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88 Cards in this Set

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  • Back
When is amputation necessary?
The amputation of a limb is often life altering in terms of self-image and yet can be life saving in the presence of severe trauma or disease.
What are the two principles guiding the choice of level of amputation?
There must be adequate circulation to ensure successful healing of the incision.

As many anatomical joints as possible must be preserved – especially the knee.
The prevalence of peripheral arterial disease (PAD) in the US is estimated to be between 3% and 6% of the adult population, increasing to as much as ____% in those 65 years and older.
As many as one-fourth of those with PAD will likely require amputation; one-third will die within ____ years of diagnosis; three-fourths will die within ____ years of diagnosis.
5 years
10 years
In the US, what are the most common causes of traumatic amputation?
Industrial and farming accidents
Motor vehicle accidents
Injury during high risk sports and leisure activities
When is toe amputation appropriate?
Performed when there is evidence of localized gangrene on the toe related to vascular insufficiency, when conservative management of a neuropathic ulcer on the plantar toe surface has not been successful, or when there is infection or osteomyelitis of the phalanges.
What is treatment for toe amputation?
Initial dressing remains in place for up to 5 days
After 5 days, patient instructed in NWB ambulation
Educate patient to keep limb elevated to reduce swelling
After 10 days, patient begin PWB
FWB allowed 2 to 3 weeks after sutures removed.
When is metatarsal head resection performed?
Typically performed when there is a nonhealing plantar ulcer with osteomyelitis and also adequate circulation for healing to occur.
When is ray resection performed?
Performed when vascular disease or neuroathic ulcer has compromised one or more rays of the forefoot and circulation is compromised enough to make healing unlikely at a more distal level.
What is it called when all 5 metarsal heads are removed?
Transmetatarsal amputation
How do you treat transmetatarsal amputation?
Dressing in place for 3 to 5 days
NWB ambulation
Keep leg elevated
Gradual progression to FWB with assistive device
Independent ambulation determined by skin condition, prior ambulatory status, postural control, and functional level.
What are the most common amputations and disarticulations of the midfoot?
What is referred to as tarsometatarsal disarticulation?
Lisfranc procedure
What is referred to as midtarsal disarticulation between the talus and navicular; calcaneus and cuboids?
Chopart procedure
How do you treat amputations of the midfoot?
NWB ambulation begins several days after surgery
PWB begins once wound is healed & sutures removed.
Both surgeries preserve the ability to bear weight through the calcaneus.
Surgery results in shortened limb; prosthetic is required.
What disarticulates the talocrural, trims the malleoli to create a flat weight bearing surface, and repositions the heel pad under the distal tibia and fibula?
Syme Amputation
How do you treat a syme amputation?
NWB ambulation begins 2 to 3 days after surgery and continues up to 8 weeks.
Initial prosthetic fitting 6 to 8 weeks after surgery.
Surgical approaches for a transtibial amputation depend on what 2 things?
Condition of skin
What are the femoral condyles designed for?
Tolerate weight bearing?
What was one of the first amputation surgeries due to simplicity of the technique & limited infection rates?
Knee disarticulation
Comfort in prosthesis, quality of gait, and energy cost of ambulation are best enhanced when the level of amputation preserves _____% of the tibia
How do you treat transtibial amputations?
Dressing remains in place for 3 – 5 days
Keep the knee in full extension from day 1
Out of bed activities begin day 2 to 3 post-op (transfers, single limb ambulation)
Staples removed after 3 weeks.
In children, what is a key point to knee disarticulation and transondylar amputation?
Preserve the growth plate of the distal epiphysis
How do you treat knee disarticulation and transondylar amputation?
Mobility training begins post-op day 1
Gait training with crutches or walker & transfer training (bed, wheelchair, toilet).
Sutures removed in 2 to 3 weeks
Prosthetic training begins in 3 to 8 weeks depending on healing of scar.
During a transfemoral amputation, function and prosthetic control improve as what increases?
As length of residual femur increases
