1.1 - NOT DONE overview of amputation

barbers

initially, who performed amputations?

50

nearly ______% with an amputation due to vascular disease die within 5 years

same mortality rate buuuuuut amputation doesn’t receive as much help (financially, research, etc.)

what is the main takeaway from the epidemiology when comparing people with cancer and amputations

lower

(upper or lower) amputations are more common

neuropathy and vascular conditions (dysvascuality)

what is the most common reason for an amputation

older; PVD is an accumulation/occurs over time

dysvascular amputations typically occur in (younger or older) people, why?

• arteriosclerosis

• chronic venous insufficiency

• thromboangiitis obliterans (burgers disease - vessel spasm)

what are some of the examples of peripheral vascular diseases that can lead to a dysvascular cause of amputation

Foot trauma → wound → wound becomes infected → infection spreads to bone (osteomyelitis) → amputation to prevent life threatening systemic infection

what is the path that leads to a PVD cause for amputation

Trauma or deformity (e.g., charcot foot) → ulcerations (wound) → same process as PVD without DM

what is the path that leads to a diabetes cause for amputation

dysvascular → trauma → cancer → congenital anomalies

order the reasons for amputation from most common to least common

• peripheral vascular disease

• diabetes

what are the common conditions that fall under the “devascularization” cause for amputations

males

amputation due to trauma is most common in (females or males)

osteosarcoma

_____________ is the most common type of cancer that warrants an amputation

11-20 years

at what age does an amputation typically occur for someone with osteosarcoma

• remove the function of inhibiting parts of the limb

• create a normal residual limb for prosthetic

what are the 2 reasons for having surgery for a congenital limb difference

dysvascular

dysvascular or traumatic cause for amputation:

older

dysvascular

dysvascular of traumatic cause for amputation:

diabetic, overweight

dysvascualr

dysvascular of traumatic cause for amputation:

healing rate slowed due to poor circulation

dysvascualr

dysvascular of traumatic cause for amputation:

less active

dysvascular

dysvascular of traumatic cause for amputation:

more common for contralateral limb amputation

traumatic

dysvascular of traumatic cause for amputation:

younger

traumatic

dysvascular of traumatic cause for amputation:

more active

traumatic

dysvascular of traumatic cause for amputation:

faster return to activity

traumatic

dysvascular of traumatic cause for amputation:

may have no PMHx

trans (ex. transtibial, transphalangeal)

the term “_________” is used when an amputation extends across the axis of a long bone

disarticulation (ex. Knee disarticulation, Toe disarticulation)

Amputations between long bones or through a joint is called a ____________

partial

the term “_________” is used when a part of the foot or hand distal to the ankle or wrist is amputated

residual limb or stump

the ____________ is the portion of the limb remaining after the amputation

stump

the residual limb is also called the __________

• amputated

• involved

• prosthetic

what are the 3 terms used to describe the side of amputation

• non-amputated

• sound

• uninvolved

• intact

what are the 4 terms used to describe the side that is not amputated

• fit and control of a prosthesis (bony anatomy, lever arm)

• distal weight bearing

• contractures

• posture and balance (laying, sitting, standing)

• gait mechanics and metabolic cost

what are the 5 things that the level of the amputation can affect

hemipelvectomy

_____________ is an amputation that involves removal of the entire leg (to include hip, buttock, and pelvic)

R

T/F: a hemipelvectomy is a common amputation

hip disarticulation

_____________ is an amputation that involves excision of the LE at the hip joint and the remaining musculature is closed over the acetabulum

• trauma

• vascular insufficiency

• femoral sarcomas

what are some common causes for a hip disarticulation

F

T/F: a hip disarticulation is a common amputation

T

T/F: contractures are not an issue with a hemipelvectomy and hip disarticulation

hip disarticulation

stuff you would need to consider for a ______________ amputation:

• limited bony anatomy for control of a prosthesis

• lacks good weight bearing surface

• laying, sitting and standing affected

T

T/F: crutches are less cumbersome for individuals with a hemipelvectomy and hip disarticulation

transfemoral amputation

_____________ is an amputation that is above the knee

• dysvascular

• trauma

what are some common causes for a transfemoral amputation

junction of middle and lower 1/3 femur

where is a transfemoral amputation typically performed at

25

a transfemoral amputation accounts for more than _____% of all LE amputation

• hip flexion

• hip abduction

• hip ER

what muscles are at risk for contracture with a transfemoral amputation

tibial

the lever arm of a trans (femoral or tibial) amputation is better at control of the prosthesis

transfemoral

stuff you would need to consider for a ______________ amputation:

• lever based on length of residuum and bony anatomy moderate for control of prosthesis

• avoid distal end WB

• sitting posture (socket) and standing balance affected

knee disarticulation

_______________ is an amputation that is through the knee joint

• diabetes

• PVD

• trauma

what are some common causes for a knee disarticulation

Gritti-Strokes

a knee disarticulation is also called ______________

• hip flexion

• hip abduction

• hip ER

what muscles are at risk for contracture with a knee disarticulation amputation

knee disarticulation

stuff you would need to consider for a ______________ amputation:

