AMPUTATIONS 2012

AMPUTATIONS: 

AMPUTATIONS VASCULAR DISEASE (50% performed on individuals with PVD secondary to diabetes) TRAUMA CANCER CONGENITAL DEFORMITIES CAUSES

TYPES OF AMPUTATIONS: 

TYPES OF AMPUTATIONS Toe Amputation (through phalange or entire toe) Distal Metatarsal Phalangeal Ray Amputation

PowerPoint Presentation: 

IV. Transmetatarsal Lisfranc (midfoot) Chopart disarticulation between talus and tarsals

PowerPoint Presentation: 

SYMES : Ankle disarticulation, through the malleoli. It is a weight bearing amputation because the heel pad is swung under the tibia and fibula and attached.

VIII. BELOW KNEE AMPUTATION (BKA)/Transtibial: 

VIII. BELOW KNEE AMPUTATION (BKA)/Transtibial Most common secondary to PVD Different lengths Short (20% of tibia left) Standard (50% of tibia left) Long (90% of the tibia left)

PowerPoint Presentation: 

BKA SURGERY

IX. KNEE DISARTICULATION: 

IX. KNEE DISARTICULATION Relatively uncommon < 1½ inches of tibia is viable Intact femur results in good weight bearing surface

ABOVE KNEE AMPUTATION (AKA)/TRANSFEMORAL: 

ABOVE KNEE AMPUTATION (AKA)/TRANSFEMORAL Lengths Long (>60% of femur left) Standard (60%-35% of femur left) Short (<35% of femur left)

HIP DISARTICULATION: 

HIP DISARTICULATION Performed for either malignancy or severe trauma

Temporary Prosthesis: 

Temporary Prosthesis Cosmetically unfinished prosthesis that has been fitted and aligned Used when amputee’s ability to wear a prosthesis is in doubt Can help shape limb better rather than dressing

PREPROSTHETIC MANAGEMENT: 

PREPROSTHETIC MANAGEMENT EXERCISE Regain/ maintain ROM & strength

POSITIONING: 

POSITIONING Elevation of the residual limb on a pillow following either transfemoral or transtibial amputation can lead to hip/knee flexion contractures and should be avoided.

MOBILITY: 

MOBILITY Reaching for an object promotes weight shifting on/off the prosthesis. Mirror reduces tendency to look at the floor.

PROSTHETICS: 

PROSTHETICS COMFORTABLE FUNCTIONAL COSMETIC

SYMES PROSTHESIS: 

SYMES PROSTHESIS Liner attached to the inner wall of the socket Liner made of flexible plastic and extends from the distal end of the socket to a point where the diameter of the proximal leg equals that of the bulbous end distally Liner stretches as the end of the residual limb is inserted into the socket Liner closes around the limb to maintain total contact and to aid in suspension

BELOW KNEE PROSTHESES: 

BELOW KNEE PROSTHESES FOOT/ANKLE MECHANISM SHANK SOCKET SUSPENSION

PowerPoint Presentation: 

SINGLE AXIS ANKLE ANKLE/FOOT MECHANISMS Allows for some DF/PF Most stable so it is good for stairclimbing Last long time (articulated prosthetic foot)

Multiple-Axis ankle: 

Multiple-Axis ankle Permits movement in all planes Accommodates to uneven ground Good for patients who have to walk on uneven terrain (articulated prosthetic foot)

SACH FOOT: 

SACH FOOT NONDYNAMIC ONE OF THE MOST POPULAR TYPES OF PROSTHETIC FEET NO DEFINITE ANKLE JOINT (NON-ARTICULATED )

DYNAMIC RESPONSE: 

DYNAMIC RESPONSE FLEX FOOT Store potential energy that’s released during push off Good for the active patient who runs, jumps, walks on uneven terrain Expensive

SHANK: 

SHANK Rigid portion of the prosthesis that connects the socket to the prosthetic foot. Endoskeleton: rigid metal, has adjustment mechanism Exoskeleton: plastic shell

SOCKETS: 