During a transfemoral amputation the surgeon preserves femoral length and muscle mass through _________ resulting in a stronger residual limb that has a better shape and improved prosthetic control.
How do you treat transfemoral amputations?
Mobility training, preprosthetic positioning (encouraging hip extension and adduction) are initiated post op day 1.
Use a prefabricated, thermoplastic, adjustable, removable rigid dressing to protect the residual limb.
Compress residual limb with ace wraps initially. After suture removal, graduate to a stump shrinker sock.
Sutures removed in 3 weeks or when wound is healed.
Prosthetic fitting determined by healing of suture line - several weeks to several months.
What are extreme surgeries undertaken to preserve life in the presence of serious infection or damage to proximal structures?
Hip disarticulations
How do you treat hip disarticulations and hemipelyectomies?
Limited periods of sitting; mobility & transfer training begin as soon as patient is medically stable; usually within 2 to 3 days postop.
Sutures removed within 2 to 3 weeks.
Patient and family education must include efforts to protect the surgical site during movement and ADLs.
Prosthetic fitting determined by rate of healing of surgical site.
What is a more aggressive and invasive surgery that leaves the individual without a bony case to support the abdominal contents on one side of the body?
What is the ideal length to keep the femur during a transfemoral amputation?
As long as you can
What percent of persons with a new amputation have noticeable phantom limb sensation?
Patients who experienced significant dysvascular limb pain in the weeks and months before surgery are more likely to experience phantom pain in the immediate postoperative period and for up to ____ years after surgery
What are the 2 components of residual limb length?
Actual limb length - measured from bony landmark to the end of the bone (tibia or femur)
Total limb length - measured from the bony landmark to the end of the soft tissue.
_______ inches of tibia (measured from medial joint line) ensures a sufficient lever arm for effective prosthetic control.
Less than ____ inches may be an insufficient length for prosthetic control.
3 inches
What is assessed by circumferential girth measurements?
Residual Limb Volume
Referral for a prosthetic fitting is made when the distal limb circumference is equal to or no more than ____ inch greater than limb circumference.
Who is to be at the initial dressing change of an amputation?
The surgeon
With each dressing change, the wound is carefully examined and the _______ and _______ of drainage is documented.
What can be a sign of infection?
Thickening drainage
Discolored drainage
Foul odor
Amputations due to trauma or non-dysvascular problems may achieve sufficient healing within ____ weeks to begin using a prefabricated adjustable prosthesis for gait training.
Amputation due to vascular disease may require _____ weeks.
How do you assess peripheral pulse?
Palpation of peripheral pulse
Skin temperature
Where are the pulse points?
1. temporal artery at the temple above and to the outer side of the eye.
2. external maximally artery at the point of crossing
3. carotid artery
4. brachial artery
5. radial artery
6. femoral artery
7. popliteal artery
8. posterior tibial pulse
9. dorsalis pedis artery
What is essential in the remaining joints for effective prosthetic use?
Normal ROM
What is used for determining hip flexion contractures for transtibial or transfemoral amputations?
Thomas Test
How do you assess muscle strength of an amputated limb?
When assessing aerobic capacity, screen for ________.
Orthostatic hypotension
Which baseline vital signs do you check when assessing aerobic capacity?
O2 Sats
When assessing locomotion and balance, what do you want to check for?
Distance able to walk with walker/crutches.
Ability to walk on a variety of surfaces.
Perform balance tests.
How do you control pain for interventions?
Anti-seizure medications
Local steroid injections
Relaxation techniques
Therapeutic touch
Therapeutic modalities
What interventions are used to deal with limb volume, shaping, and post-op edema?
Rigid dressing and immediate post-op prostheses
Removable rigid dressing
Semirigid dressing
Effectiveness of ace wraps depends on what?
Patient education
Teach patient and caregivers to inspect skin daily, using a _______ to see difficult areas.
What are key points to skin care and scar management?
The incision must not adhere to underlying deep tissue or bone as healing progresses.

