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O Amp & Prosth

notes

TermDefinition
causes of LE amputations peripheral vascular dx (abt 2/3 related to DM), trauma, tumor, congenital, ratio of male to female is 3:1
causes of UE amputations trauma, congenital limb defect, CA
surgical goals preserve limb, provide wt bearing surface for prosthesis, promote wound healing, remove devitalized tissue
amputation levels hip disarticulation (2%), transfemoral (AK 32.6%), knee disarticulation (mostly kids .7%), transtibial (BK 53.8%), symes (2.6%), partial foot
removal of first toe... causes probs w/brisk walking or running
removal of second toe... causes hallux valgus
Syme disarticulation @ ankle- remove malleoli & attach heel pad to end of tibia
transtibial BK
knee disarticulation good for kids, saves epiphysis
transfemoral AK-greater chance of healing w/PVD but decreased gait ability, watch for hip flex contracture, may also get abd contracture
hemipelvectomy limb plus lower half of pelvis
hemicorporectomy both limbs plus most of pelvis below L4, mostly caused by CA
temp prosthesis fitted immediately after procedure-psychological benefits, more basic, not custom fit
permanent prosthesis takes several months-limb size changes a lot 1st year
most prosthesis... endoskeletal
exoskeletal outer lamination structure, more heavy duty, heavy pt, heavier, non-alignable, like a Barbie doll, cheaper
SACH (solid ankle cushioned heel) inexpensive, light prosthetic foot, good for most pts, internal design, solid ankle (wood), cushion heel-facilitates dorsiflex (soft rubber), no ant spring
multiaxis prosthetic foot for athlete, does inversion & eversion. can be used for hiking, running, skiing, etc
soft socket/interface insert make of silicone. good for PVD-protects area from friction & compression. creates suction so is used as a type of suspension. called "gel liner", limb cushioning, variety of materials/silicone gel, better for normal changes in limb volume
hard socket/interface easier to clean, use w/socks, not as comfortable, better for big fluctuations in limb size, simple alternative, variety of socks made of cotton or wool, socks often referred to as "ply"
PTB (patellar tendon bearing) wt bearing of patellar tendon (20%)/tibial flares (60% med>lat) & rest is total contact
total contact made from mold of limb. goal is to bear wt thru out entire prosthesis but mainly patellar tendon
PTB design of socket hugs the leg & holds it on. combined w/a neoprene sleeve. proper fit allow user not to wear straps
PTB supracondylar high medially & laterally for pt having trouble keeping prosthesis on with PTB
PTB supracondylar suprapatellar high medial, lateral & ant. also has suprapatellar bar (if pt is still having problem keeping prosthesis on with supracondylar this is the next step)
proximal sleeve suspension elastic sleeve, cosmetic, variety of materials, needs replacement, no pistoning
supracondylar suspension w/o sleeve forms over femoral condyles, removable wedge, foam wedge, bulky at the knee, shorter limb lengths
sleeve pin suspension cushion or elastic sleeve, custom or off the shelf, distal pin locks, extra length for mech, most often used
TF suspension wt bearing is ishial tuberosity, harder for AK amputees to maintain stability than is for BK.
goals of TF suspension 1)achieve med/lat stability 2)keep knee stable in stance phase
wt bearing for TF suspension ischial tuberosity
quadrilateral socket (better for early prosthetic users w/longer residual limb) post flare for ischial tub, limb positioned in slight ADD which enhances glute med, slight flex enhances glute max, total contact socket which enhances venous return, ischial/glute wt bearing, older design (1950s)
ischial containment (better for active users w/short limb) total contact & WB is on sides & bottom, places hip in slight flex to facilitate hip ext, also newer socket type is Comfortflex, more flexible & adapts to body contours, newer design (1980s), stabilizes femur in ABD, usually fewer gait dev
total suction socket hard to fit due to fluctuating limb size but best type, can be a "wet fit" w/lotion or dry fit w/sock
semisuction socket partial suction w/also some other type of suspension like a belt
no suction socket socket has hole at the end so no suction possible-belt needed. a looser fit but easy to don/doff
suction suspension socket smaller than leg, residuum pulled into socket, air valve, just enough to hold leg, difficult to don
locking prosthetic knee automatically locks when pt stands or pt manual locks
braking prosthetic knee friction knees-uses wt activated friction to control deceleration into swing phase. also lots of stance phase stability
polycentric prosthetic knee very cosmetic but not as stable but allows for knee rotation. leg shortens w/swing through. good for knee disarticulation. can also be cadence dependent so faster gait results in increased resistance to flex & ext
single axis knee knee is stable, pt not as stable
braking knee extremely unstable pt
polycentric knee athlete
single axis knee single pivot, inexpensive, adjustable knee friction, extension aid, variety of control units
braking knee single axis w/brake, locks when loaded, momentary instability, majority of pts, not for more active pts
polycentric knee moving knee center, variable stability, more cosmetic, toe clearance, more mechanisms, variety of types
manual locking knee locks out when standing, "stiff legged" gait, transfering, max stability, post-op or geriatric
neuromas nerve keeps growing w/nowhere to go, just makes painful nerve ball
phantom limb pain (70%)-can be caused by neuroma-pn meds-better in time
phantom limb sensations still "feels like" limb is there-tend to get better in time
joint contractures common-need to be managed quickly
most common contractures for AK hip flex, abd
most common contracture for BK knee ext
AK doesn't have... functional quad, can contract but not use (no quad sets- still do glute sets tho)
why is compression bandaging important for all amputees reduce edema, controls pn, enhances wound healing, protects incision, shapes & desensitizes limb
transtibial 4-6 weeks outpatient PT
transfemoral 6-12 weeks outpatient PT
temp prosthesis 4-5 weeks after amputation
provide permanent prosthesis 3-6 months post-op
replacement prosthesis every 4-5 years
Created by: jessigirrl4