SOCKETS THIGH LACER PROVIDES MEDIAL-LATERAL SUPPORT SUPPORT BODY WEIGHT AND HOLD RESIDUAL LIMB FIRMLY AND COMFORTABLY DURING ALL ACTIVITIES

PATELLAR-TENDON BEARING SOCKET (PTB): 

PATELLAR-TENDON BEARING SOCKET (PTB) Total contact socket Most commonly used socket for transtibial amputations Efficient distribution of pressure through convex build ups on pressure tolerant areas, and concavities over pressure sensitive areas Major weight bearing area is the patellar tendon

SUSPENSIONS: 

SUSPENSIONS CUFF SUSPENSION ATTACHES TO PROXIMAL PART OF THE SOCKET ALLOWS FULL USE OF THIGH MUSCLES WEARER CAN EASILY TIGHTEN OR LOOSEN HOW THE PROSTHESIS ATTACHES TO THE RESIDUAL LIMB

SUPRACONDYLAR/ SUPRAPATELLAR SUSPENSION: 

SUPRACONDYLAR/ SUPRAPATELLAR SUSPENSION Proximal brim of the prosthetic socket is extended over the patella and femoral condyles with suspension pressure exerted over the patella and medial femoral condyles

ABOVE KNEE PROSTHESIS (TRANSFEMORAL): 

ABOVE KNEE PROSTHESIS (TRANSFEMORAL) SACH AND Single-Axis most common FOOT/ANKLE MECHANISM SOCKETS QUADRILATERAL ISCHIAL CONTAINMENT

QUADRILATERAL: 

QUADRILATERAL MOST COMMON NAMED FOR IT’S FOUR WALLS THAT EACH HAVE A SPECIFIC FUNCTION SCARPA’S BULGE IS A CONVEXITY ON THE ANTERIOR WALL TO MAXIMIZE PRESSURE DISTRIBUTION IN THE VICINITY OF FEMORAL TRIANGLE

ISHIAL CONTAINMENT SOCKET: 

ISHIAL CONTAINMENT SOCKET DEVELOPED IN LATE ’80s AND EARLY ’90s NAME DESCRIBES IT’S MAJOR CHARACTERISTIC: ISHIAL TUBEROSITY AND PART OF THE RAMUS ARE ENCLOSED WITHIN THE SOCKET. THIS ALLOWS FOR GREATER DISTRIBUTION OF WEIGHT BEARING AND STABILIZING FORCES.

SUSPENSION: 

SUSPENSION NONSUCTION Silesian Belt: for patient’s who can’t Tolerate snug socket Partial Suction 3. Total Suction

DRESSINGS: 

DRESSINGS RIGID DRESSINGS APPLIED IN OR IMMEDIALTEY FOLLOWING SURGERY

SOFT DRESSINGS: 

SOFT DRESSINGS Advantages: * Inexpensive * Light weight * Readily available * Can be laundered Disadvantages: * Poor edema control * Requires skill in application * Needs frequent re-application * Can slip and form tourniquet ACE WRAPS

SOFT DRESSINGS: 

SOFT DRESSINGS STUMP SHRINKERS USED TO CONTROL EDEMA AND SHAPE RESIDUAL LIMB

PowerPoint Presentation: 

WEIGHT BEARING AREAS OF BKA

PowerPoint Presentation: 

POSITIONING GUIDELINES

CIRCUMDUCTION: 

CIRCUMDUCTION Prosthetic causes Long Prosthesis Inadequate suspension Stiffness of knee unit Anatomic Causes Abduction contracture Poor knee control

CIRCUMDUCTION: 

CIRCUMDUCTION

LATERAL TRUNK BENDING: 

LATERAL TRUNK BENDING Prosthetic Causes Short Prosthesis High medial wall Malalignment in abduction Anatomic Causes Weak Abductors Abduction contracture Hip Pain

LATERAL TRUNK BENDING: 

LATERAL TRUNK BENDING

ABDUCTED GAIT: 

ABDUCTED GAIT Prosthetic Causes Long Prosthesis High Medial Wall Excessive abduction of hip joint Anatomic Causes Abduction contracture Instability

ABDUCTED GAIT: 

ABDUCTED GAIT