q

When a patient comes to you with an amputation and diabetes, ask them about these comorbidities…

A

renal failure (ask about urination)
cardiac disease
stroke
retinopathy (ask how their vision is)

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12
Q

Signs of diabetic neuropathy

A

decreased temp in feet
stocking glove sensory loss
decreased DTRs
dry scaly skin d/t decreased circulation
skin breakdown
intrinsic weakness, structural changes in the foot (Charcot)

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13
Q

This type of bone tumor is found in males 10-25, often in the metaphysis of long bones

A

osteosarcoma

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14
Q

This type of bone tumor is found in 5-30 year old males, the bone cortex erodes and a mass is produced

A

Ewing’s sarcoma

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15
Q

This congenital birth defect has

no distal structure

A

transverse

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16
Q

This congenital birth defect has

total or partial absence with normal skeletal structure beyond

A

longitudinal

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17
Q

This congenital birth defect is an

absence of the whole limb

A

amelia

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18
Q

This congenital birth defect is an

absence of hand or foot

A

apodia

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19
Q

This congenital birth defect is an

absence of limb segment, flipper limb

A

phocomelia

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20
Q

What is the goal of surgical amputations?

A

preserve as much of the functional healthy limb as possible

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21
Q

What is a neuroma?

A

painful collection of nerve axons near the skin, can be palpated and is very sensitive!

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22
Q

Amputation procedures:

Attachment of muscle to muscle

A

myoplasty

23
Q

Amputation procedures:

attachment of muscle to fascia

A

myofascial flap

24
Q

Amputation procedures:

attachment of muscle to periosteal bone

A

myodesis

25
Q

T/F: a typical transtibial amputation includes myoplasty, myofascial flap, AND myodesis

A

True. Typical amputation includes all 3.

26
Q

What type of flap is preferred on a transtibial amputation?

A

long posterior flap, provides a good weight bearing surface

27
Q

In severe dysvascular situations, medial and lateral tissue is used to create this type of flap

A

skew flap

28
Q

What type of flap is used when conserving bone length or vascular issues is not a concern?

A

equal length flap

29
Q

What is the ideal shape of a residual limb?

A

cylindrical

30
Q

Where is the transfemoral amputation ideally performed?

A

4” or 10 cm above anatomical end of knee

31
Q

An autograft from the proximal tibia or iliac crest which creates a BRIDGE between distal tibia and fibula is called…

A

ERTL procedure

32
Q

What is the goal of an ERTL procedure?

A

prevents separation of fibula from tibia

permits greater end bearing

33
Q

What is the advantage of a rotationplasty?

A
  • preserves the ankle joint to act as a knee joint

- provides a longer lever for prosthetic control vs a very short AKA

34
Q

What are advantages of osseointegration?

A

Lighter
No socket
greater motion
more precise control

35
Q

What are disadvantages to osseointegration?

A

2 surgeries

high risk of infection

36
Q

What is osseointegration?

A
  • More prevalent in Europe

- direct skeletal attachment of prosthetic limb

37
Q

What are some problems with short transfemoral amputations?

A

more skin breakdown

hard to get enough hip extension since there’s less leverage

38
Q

Levels of amputation::

hemipelvectomy

A

loss of Ilium, ischium or pubis

39
Q

Levels of amputation:: hip disarticulation

A

loss of entire femur

40
Q

Levels of amputation: Transfemoral classifications

A

short <35 % of femur
medium 35-60%
long >60%

41
Q

Levels of amputation::

supracondylar

A

patella left for better end bearing

may delay healing

42
Q

Would you recommend a knee disarticulation to an adult patient?

A

No! Results in abnormal gait, difficulty with swing phase.

43
Q

Why would a knee disarticulation be performed?

A

To maintain femoral length in growing children

44
Q

Levels of amputation::

Transtibial classifications

A

very short <20% tibial length present
standard 20-50%
long >50%

45
Q

What level of transtibial amputation is typically best?

A

Standard!
if very short, short lever arm and knee ext difficult
if long there may not be adequate circulation

46
Q

What is a syme amputation?

A

ankle disarticulation

tibia and fibula shaved, and a thin layer of the calcaneus is fixed to the distal tibia

47
Q

Advantages of a syme amputation

A

long lever arm

ability to ambulate without a prosthesis

48
Q

Disadvantages of a syme amputation

A

neuroma of posterior tibial nerve
poor cosmesis
unstable heel flap

49
Q

What is a Lisfranc disarticulation?

A
  • disarticulation of all five metatarsals and digits

- performed at tarsometatarsal joint

50
Q

What is a Chopart disarticulation?

A
  • through the midtarsal joint, leaves the calcaneus and talus
  • performed at the talonavicular and calcaneocuboid joints
51
Q

Why are Chopart and Lisfranc disarticulations not performed as often today?

A

They lead to equinovarus deformity

and skin breakdown! Important to stress dorsiflexion stretching to avoid equinovarus.

52
Q

What orthotics might someone use if part of their foot is amputated?

A
  • a shoe filler to hold hindfoot in the shoe

- a rocker bottom

53
Q

What foot amputation has a 30% failure rate?

A

transmetatarsal

d/t loss of weightbearing area and decreased ability to plantarflex well

Prosthetics- H (2 decks)

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