When the wound is well closed, gentle mobilization of the scar can begin.

After suture removal, normal bathing resumes - clean daily with mild non-drying soap.

Moisturizer or skin cream may be applied to dry skin areas.
What is a key component of preprosthetic rehabilitation to prevent contractures?
Proper positioning
What are goals of strengthening?
Remediation of specific weaknesses detected during examination.
Maximization of overall strength and muscular endurance for safe, energy-efficient prosthetic gait
During the first week, what do you do for transtibial amputation and transfemoral amputations?
Transtibial Amputations - quad sets and short arc quads.
Transfemoral Amputations - glut sets and short arc hip extension and abduction.
After the first week, what do you do for transtibial amputation and transfemoral amputations?
Transtibial Amputations - knee and hip strengthening exercises.
Transfemoral Amputations - hip extension, abduction, adduction emphasized
Make sure that every patient has ________ when they go home.
a wheel chair
What do general strengthening for trunk and upper extremities include?
Back extensors
Trunk rotation
What does postural control for amputees include?
Transtibial Amputations - knee and hip strengthening exercises.
Transfemoral Amputations - hip extension, abduction, adduction emphasized
How do wheelchairs and seating affect amputees?
Loss of limb results in changes in center of mass. Include anti-tip devices on wheelchair.
How do you deal with ambulation and locomotion of an amputee?
Walker - good for initial gait training. May teach abnormal gait patterns. Use crutches whenever possible.

Walking with a prosthesis is more energy efficient that single limb ambulation with crutches.
What begins early in the rehab process, and should include positioning, residual limb care, and functional training?
Patient and family education
What has the following characteristics?
Internal keel
Molded foam-rubber shell
Plantarflexion and dorsiflexion bumpers
5-7 degrees DF and 15 degrees PF
Doesn't allow walking up a steep incline
Single Axis Foot
What has the following characteristics?
One of most common foot assemblies used
Frequently used with temporary prostheses
Long keel adds to foot stability
What are the differences between different types of foot orthotics? (Chart)
Which code has the following decription?

The patient has the ability or potential for ambulation with VARIABLE cadence. He or she is likely to achieve community ambulation, with the ability to
Which code has the following decription?

The patient does not have the ability or potential to AMBULATE or TRANSLATE safely with or without assistance, and a prosthesis does not enhance quality of life or mobility.
Which code has the following decription?

The patient has the ability or potential for prosthetic ambulation that exceeds BASIC ambulatory skills, exhibiting high impact, stress, or energy levels during activity. This category includes most children, active adults, or athletes with amputation.
Which code has the following decription?

The patient has the ability or potential for ambulation, including the ability to traverse low-level environmental barriers such as curbs, stairs, or uneven surfaces. With a prosthesis, the patient is considered a limited COMMUNITY ambulator.
Which code has the following decription?

The patient has the ability or potential to use a prosthesis for transfers or ambulation on LEVEL surfaces at a fixed cadence. With a prosthesis, the patient achieves limited or unlimited household ambulation status.
What are the components of a transtibial prosthesis?
1. the socket and its interface
2. the suspension mechanism
3. the shank (pylon)
4. the prosthetic foot
What is the most commonly prescribed transtibial socket?
PTB- patellar tendon bearing
How does the PTB distribute pressure?
The PTB total surface design distributes the primary loading pressures of weight bearing over several surfaces of the residual limb.
What is a rigid plastic interface worn with a prosthetic sock?
Hard Socket
What are advantages to a hard socket?
- reduces shearing & friction enhancing function
- cosmetically appealing
- easy to clean
- durable
What are disadvantages of hard sockets?
• Difficult to manufacture
• Difficult to adjust or modify as residual limb changes shape
• Hard on patients with fragile skin or bony prominences.
What is the interface between the socket and the residual limb?
Prosthetic Sock
What are the goals of the prosthetic socks?
1. cushion forces applied to the residual limb during ambulation
2. accommodate to changes in the volume of the residual limb.
3. absorb moisture and keeps it away from the skin.
At what point with a prosthetic sock should a new socket be designed?
Once the layers of socks reach a ply of 10 or more, a new socket may be necessary.
What type of liner is used for patients with fragile skin or bony prominences, or high levels of activity?
Soft Liner
What type of liner is made of silicon; worn directly against skin to minimize shearing?
Roll On Liners
What are advantages of roll on liners?
• Effective in dispersing forces during gait
• Provides suspension of the prosthesis
• Accommodates to minor changes in residual limb volume
What are disadvantages of roll on liners?
• Wearers may not tolerate on the skin (blistering)
• Requires significant dexterity & upper extremity strength to don.
• Requires greater care in cleaning ( to reduce odor & bacteria)
• May cause contact dermatitis, bacterial infections, or follicular irritation.
What is the purpose of the flexible socket in a rigid frame?
The flexibility allows the socket to change shape slightly during muscle contraction or movement into knee flexion.