• long anatomic lever provides power for ambulation and bony anatomy allows for better control

• Bulbus end complicates prosthetic fitting and limits space for knee mechanism

• broad, horizontal distal end tolerates WB

transfemoral

a knee disarticulation amputation has the same sitting, standing, and gait as a _____________ amputation

transtibial

a ______________ amputation is below the knee amputation

5-6 inches

the standard length of a transtibial amputation is about ____-____ of the tibia remaining from the tibial plateau

25

transtibial amputations account for _____% of LE amputations

• diabetes

• PVD trauma

what are some common causes for a transtibial amputation

transtibial

stuff you would need to consider for a ______________ amputation:

• lever based on length of residuum and bony anatomy better for control of prosthesis

• avoid WB on distal end

• sitting can be affected by socket

knee flexion

what muscles are at risk for contracture with a transtibial amputation

ankle (symes) disarticulation

a _____________ amputation is at the talocrural joint with removal of the inferior projections of the tibia and fibula

T (it attaches to the distal tibia)

T/F: the heel fat pad is preserved with an ankle disarticulation amputation

50

ankle (symes) disarticulation accounts for ________% of LE amputations

• diabetes

• PVD

• traumatic

what are some common causes for an ankle disarticulation

ankle (symes) disarticulation

stuff you would need to consider for a ______________ amputation:

• long lever arm of the tibia creates good control of protesis

• bulbus end complicates prosthetic fitting and limits space for foot mechanism

• ambulation for short distances without prosthesis

transtibial

an ankle (symes) disarticulation amputation will have the same gait as a _____________ amputation

chopart

___________ is a partial foot amputation where there is disarticulation of the midtarsal joint

calcaneus; talus

a chopart amputation preserves the _____________ and ____________ bones

lisfranc

___________ is a partial foot amputation where there is disarticulation of the tarsometatarsal joint

transmetatarsal

___________ is a partial foot amputation that is performed through mid-/proximal MT shaft

dysvascularity

_______________ is the cause of all partial foot amputations

ray

a ___________ amputation is a longitudinal amputation of one or more metatarsals or toes

transphalangeal

a ______________ amputation involves the amputation/disarticulation of one or more toes

Dysvascularity or trauma (including frostbite, gangrene, infection)

the cause for both a ray or transphalangeal amputation is either ____________ or _______________

partial foot, ray, and transphalangeal

stuff you would need to consider for a ______________ amputation:

• increase risk for tissue breakdown (limited soft tissue envelope)

• Can WB on remaining portion of the foot

• Risk for remaining foot drawn into equinovarus

loss of great toe lever

the primary impact on gait for a partial foot, ray, and transphalangeal amputation is _____________

equinovarus

_______________ is a common congenital deformity where a baby’s foot is twisted inward and downward due to short, tight ligaments and tendons

T

T/F: a prosthesis is typically not prescribed for a partial foot, ray, and transphalangeal amputation

guillotine

the _____________ surgical approach for an amputation involves all tissues being divided at the same level

guillotine

indications for the _______________ surgical approach for an amputation:

• an infection

• when all dead tissue has not been removed

equal

a fish mouth amputation technique is when the skin flaps are (equal or unequal)

unequal

a flap amputation technique is when the skin flaps are (equal or unequal)

frontal; sagittal

both the fish mouth and flap amputation techniques orient the incision at the distal end in either _________ or _________ plane

posterior; because the thick gastroc and soleus will cover the residual limb and the incision goes on the anterior end away from pressure/WB

a ______________ flab amputation approach is most common in the LE, why?

• transfemoral

• transtibial

the sciatic nerve is cut and permitted to retract proximally to prevent formation of a neuroma in what types of amputations?

• symes (ankle disarticulation)

the anterior and posterior nerves are cut and permitted to retract proximally to prevent formation of a neuroma in what types of amputations?

5cm

tissue and muscle are separated from the bone at least ________ proximal to the incision line (TF: femur; TT: tibia)

myodesis

______________ is soft tissue management that anchors muscle to bone

myoplasty

______________ is soft tissue management where the muscle is looped around the end and sewen to each other

tendosis

______________ is soft tissue management that attaches the tendons to bone

agonist-antagonist myoneural interface (AMI)

___________________ is an experimental soft tissue management where the muscles are linked together so that control and proprioception feedback (via EMG recording) can be used to control a prosthesis

osseointegration (OI)

__________________ is an internal prosthetic implant (“abutment”) that protrudes through soft tissue and skin to external components

bone

an osseointegration (OI) is anchored by ___________

osseointegration (OI)

_____________ is an option when a traditional socket is NOT tolerated

transtibial (TT)

the Ertl procedure is a modification of the ___________ procedure

Ertl

the _____________ procedure installs a bone as a “bridge” between the fibula and tibia to allow for distal end WB

length (viable tissue)

the goal for prosthetic surgery is to preserve as much ___________ as possible

• Lever for stabilization

• Total surface for distribution on forces and for thermoregulation

• Proprioceptive feedback

• Phantom pain and sensation

• Energy requirements for ambulation

the benefits for preserving as much length as possible (5)