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S3- Amputation And Prosthetics > LE Amputation Etiology > Flashcards

LE Amputation Etiology Flashcards

1
Q

It is estimated that > ________ individuals are living with the loss of 1 or more limbs in the US. Rates increase dramatically with _____.

A
  • 2 million

- age

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2
Q

82% of amputations are due to _________.

-Secondary to complications of _____, _____.

A
  • vascular disease

- diabetes, PAD

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3
Q

What is important in reducing the incidence of amputations?

A
  • Early patient education

- Proper foot care

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4
Q

Majority of LE amputations are due to __________ while a majority of UE amputations are due to _________.

A
  • vascular disease

- trauma

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5
Q

Why are the rates of amputation decreasing among diabetics, trauma patients, and cancer patients, despite an overall increase in these conditions?

A

We are doing a better job of educating patients and managing diabetes.

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6
Q

Do comorbidities increase the risk of amputations?

A

Yes

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7
Q

Are males or females more likely to have dysvascular and trauma related amputations?

A

Males

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8
Q

Is there racial disparity in regards to amputations?

A

Yes, African Americans, Hispanic American, and Native Americans are more likely.

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9
Q

Trauma and cancer related amputations are on the _______.

A

decline

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10
Q

What are the top 4 causes of amputation (in order)?

A
  • Diabetes and PAD (Dysvascular Disease)
  • Trauma
  • Cancer
  • Congenital Deficiencies
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11
Q

____________ is the most common risk factor for ulcer development in diabetes.

A

Peripheral Neuropathy

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12
Q

Describe the cascade of symptoms of peripheral neuropathy in diabetics that leads to amputation.

A
  • Elevated Blood Sugars damages blood vessels and nerves leading to
  • Loss of Protective Sensation resulting in blister or minor injury leading to a
  • Ulceration that is non-healing causing
  • Amputation
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13
Q

What are the 3 clinical signs of peripheral neuropathy?

A
  • Deficits in sensation
  • Motor impairments
  • Autonomic dysfunction (different color, hair loss)

All these lead to a vulnerability of the foot to high-pressure and repetitive low-pressure traumas.

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14
Q

What are some other diabetic complications that lead to amputation other than peripheral neuropathy?

A
  1. ) Severe ischemic pain
  2. ) Absent pulses
  3. ) Local necrosis
  4. ) Osteomyelitis (bone infection)
  5. ) Systemic toxicity
  6. ) Acute embolism
  7. ) DVT
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15
Q

What are the 2 classic symptoms of PAD?

A
  1. ) Intermittent claudication (leg pain brought about by activity)
  2. ) Loss of one or more LE pulses
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16
Q

What are the 3 risk factors of PAD?

A
  1. ) Poorly managed HTN
  2. ) High cholesterol and triglyceride levels
  3. ) History of tobacco use
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17
Q

The 3 risk factors for PAD are also risk factors for _________ and _________.

A
  • Stroke

- Cardiovascular Disease

18
Q

How do we prevent limb loss in patients with diabetes?

A
  • Foot screens (protective sensation, skin temp, distal pulses, visual observation)
  • Patient recommendations (daily foot checks)
19
Q

Do all diabetic patients receive foot screens?

A

ALL patients

20
Q

What is included in a foot screen?

A
  • Protective sensation with 10g monofilament
  • Skin Temp with palpations for distal pulses (looking for elevated)
  • Distal Pulses (arteriosclerosis obliterans)
  • Visual Observation (nail shape and color, deformities, swelling, callus formation)
21
Q

Protective sensation portion of the foot screen is done with a __g monofilament.

A

10g

22
Q

Why are we looking for elevated temperatures when doing a foot screen?

A

Elevated temps show signs of inflammatory response.

23
Q

When educating patient on performing daily foot checks, what do we tell them to look for?

A
  • Increased temp
  • Check pulse
  • Nail color change
  • Open wounds
24
Q

What do we do if our patients cant see their feet either from obesity or lack of mobility?

A
  • Teach them to use a mirror

- Teach caregiver

25
Q

Bottom Line:

  • ___________ and _____ are the major predisposing risk factors for LE amputation in individuals with DM.
  • Amputations in this population are associated with:
    • Significant __________
    • Significant _________ limitations
    • Future disability
    • Another LE amputation
    • __________ (33% in 1 year)
    • Increased health care costs
A

-Peripheral neuropathy and PAD

  • morbidity
  • functional
  • mortality
26
Q

Why would an amputation due to diabetes predispose an individual for a second amputation or revision?

A
  • Can be contralateral limb but often times the same limb

- Surgical incisions don’t have good blood flow or blood getting there isn’t oxygenated leading to a 2nd amputation.

27
Q

What is the 2nd leading cause for amputations behind Diabetes and PAD?

A

Trauma

28
Q

What are the leading causes of trauma amputation?

A
  • MVA
  • Farming accidents
  • Power tools
  • Firearms
  • Burns and electrocutions
29
Q

What is the typical patient profile for an individual who suffers limb loss from trauma?

A
  • MEN
  • 20-29 yo
  • Primary cause of UE amp.
30
Q

There tends to be an increased __________ impact with trauma amputations.

A

psychological

31
Q

What are some challenges of traumatic amputations?

A
  • Limb length, shape (for prosthetics)
  • Partial vs. full amputation
  • Multiple surgeons
  • Tissue viability and loss
  • Pain
  • Other injuries
32
Q

What is the 3rd leading cause for amputations behind trauma?

A

Cancer

33
Q

Cancer amputation is a result of _________ at or near epiphysis of long bones such as distal ______, proximal _______, proximal ________.

A
  • osteosarcoma

- distal femur, proximal tibia, proximal humerus

34
Q

What is the typical patient profile for an individual who suffers limb loss from cancer?

A
  • Male

- Late childhood through early adulthood (~12-24)

35
Q

What are some other factors of cancer amputation?

A
  • chemo and radiation

- surgery

36
Q

What do we look for in patients with osteosarcoma?

A
  • Pain with weightbearing
  • Hx of worsening, deep local pain
  • Fractures (often first sign)
37
Q

What is the 4th leading cause for amputations behind cancer?

A

Congenital Deficiency

38
Q

Surgical intervention is ____ common with congenital deficiency.

A

less

39
Q

What are challenges for pediatric amputees?

A
  • Rapid growth
  • Cosmesis
  • Provide for function
40
Q

Main Takeaways:

  • ________ disease is the leading cause of LE amputation (diabetic complications).
  • ______ more affected than ________.
  • Lower limb __x more likely that upper limb
  • Traumatic amputations are more likely to occur in men, __-__ yo.
  • _______ is third leading cause.
  • Congenital deformity/deficiency is less than _% of all amputations.
A
  • Dysvascular
  • Males, females
  • 11x
  • 20-29 yo
  • Cancer
  • 1%

S3- Amputation And Prosthetics (10 decks)

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